endocrine- diabetes, diabetes insipidus

complications of diabetes: diabetic ketoacidosis

-deficit of insulin results in disorders in the metabolism of carbohydrates, proteins, and fats -ultimately results in ketosis and metabolic acidosis -management of DKA is directed toward correcting dehydration, electrolyte loss, and acidosis

long-term complications of diabetes #1

-diabetic macrovascular complications: -blood vessel walls thicken, sclerose, and become occluded by plaque that adheres to the vessel walls -leads to coronary artery disease, cerebrovascular disease, and peripheral vascular disease -focus of management is aggressive modification and reduction of risk factors

b) NPH insulin peaks in 6 to 8 hours.

a morning dose of NPH insulin is given at 7:30 AM. what is the timeframe in which the nurse can expect it to peak? a) 11:30 AM and 1:30 PM b) 1:30 PM and 3:30 PM c) 3:30 PM and 9:30 PM d) 5:30 PM and 11:30 PM

c)

while assessing a client with cushing syndrome, the nurse should expect high blood glucose reading due to increased secretion of which of the following? a) the thyroid gland b) the parathyroid glands c) the adrenal glands d) the pituitary gland

c) the client should perform nail care after bathing, when toenails are soft and easier to trim. d) the client should trim toenails straight across to prevent injury to soft tissues of the toes. e) the client should wear closed-toe shoes to prevent injury to soft tissue of the toes and feet.

a nurse is reinforcing teaching about foot care with a client who has diabetes mellitus. which of the following information should the nurse include in the teaching? (select all that apply.) a) remove calluses using over-the-counter remedies. b) apply lotion between toes. c) perform nail care after bathing. d) trim toenails straight across. e) wear closed-toe shoes.

c) damaged kidneys start "leaking" protein in the form of microalbumin. normally, protein is not found in urine.

which does the nurse recognize as an early indicator of nephropathy? a) hematuria b) glycosuria c) albuminuria d) polyuria

false) DKA and HHNS are primarily associated with type 1 diabetes. DKA and HHNS both ultimately result from and absence of insulin.

-is the following statement true or false? -patients with type 2 diabetes are more susceptible to DKA and HHNS than are patients with type 1 diabetes.

b) decreased serum T3 is an expected finding for a client who has hypothyroidism.

a nurse in a provider's office is reviewing laboratory results for a client who has secondary hypothyroidism. which of the following findings should the nurse expect? a) elevated serum T4 b) decreased serum T3 c) elevated serum thyroid-stimulating hormone d) decreased serum cholesterol

b) the urine of a client who has diabetes insipidus will be dilute with a urine specific gravity of less than 1.005.

a nurse is caring for a client who has diabetes insipidus. which of the following urinalysis laboratory findings should the nurse anticipate? a) presence of glucose b) decreased specific gravity c) presence of ketones d) presence of red blood cells

a) to identify wounds early, patients with diabetes should be encouraged to begin the habit of thoroughly inspecting both feet on a daily basis. tight shoes and frequent cutting of the toenails can increase the risk of foot ulcers. exercise should not be avoided.

in an effort to prevent foot and leg complications of diabetes, what measure should the nurse recommend to a patient with recently diagnosed type 1 diabetes? a) daily inspection of all surfaces of the feet b) wearing tight shoes with good arch support c) cutting the toenails daily d) avoiding walking whenever necessary

1) the classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. options 2, 3, and 4 are not signs of hyperglycemia.

the nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. which statement made by the client would indicate hyperglycemia and thus warrant primary health care provider notification? 1) "i am urinating a lot." 2) "my pulse is really slow." 3) "i am sweating for no reason." 4) "my blood pressure is really high."

b) body weight is a modifiable risk factor for diabetes; age, ethnicity, and family history are beyond the patient's control.

which of the following risk factors for diabetes would a nurse identify as being modifiable? a) the patient is of native american ancestry. b) the patient is moderately obese. c) the patient's mother and brother have type 1 diabetes. d) the patient is 51 years old.

2) humulin NPH is an intermediate-acting insulin. the onset of action is 1 to 2 hours, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. hypoglycemic reactions most likely occur during peak time.

a client is taking humulin NPH insulin daily every morning. the nurse reinforces instructions to the client and would tell the client that which is the most likely time for a hypoglycemic reaction to occur? 1) 2 to 4 hours after administration 2) 6 to 14 hours after administration 3) 16 to 18 hours after administration 4) 18 to 24 hours after administration

1) lipodystrophy occurs in some diabetic clients when the same injection sites are used for prolonged periods of time. thus, clients are instructed to adhere to a rotating injection site plan to avoid tissue changes. preparation of the site, aspiration, and the angle of insulin administration do not produce tissue damage.

the nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. which further information would the nurse obtain from the client during data collection? 1) plan for injection rotation 2) consistency of aspiration 3) preparation of the injection site 4) angle at which the medication is administered

d) when rapid- or short-acting insulins are given with longer-acting insulins, they usually are mixed together in the same syringe. injection sites should be rotated, and insulin should be stored in a refrigerator. insulin syringes range in size from 0.3 mL to 1 mL.

when caring for a hospital patient who requires insulin injections, the nurse should: a) use the same injection site for all of the injections needed during that day b) store insulin vials in a warm, dry, dark place c) use 3 mL or 5 mL syringe d) mix rapid-acting and long-acting insulin the the same syringe

nursing management of diabetes

-requires a comprehensive plan that addresses multiple factors -extensive patient education is necessary: -should address pathophysiology, treatments, potential complications, and practical considerations -a systematic teaching process must be followed

special issues in diabetes care

-surgery creates special risks for patients with diabetes -hospitalization creates a potential for unstable blood sugar levels: -in addition to nursing assessment for the primary problem, assessment of the patient with diabetes must focus on hypoglycemia and hyperglycemia, skin assessment, and diabetes self-care skills -goals and interventions address improved nutritional status, maintenance of skin integrity, ability to perform basic diabetes self-care skills, and preventative care for the avoidance of chronic complications of diabetes

a) hand tremors are a manifestation of hyperthyroidism that can result from thyroid hormone replacement therapy. the nurse should report this finding to the provider for a possible decrease in the medication dosage.

a nurse in a provider's office is collecting data from a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. which of the following findings indicate that the client might need a decrease in the dosage of the medication? a) hand tremors b) bradycardia c) pallor d) slow speech

b) HbA1c measures blood glucose control over the past 120 days.

a nurse is caring for a client who asks why the provider bases the medication regimen on the HbA1c 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 provider prescribed to determine that you have diabetes." d) "HbA1c determines if you need an additional dose of insulin at this time."

b) the nurse should identify orthostatic hypotension as a manifestation of dehydration, which can occur during a water deprivation test.

a nurse is collecting data from a client during a water deprivation test. which of the following manifestations should the nurse identify as indicating dehydration? a) bradycardia b) orthostatic hypotension c) neck vein distention d) crackles in lungs

b) propranolol can cause bradycardia. clients should take their pulse before each dose. if there is a significant change, withhold the dose and consult the provider.

a nurse is reinforcing instructions with a client who has graves' disease and 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."

c) without the action of ADH on the distal nephron of the kidney, an enormous daily output of very dilute urine occurs. signs and symptoms of fluid volume deficit occur as patients are unable to compensate for the massive urinary loss. incontinence is not a priority problem.

which of the following nursing diagnoses should be prioritized in the care of a patient with diabetes insipidus? a) risk for urge urinary incontinence b) overflow urinary incontinence c) deficient fluid volume d) excess fluid volume

a) methimazole can cause hematologic effects, including leukopenia and thrombocytopenia. the nurse should monitor CBC. b) methimazole reduces thyroid hormone production. the nurse should monitor T3. d) methimazole should be taken at the same time every day to maintain blood levels.

a nurse in a provider's office is assisting with 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? (select all that apply.) a) monitor CBC. b) monitor triiodothyronine. 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.

a) healthy nutrition should include decreasing the consumption of meats and processed foods, which can prevent diabetes and hyperlipidemia. b) healthy nutrition should include lowering LDL by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia. c) healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. e) healthy nutrition should include omega-3 fatty acids for secondary prevention of diabetes and heart disease.

a nurse is assisting with a presentation about nutrition habits that prevent type 2 diabetes mellitus for a group of clients. which of the following should the nurse include? (select all that apply.) a) eat less meat and processed foods. b) decrease intake of saturated fats. c) increase daily fiber intake. d) limit unsaturated fat intake to 15% of daily caloric intake. e) include omega-3 fatty acids in the diet.

a) suppression of the immune system places the client at risk for infection. b) overproduction of cortisol inhibits the production of a protective mucus lining in the stomach and causes an increase in the amount of gastric acid. these factors place clients who have cushing's disease at increased for gastric ulcers. d) clients who have cushing's disease are at risk for bone fractures because decreased calcium reabsorption can lead to osteoporosis.

a nurse is caring for a client who has cushing's disease. clients who have cushing's disease are at in increased risk for which of the following? (select all that apply.) a) infection b) gastric ulcer c) renal calculi d) bone fractures e) dysphagia

a) a decrease in serum sodium is caused by an increase in the secretion of ADH. c) a decrease in serum osmolarity is caused by an increase in the secretion of ADH.

a nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone. which of the following findings should the nurse expect? (select all that apply.) a) decreased serum sodium b) decreased urine specific gravity c) decreased serum osmolarity d) polyuria e) increased thirst

a) the client can require oral or tracheal suctioning. the nurse should ensure that suctioning equipment is available. b) the client can require supplemental oxygen due to respiratory complications. humidified oxygen thins secretions and promotes respiratory exchange. this equipment should be available. d) the client can experience respiratory obstruction. a tracheostomy tray should be available at the bedside.

a nurse is preparing to receive 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

a) the greatest risk to a client who has cushing's disease is fluid retention, which can lead to pulmonary edema, hypertension, and heart failure.

at the beginning of a shift, a nurse is collecting data on a client who has cushing's disease. which of the following findings is the nurse's priority? a) weight gain b) fatigue c) fragile skin d) joint pain

complications of diabetes: hypoglycemia

-blood glucose less than 50 to 60 mg/dL -can be caused by too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity -signs include inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness -usually treated with 15 g of a fast-acting concentrated source of carbohydrate -glucagon may be required

diabetes mellitus

-characterized by elevated levels of glucose in the blood -affects many body systems and has major physical, social, and economic consequences: -the leading cause of nontraumatic amputations, blindness in working-age adults, and end-stage renal disease -affects nearly 24 million people in the united states -costs related to diabetes are estimated to be $174 billion annually

complications of diabetes: hyperglycemic hyperosmolar nonketotic syndrome

-characterized by hyperosmolarity and hyperglycemia with alterations in level of consciousness -manifestations include hypotension, profound dehydration, tachycardia, and variable neurologic signs -fluid replacement, correction of electrolyte imbalances, and insulin administration -nursing care includes close monitoring of vital signs, fluid status, and laboratory values

clinical manifestations and assessment diabetes mellitus

-classic clinical manifestations include the "three Ps": -polyuria -polydipsia -polyphagia -other symptoms include dehydration, weight loss, fatigue and weakness, vision changes, tingling or numbness in the hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections -abnormally high blood glucose level is the basic criterion for the diagnosis of diabetes

pituitary disorders #1

-hypersecretion is the most common cause of pituitary disorders: -involves hypersecretion of ACTH that leads to cushing syndrome or oversecretion of growth hormone leading to acromegaly -hyposecretion causes the thyroid gland, the adrenal cortex, and the gonads to atrophy -hyposecretion of ADH results in diabetes insipidus -hypersecretion of ADH leads to syndrome of inappropriate ADH

false) a patient's glycated hemoglobin indicates the average blood glucose level over the previous several weeks, but it does not indicate the range of the levels.

-is the following statement true or false? -a patient's glycated hemoglobin level has been found to be significantly elevated. this indicates that the patient has been experiencing wide fluctuations in blood glucose levels.

b) c) adrenalectomy is the treatment of choice for patients with primary adrenal hypertrophy. spironolactone might be prescribed if high BP and hypokalemia. it is a drug that treats fluid retention and maintains potassium levels in the body. corticosteroids should be reduced or tapered rather than increased. diet high in carbohydrates and high in protein should be encouraged.

a 55-year-old female presents to the clinic with complaints of fatigue and tiredness. the nurse notices that the patient's skin is thin, fragile, and easily traumatized. ecchymosis and purple striae are noted over the thighs and abdomen. she presents with a slight kyphosis and a protruding abdomen. which of the following methods of management might be appropriate for her? a) increase dose of corticosteroids b) unilateral or bilateral adrenalectomy c) increase dose of spironolactone d) diet that is high in carbohydrates and low in protein

2) insulin dosages would not be adjusted or increased before unusual exercise. if acetone is found in the urine, it may possibly indicate the need for additional insulin. to minimize the discomfort associated with insulin injections, the insulin needs to be administered at room temperature. injection sites need to be systematically rotated from one area to another. the client would be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. this prevents dramatic changes in daily insulin absorption.

a client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. which teaching information would the nurse reinforce upon discharge? 1) keep insulin vials refrigerated at all times. 2) rotate the insulin injection sites systematically. 3) increase the amount of insulin before unusual exercise. 4) monitor the urine acetone level to determine the insulin dosage.

2) prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. option 1, a B-blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

a client with diabetes mellitus visits a healthcare clinic. the client's diabetes mellitus has been previously well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 mg/dL to 200 mg/dL. which medication, added to the client's regimen, may have contributed to the hyperglycemia? 1) atenolol 2) prednisone 3) phenelzine 4) allopurinol

4) a hypoglycemic reaction may occur in response to increased exercise. clients need to avoid exercising during the peak time of insulin. humulin N insulin peaks between 6 and 14 hours; therefore, late-afternoon exercise would occur during the peak of the medication.

a client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. which statement by the client indicates a correct understanding of humulin N insulin and exercise? 1) "i should not exercise after lunch." 2) "i should not exercise after breakfast." 3) "i should not exercise in the late evening." 4) "i should not exercise in the late afternoon."

a) the nurse should monitor the client's daily weight because decreasing weight is an indication of effective therapy. b) 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. c) the nurse should record daily I&O because increased urine output is an indication of effective therapy. d) the nurse should initiate aspiration precautions, because myxedema coma is a severe complication of hypothyroidism that can lead to a compromised airway.

a nurse is assisting in planning 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 input and output. d) initiate aspiration precautions. e) provide warmth using a heating pad.

a) no change in plasma cortisol indicates primary adrenal insufficiency after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol.

a nurse is caring for a client who had 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 is plasma cortisol b) elevated fasting blood glucose c) decrease in sodium d) increase in urinary output

d) the nurse should expect a client who has acromegaly to report visual changes such as double vision and to have decreased visual acuity.

a nurse is caring for a client who has acromegaly. which of the following findings should the nurse expect? a) muscle rigidity b) sunken eyes c) sluggish deep tendon reflexes d) visual disturbances

c) excessive levels of thyroid hormone can cause the client to experience dyspnea. d) when thyroid crisis occurs, the client can experience gastrointestinal conditions, such as vomiting, diarrhea, and abdominal pain. e) excessive thyroid hormone levels can cause the client to experience confusion.

a nurse is caring for a client who is 12 hr postoperative following a thyroidectomy. which of the following findings indicate that the client is experiencing thyroid crisis? (select all that apply.) a) bradycardia b) hypothermia c) dyspnea d) abdominal pain e) mental confusion

b) abnormal menstrual periods, including menorrhagia and amenorrhea, are manifestations of hypothyroidism. c) dry skin is a manifestation of hypothyroidism. e) hoarseness is a manifestation of hypothyroidism.

a nurse is collecting an admission history from a female 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

b) fruity odor of breath is a manifestation of elevated ketone levels that lead to metabolic acidosis. c) abdominal pain is a GI manifestation of increased ketones and acidosis. d) kussmaul respirations are an attempt to excrete carbon dioxide and acid when in metabolic acidosis. e) metabolic acidosis is caused by glucose, protein, and fat breakdown, which produces ketones.

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 aspirations e) metabolic acidosis

b) administering insulin aspart when breakfast arrives can prevent a hypoglycemic episode. insulin aspart is rapid-acting, and should be administered 5 to 10 min before breakfast.

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 hour after insulin administration. d) clarify the prescription because insulin should not be administered at this time.

c) the client should eat a high-fiber diet and take docusate to avoid constipation, which contributes to increased intracranial pressure when straining to have a bowel movement. d) sweet-tasting fluid is an indication of a cerebrospinal fluid leak. the client should notify the provider.

a nurse is reinforcing discharge teaching with a client who had a transsphenoidal hypophysectomy. which of the following instructions should the nurse include? (select all that apply.) a) brush teeth after every meal or snack. b) avoid bending at the knees. c) eat a high-fiber diet. d) notify the provider of any sweet-tasting drainage. e) notify the provider of a diminished sense of smell.

d) muscle weakness, weight loss, extreme thirst, headache, constipation, and dizziness are manifestations of dehydration that occur with diabetes insipidus.

a nurse is reinforcing teaching with 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) "muscle weakness is a symptom of diabetes insipidus."

b) the provider carefully titrates the dosage of this medication, increasing it slowly until the client reaches a euthyroid state. the client should not discontinue the medication unless directed by the provider. c) serum TSH levels monitor the effectiveness of the medication. d) taking the medication on an empty stomach promotes absorption.

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 include? (select all that apply.) a) weight gain will occur while taking this medication. b) do not discontinue medication without the advice of the provider. c) have follow-up serum TSH levels performed. d) take the medication on an empty stomach. e) use fiber laxatives for constipation.

a) the client who has type 2 diabetes mellitus and had a myocardial infarction is at risk for developing HHS. this is due to the increased hormone production during illness or stress, which can stimulate the liver to produce glucose and decrease the effects of insulin. b) the client who has type 2 diabetes mellitus can be at risk for developing HHS when the BUN is 35 mg/dL because it is an indication of decreased kidney function and inability of the kidney to filter high levels of blood glucose into the urine. c) a calcium channel blocker is one of several medications that increase the risk for HHS in a client who has type 2 diabetes mellitus. d) the older adult client is at risk for developing type 2 diabetes mellitus and can be unaware of associated manifestations, increasing the risk for HHS.

a nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state. which of the following factors can cause HHS? (select all that apply.) a) evidence of recent myocardial infarction. b) BUN 35 mg/dL c) takes a calcium channel blocker d) age 77 years e) fluid volume excess

a) increased triiodothyronine indicates hyperthyroidism.

a nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. the nurse should identify that an elevation in which of the following substances indicates hyperthyroidism? a) triiodothyronine b) plasma-free metanephrine c) urine cortisol d) urine osmolarity

a) SIADH results in water retention, causing a low sodium level. c) SIADH results in an increase in urine osmolarity due to the decreased urine volume. d) SIADH results in water retention, causing a high urine sodium level. e) SIADH results in water retention, causing an increase in urine specific gravity.

a nurse is reviewing the medical record of a client who has syndrome of inappropriate antidiuretic hormone. which of the following laboratory findings should the nurse expect? (select all that apply.) a) low sodium b) high potassium c) increased urine osmolarity d) high urine sodium e) increased urine specific gravity

a) d) f) the patient with SIADH has hyponatremia and not hypernatremia. unlike healthy people, patients with SIADH cannot excrete diluted urine. as a result, they retain water and hyponatremia is seen.

a patient presented to the unit with an ADH-secreting tumor. upon diagnostic and physical evaluation, the nurse suspects the patient is experiencing SIADH. which of the following is a clinical manifestation of SIADH? select all that apply. a) hyponatremia b) hypernatremia c) increased serum osmolarity d) reduced serum osmolarity e) dry mucous membranes f) low urine output

c)

an elderly woman complaining of weight gain, depression, and lethargy is diagnosed with hypothyroidism, and thyroid replacement is prescribed. during initiation of thyroid replacement therapy for the patient, the priority assessment for the nurse is to evaluate which of the following? a) mental status b) nutritional status c) cardiovascular function d) bowel function

1) when alcohol is combined with glimepiride, a disulfiram-like reaction may occur. this syndrome includes flushing, palpitations, and nausea. alcohol can also potentiate the hypoglycemic effects of the medication. clients need to be instructed to avoid alcohol consumption while taking this medication. the items in options 2, 3, and 4 do not need to be avoided.

glimepiride is prescribed for a client with diabetes mellitus. the nurse reinforces instructions for the client and tells the client to avoid which while taking this medication? 1) alcohol 2) organ meats 3) whole-grain cereals 4) carbonated beverages

1) 2) 3) 4) repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that is taken 30 minutes before meals and that would be withheld if the client does not eat. hypoglycemia is a side effect of repaglinide, and the client needs to always be prepared by carrying a simple sugar with her or him at all times. metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. a common side effect of metformin is diarrhea. muscle pain may occur as an adverse effect from metformin, but it also might signify a more serious condition that warrants primary health care provider notification, not the use of acetaminophen.

the home care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. the client, prescribed repaglinide and metformin, asks the nurse to explain these medications. the nurse would reinforce which instructions to the client? select all that apply. 1) diarrhea can occur secondary to metformin. 2) the repaglinide is not taken if a meal is skipped. 3) the repaglinide is taken 30 minutes before eating. 4) candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. 5) muscle pain is an expected side effect of metformin and may be treated with acetaminophen. 6) metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

3) the client would use a moisturizing lotion on his or her feet, but would avoid applying the lotion between the toes. the client would also be instructed to soak the feet and to avoid hot water to prevent burns. the client may cut the toenails straight across and even with the toe itself, but he or she needs to consult s podiatrist if the toenails are thick or hard to cut or if his or her vision is poor. the client would be instructed to wash the feet daily with mild soap.

the nurse is assisting with preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. which instruction would be included in the plan of care? 1) soak the feet in hot water. 2) avoid using soap to wash the feet. 3) apply a moisturizing lotion to dry feet, but not between the toes. 4) always have a podiatrist cut your toenails; never cut them yourself.

3) client education after DKA would emphasize the need for home glucose monitoring four to five times per day. it is also important to instruct the client to notify the PHCP when illness occurs. the presence of urinary ketones indicates that DKA has already occurred. the client needs to eat well-balanced meals with snacks, as prescribed.

the nurse is reinforcing instructions to a client with diabetes mellitus who is recovering from diabetic ketoacidosis regarding measures to prevent a recurrence. which instruction is important for the nurse to emphasize? 1) eat six small meals daily. 2) test the urine ketone level. 3) monitor blood glucose levels frequently. 4) receive appropriate follow-up health care.

1) when preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. this sequence will avoid contaminating the vial of regular insulin with insulin of another type. options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

the nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. which action performed by the client indicates the need for further teaching? 1) withdraws the NPH insulin first 2) withdraws the regular insulin first 3) injects air into the NPH insulin vial first 4) injects an amount of air equal to the desired dose of insulin into the vial

3) it is important to emphasize to the client and family that they are not eating a diabetic diet, but rather following a balanced meal plan. adherence to nutritional principles is an important component of diabetic management, and an individualized meal plan would be developed for the client. it is not necessary for the client to purchase special dietetic foods.

the nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. which statement made by the client indicates the need for further teaching? 1) "i'll eat a balanced meal plan." 2) "i need to drink diet soft drinks." 3) "i need to buy special dietetic foods." 4) "i will snack on fruit instead of cake."

a) illness and infection increase blood sugar levels, making diabetes difficult to control with oral antidiabetic agents alone.

the nurse would expect that insulin may be substituted for other antidiabetic agents in which of the following patients? a) in a patient with a history of DM hospitalized for an acute infection b) in a patient having difficulty with weight management c) in a patient experiencing hypoglycemia d) in a patient who is newly diagnosed with borderline hyperglycemia

a) c) d) nasal packs are not removed until the third or fourth postoperative day. removing the nasal pack the day after surgery may exacerbate bleeding. if a sublabial approach is used, the patient is advised not to brush his or her teeth until the incision above the teeth has been healed.

the nursing management of a patient who underwent transsphenoidal removal of a pituitary tumor yesterday includes which of the following actions? select all that apply. a) maintaining oral care b) removing nasal pack to check for bleeding and CSF leak c) giving fluid after nausea, and then slowly progressing to normal diet d) raising the head of the bed to promote drainage e) brush teeth to prevent bacterial overgrowth with hard toothbrush

2) exenatide is an incretin mimetic used for type 2 diabetes mellitus only. it is not recommended for clients taking insulin. hence, the nurse would hold the medication and question the PHCP regarding this prescription. although options 1 and 3 are correct statements about the medication, in this situation it would not be administered. the medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

the primary health care provider prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. the nurse prepares for which most appropriate intervention? 1) the medication is administered within 60 minutes before the morning and evening meal. 2) the medication is withheld and the PHCP is called to question the prescription for the client. 3) the client is monitored for gastrointestinal side effects after administration of the medication. 4) the insulin is withdrawn from the penlet into an insulin syringe to prepare for administration.

a) b) severe headache, perspiration, are indicative of pheochromocytoma. high, not low, blood pressure is strongly associated with pheochromocytoma. the massive release of catecholamines is associated with tremor, and nervousness, not lethargy. palpitations may also be seen.

upon evaluation of the patient's laboratory data and clinical signs and symptoms, the nurse suspects that the patient may have pheochromocytoma. which of the following is directly related with pheochromocytoma? select all that apply. a) severe headache; pain score of 9 out of 10 b) perspiration c) blood pressure 80/90 mm hg d) pallor e) lethargy

b) activity lowers the blood glucose; more food is needed with increased activity.

what should be included when teaching a newly diagnosed patient about the dietary management of diabetes? a) food intake should be decreased before exercise. b) consistency between food intake and activity is important. c) carbohydrates are strictly limited. d) insulin and other antidiabetic agents decrease the need for dietary management.

4) during illness, the client would monitor the blood glucose level, and he or she would notify the primary health care provider if the level is greater than 250 mg/dL. insulin is not stopped. in fact, insulin may need to be increased during times of illness. doses would not be adjusted without the PHCP's advice.

when the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective? 1) "i will stop taking my insulin if i'm too sick to eat." 2) "i will decrease my insulin dose during times of illness." 3) "i will adjust my insulin dose according to the level of glucose in my urine." 4) "i will notify my primary health care provider if my blood glucose level is consistently greater than 250."

diagnostic evaluation endocrine dysfunction

-anterior pituitary gland tests -posterior pituitary gland tests -thyroid gland tests -parathyroid tests -adrenal medulla tests -adrenal cortex tests

pancreatic islets

-beta cells of the pancreas secrete insulin -alpha cells of the pancreas secrete the hormone glucagon -delta cells of the pancreas secrete somatostatin

pituitary disorders #2

-disorders are usually caused by a pituitary tumor -treated with medications and/or surgery

diabetes management: nutrition and exercise

-goals are control of caloric intake for a healthy body weight, control of blood glucose levels, and normalization of lipids and blood pressure -consistency in the amount of calories and carbohydrates ingested at each meal is essential: -must also be balanced against fat and protein intake according to a defined food classification system -exercise is vital in managing diabetes

assessment of the endocrine system

-health history -endocrine disorders often manifest with nonspecific symptoms or complaints than can be attributed to a variety of disorders: -indications of pituitary dysfunction -indications of thyroid dysfunction -indications of parathyroid dysfunction -indications of adrenal dysfunction

physical examination of the patient with endocrine dysfunction

-many disorders cause characteristic changes in appearance -vital sign changes are common -thyroid gland should be inspected and palpated -eyes and vision should be assessed

diabetes management: insulin and medications

-may be rapid-acting, short-acting, intermediate-acting, or long-acting -insulin regimens vary from one to four injections a day -usually self-administered by the patient: -must be correctly administered in an inpatient setting -complications of insulin use must be monitored -insulin pumps are appropriate for some patients -multiple oral antihyperglycemics are available

syndrome of inappropriate antidiuretic hormone

-patients with this disorder cannot excrete diluted urine and develop dilutional hyponatremia -medical management includes identifying and eliminating the underlying cause -nursing management includes close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status

diabetes insipidus #2

-treatment goals are to replace ADH, to ensure adequate fluid replacement, and to identify and correct the underlying intracranial pathology -nursing management includes maintaining adequate fluid volume, monitoring patient's weight, administering vasopressin, monitoring vital signs, and monitoring patient's intake and output

diabetes insipidus #1

-a deficiency of ADH is characterized by excessive thirst and large volumes of dilute urine. -three types: -neurogenic: results from damage to the posterior pituitary gland -nephrogenic: results from drug-related damage to the renal tubules -psychogenic: results from excessive water intake

diabetes management: self-monitoring of blood glucose

-allow for detection and prevention of hypoglycemia and hyperglycemia -various methods for SMBG are available and should be used frequently -glycated hemoglobin levels reflect average blood glucose levels over a period of approximately 2 to 3 months -urine testing for ketones and glucose may also be performed

pathophysiology diabetes mellitus

-type 1 diabetes: -characterized by destruction of the pancreatic beta cells -results in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia -type 2 diabetes: -main problems are insulin resistance and impaired insulin secretion -gestational diabetes mellitus is any degree of glucose intolerance with onset during pregnancy

d)

a 47-year-old woman presents to her primary care provider complaining of bone pain. routine laboratory studies reveal a high serum calcium of 12.0 mg/dL and increased PTH levels. which of the following is the most likely diagnosis? a) graves disease b) cushing disease c) addison disease d) hyperparathyroidism

b)

a client complains of nervousness and palpitations. upon assessing the patient's heart rate, the nurse notes a heart rate of 120 bpm. which of the following endocrine disorders is associated with palpitations and increased heart rate? a) hypothyroidism b) hyperthyroidism c) SIADH d) hypoparathyroidism

b) physical and emotional stress increase the need for hydrocortisone. the provider might increase the dosage when stress occurs. c) weakness and dizziness are indications of adrenal insufficiency. the client should report these indications to the provider. d) rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. if hydrocortisone is discontinued, the dose is tapered.

a nurse is reinforcing teaching with a client who has addison's disease and is taking hydrocortisone. which of the following instructions should the nurse include? (select all that apply.) a) take the medication on an empty stomach. b) notify the provider of any illness or stress. c) report any manifestations of weakness or dizziness. d) do not discontinue the medication suddenly. e) eat a low-sodium diet.

b) hyperthyroidism increases metabolism, causing heat intolerance. d) hyperthyroidism increases metabolism, causing palpitations. e) hyperthyroidism increases metabolism, causing weight loss.

a nurse is reviewing 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) desmopressin promotes renal conservation of water. the hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water resorption. the therapeutic effect of this medication would be manifested by a decreased urine output. options 2, 3, and 4 are unrelated to the effects of this medication.

desmopressin acetate is prescribed for the treatment of diabetes insipidus. the nurse monitors the client after medication administration for which therapeutic response? 1) decreased urinary output 2) decreased blood pressure 3) decreased peripheral edema 4) decreased blood glucose level

2) insulin in unopened vials needs to be stored under refrigeration until needed. vials are not frozen because freezing affects the chemical composition of insulin. when stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. freezing insulin, storing insulin in a dark, dry place, and keeping the insulin at room temperature are all incorrect actions.

the homecare nurse visits a client recently diagnosed with diabetes mellitus who is taking humulin NPH insulin daily. the client asks the nurse how to store the unopened vials of insulin. the nurse would provide which information? 1) freeze the insulin. 2) refrigerate the insulin. 3) store the insulin in a dark, dry place. 4) keep the insulin at room temperature.

long-term complications of diabetes #2

-diabetic retinopathy -diabetic nephropathy -diabetic neuropathy: -peripheral neuropathy -autonomic neuopathies -complications of the feet and legs

risk factors diabetes mellitus

-family history of diabetes -obesity -ethnicity -age > or = 45 years -previous impaired glucose tolerance fasting glucose -hypertension -high HDL cholesterol level -history of gestational diabetes or delivery of babies over 9 pounds

b) 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.

a nurse in a provider's office is reviewing the health record of a client who is undergoing evaluation for graves' disease. which of the following laboratory results is an expected finding? a) decreased thyrotropin receptor antibodies b) decreased thyroid-stimulating hormone c) decreased free thyroxine index d) decreased triiodothyronine

b) a patient with graves' disease is likely to show signs of exophthalmos. instillation of eye ointment is necessary to minimize corneal damage. patients with graves' disease perspire easily and we should keep room temperature cool rather than warm.

a 70-year-old female patient is admitted to the unit with enlargement of the thyroid gland, hypertension, high TSH levels, and bulging eyes. what nursing intervention is most appropriate for this patient? a) providing a blanket b) instilling eye ointment c) providing a warm bath d) keep room temperature comfortable at 85 degrees F

c) secretion of corticotropin-releasing hormone from the hypothalamus prompts the pituitary gland to secrete ACTH.

a nurse is planning to reinforce teaching with a client who is being evaluated for addison's disease about the adrenocorticotropic hormone stimulation test. the nurse should base her instructions to the client on which of the following information? 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 will take a dose of ACTH by mouth the evening before the test.

d) normal saline replaces fluids without adding glucose or electrolytes. A and B contain 5% dextrose and C contains potassium as well as other electrolytes.

the nurse anticipates that during the initial treatment of diabetic ketoacidosis, the provider will order which solution? a) D5W b) D5.45% saline c) lactated ringer solution d) 0.9% saline

c)

the nurse is assessing a client for acromegaly at the clinic. besides asking about changes in shoe size and facial features, the nurse should also inquire about changes in which of the following? a) hearing b) bowel habits c) vision d) taste of foods

2) shakiness is a sign of hypoglycemia, and it would indicate the need for food or glucose. fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.

the nurse reinforces teaching to a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. the client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops? 1) polyuria 2) shakiness 3) blurred vision 4) fruity breath odor