Endocrine Disorders EAQ

A nurse mixes a short-acting and an intermediate-acting insulin in the same syringe to administer to a client with diabetes. List the actions in the order the nurse should perform them.

1.Put air into the intermediate-acting insulin vial. 2.Put air into the short-acting insulin vial. 3.Withdraw the prescribed amount of short-acting insulin. 4.Withdraw the prescribed amount of intermediate-acting insulin. 5.Don a pair of clean gloves

A client is worried about what to expect after having a pancreatoduodenectomy (Whipple procedure) for cancer of the pancreas. What is most important for the nurse to know when helping this client plan for the future?

B. The stage and grade of the clients cancer RATIONALE: The stage and grade of the client's cancer are the best predictors of the outcome of therapy. Any history of alcohol or tobacco use is not helpful in understanding the likelihood of additional problems associated with the current cancer. Information about any previous exposure to known carcinogens is not helpful in understanding the likelihood of additional problems associated with the current cancer. The survival rate for individuals with pancreatic cancer is useful, but it is not specific for this client.

A nurse is caring for a client who was admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder?

D. Hypoglycemia and hypotension RATIONALE: Adrenocortical insufficiency causes decreased glucocorticoids, resulting in hypoglycemia; also, it causes decreased aldosterone, resulting in fluid excretion that leads to hypotension. Although diarrhea can occur initially with steroid replacement, it should subside; pyrexia will occur only if there is a concomitant infection. Edema and hypertension are not related to Addison disease; they are associated with Cushing disease, because of excessive cortisol and aldosterone, resulting in fluid and sodium retention. Moon face and hirsutism are related to Cushing disease, not Addison disease; moon facies is caused by adipose tissue deposition, and hirsutism is caused by excessive androgen secretion.

A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor?

D. Low blood sugar RATIONALE: Oral hypoglycemic agents decrease serum glucose levels that may precipitate hypoglycemia. Ketonuria occurs with insulin-dependent diabetes. Weight gain usually is noted in adult-onset diabetes. Ketoacidosis occurs with insulin-dependent diabetes.

The health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. The goal of treatment is that the client will have glucose levels within which range?

B. 70 to 105 mg/dL of blood RATIONALE: 70 to 105 mg/dL of blood is the expected range for blood glucose. The ranges of 40 to 65 mg/dL of blood, 110 to 145 mg/dL of blood, and 150 to 175 mg/dL of blood are indicative of hypoglycemia.

The nurse is assessing a client who reports frequent urination. Which inquiry made by the nurse will help determine diabetes insipidus?

C. "Are you on lithium carbonate therapy?"

A female client receiving cortisone therapy for adrenal insufficiency expresses concern she is developing facial hair. How should the nurse respond?

D. "The drug contains a hormone that causes male characteristics." RATIONALE: Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. The response "Do not worry because it will disappear with therapy" denies the client's concerns; hirsutism results from therapy, which is provided on a long-term basis. The response "This is not important as long as you are feeling better" denies the client's feelings.

A client with diabetes asks the nurse whether the new forearm lancet device gives the same results as a traditional lancet when testing the blood glucose. How should the nurse respond?

A. "There is no difference between readings." RATIONALE: The forearm glucose monitor is calibrated to be consistent with results obtained from a fingerstick. Individuals of all ages can use these glucose monitors. A different scale is not used for each monitor; accompanying literature will indicate if the monitor reading reflects venous blood values even though capillary blood is used. There is no difference in the time required to complete the test.

A nurse is caring for a client who has a 20-year history of type 2 diabetes. Which physiological changes will the nurse assess for that are associated with a long history of diabetes?

A. Blurry, spotty, or hazy vision RATIONALE: Blurry, spotty, or hazy vision, floaters or cobwebs in the visual field, cataracts, and complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.

A client is admitted to the hospital with diabetic ketoacidosis. The nurse identifies that the elevated ketone level present with this disorder is caused by the incomplete oxidation of what?

A. Fats RATIONALE: Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism results in nitrogenous waste production, causing elevated blood urea nitrogen (BUN). Potassium is not oxidized. Ketones do not result when there are alterations in potassium levels. Carbohydrates do not contain fatty acids that are broken down into ketones.

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply.

A. Hirsutism C. Buffalo hump RATIONALE: Excessive hairiness, especially a male pattern of hair distribution on a woman (hirsutism), occurs with Cushing syndrome because of an androgen excess. Cushing syndrome results from excess adrenocortical activity. Hypercortisolism causes fat redistribution, resulting in "buffalo hump"; it also contributes to slow wound healing, hirsutism, weight gain, hypertension, acne, thin arms and legs, and behavioral changes. Menorrhagia (excessive menstrual bleeding) does not occur; menses may cease or be scanty because of virilization. Edema does not occur except when severe heart failure is present. Headaches do not occur with this syndrome.

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because of what reason?

A. It is released slowly RATIONALE: The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

A nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). Which client response is associated with an underproduction of thyroxine?

A. Myxedema RATIONALE: Myxedema is the severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Acromegaly results from excess growth hormone in adults once the epiphyses are closed. Graves disease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids.

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiological finding should be the nurse's focus when collecting additional data about this client?

A. Starvation RATIONALE: In starvation there are inadequate carbohydrates available for immediate energy, and stored fats are used in excessive amounts, producing ketones. There is no fat in alcohol; fat oxidation does not occur. Bone healing does not require the use of great amounts of fat; calcium is deposited to form callus. A positive nitrogen balance does not require the use of great amounts of fat.

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?

B. Hyperplasia of the adrenal cortex RATIONALE: Hyperplasia of the adrenal cortex leads to increased secretion of cortical hormones, which causes signs of Cushing syndrome. Pituitary hypoplasia is a malfunction of the pituitary that will result in Simmonds disease (panhypopituitarism), which has clinical manifestations similar to those for Addison disease. Cushing syndrome results from excessive cortical hormones. ACTH stimulates production of adrenal hormones. Inadequate ACTH will result in Addisonian signs and symptoms.

A client with hyperthyroidism has been treated with radioactive iodine (131I) to destroy overactive thyroid gland cells. To reduce radiation exposure, the nurse's principles for providing care should be based on what?

B. Limiting distance and time spent with the client RATIONALE: When caring for clients who are radioactive, the three most important concepts for reducing radiation exposure are to limit exposure time, increase distance, and use shielding. In this situation, time and distance provide the best reduction in radiation exposure. Wearing a lead-shield apron will help prevent radiation exposure, but time and distance are the first priorities. A radiation meter measures exposure, but does nothing to protect caretakers. Remaining at least 6 feet (1.8 m) away from the client at all times is not a practical approach.

A client with a diagnosis of Graves disease refuses to have radioactive iodine (RAI) therapy, and a subtotal thyroidectomy is performed. What should the nurse do postoperatively to reduce the risk of thyroid storm?

B. Prevent infection at the surgical site RATIONALE: Conditions such as trauma and infection can precipitate thyroid storm (thyroid crisis, thyrotoxic crisis). A high-calorie diet does not prevent crisis; it restores glycogen reserves depleted by an increased metabolic rate. Postoperative breathing exercises prevent respiratory complications, not thyroid storm. Learning how to support the neck after surgery limits tension on the suture line, thereby decreasing the risk of hemorrhage, not thyroid storm.

A registered nurse is providing information to a group of student nurses regarding the actions of parathyroid hormone (PTH). Which statement made by the student nurse indicates a need for further teaching? Select all that apply.

C. "It allows reabsorption of phosphorus in the kidney tubules." D. "It decreases serum calcium levels by increasing bone resorption." RATIONALE: Parathyroid hormone (PTH) allows calcium to be reabsorbed in the kidney tubules. PTH increases bone resorption, thus increasing serum calcium levels. PTH activates vitamin D in the kidneys, which increases the absorption of calcium and phosphorous from the intestines. Secretion of PTH increases serum calcium levels. PTH regulates calcium and phosphorous metabolism by acting on the GI tract, bones, and kidneys.

A nurse is collecting information about a client who has type 1 diabetes and is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? Select all that apply.

C. Excessive emotional stress D. Running a fever with the flu RATIONALE: Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level. Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; this may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia).

Four hours after surgery, the blood glucose level of a client who has type 1 diabetes is elevated. What intervention should the nurse implement?

C. Give supplemental doses of regular insulin RATIONALE: The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes. The client has type 1, not type 2, diabetes, and an oral hypoglycemic will not be effective. Blood glucose levels are far more accurate than urine glucose levels. The rate may be increased because polyuria often accompanies hyperglycemia.

A client suspected to have hyperpituitarism is sent by the primary healthcare provider to undergo a suppression test. Which laboratory value would indicate a positive result?

D. 6 ng/mL RATIONALE: When the growth hormone level in a suppression test is above 5 ng/mL, this indicates a positive result, which means the client is suffering from hyperpituitarism. Therefore, 6 ng/mL indicates a positive suppression test. When growth hormone level falls below 5 ng/mL, this indicates a negative result, which means the client is not suffering with hyperpituitarism. Therefore, 3 ng/mL, 4 ng/mL, and 5 ng/mL indicate negative results, and the client does not have hyperpituitarism.

A nurse is caring for an alert client who has diabetes and is receiving an 1800-calorie American Diabetic Association diet. The client's blood glucose level is 60 mg/dL. The health care provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. What should the nurse do?

D. Ask the client to ingest one tube of glucose gel RATIONALE: One tube of glucose gel contains 15 g of carbohydrate and is the most appropriate intervention in this situation. Providing 12 ounces of non-diet soda is too much carbohydrate; 4 to 6 ounces is adequate. Administering dextrose by IV push is not appropriate for an alert client who is able to eat and drink. Having the client drink 8 ounces of fruit juice is too much carbohydrate; 4 to 6 ounces is adequate.

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client?

D. Inadequate wound healing RATIONALE: Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

A nurse plans to set up emergency equipment at the bedside of a client in the immediate postoperative period after a thyroidectomy. What should the nurse include in the bedside setup?

B. Tracheostomy set and oxygen RATIONALE: A tracheostomy set and oxygen are necessary if the client experiences an acute respiratory obstruction as a result of postoperative edema, nerve damage, or tetany. A cardiac arrest is not an expected response after thyroid surgery. Acidosis requiring sodium bicarbonate and cardiac arrest are not expected responses after a thyroidectomy. If the airway is obstructed by postoperative edema, the use of a mechanical airway will be ineffective because it will not reach beyond the point of the obstruction. A nonrebreather mask is designed to deliver high concentrations of oxygen. In the event of an airway obstruction, the client's need is to circumvent the obstruction, not deliver high concentrations of oxygen.

Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply.

A. Confusion B. Tremors E. Diaphoresis RATIONALE: Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply.

A. Diarrhea C. Weight loss

Postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing?

B. Hypocalcemia RATIONALE: The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood. Hypokalemia is characterized by generalized weakness, a decrease in reflexes, shallow respirations, and cardiac dysrhythmias. Thyrotoxic crisis is characterized by tachycardia, hyperpyrexia, and an exacerbation of hyperthyroid symptoms. Hypovolemic shock is characterized by a weak, thready pulse and hypotension.

A client is receiving dexamethasone for adrenocortical insufficiency. What should the nurse do to monitor for a negative side effect of the medication?

B. Measure blood glucose levels RATIONALE: Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely. Assessing bowel sounds is unnecessary; corticosteroids are not known to precipitate cessation of gastrointestinal activity. Although corticosteroids may increase the risk of developing an infection, routine culturing of respiratory secretions is unnecessary. Culturing respiratory secretions becomes necessary when the client exhibits adaptations of a respiratory infection. Monitoring deep tendon reflexes is required when administering magnesium sulfate, not dexamethasone.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply.

C. Acetone breath E. Decreased arterial carbon dioxide level RATIONALE: A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia, the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis. With ketoacidosis the serum bicarbonate level is decreased, not increased, in an effort to neutralize ketones when seeking acid-base balance.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

C. Urine negative for ketones and hyperglycemia RATIONALE: In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL. Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.

A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription?

D. Vasoactive drugs RATIONALE: Having a normally functioning thyroid (euthyroid) decreases the risk of thyrotoxic crisis after surgery. Ideally the client should be normotensive; some clients are slightly hypertensive because of the increased metabolic rate associated with hyperthyroidism. Vasoactive drugs increase the blood pressure and would not be used with this client. Weighing in the expected range may be impossible; the client may be underweight because of the increased metabolic rate associated with hyperthyroidism. The client should be in a positive nitrogen bala

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? Select all that apply.

A. Thirst D. Fruity breath odor E. Excessive urination RATIONALE: Thirst (polydypsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia . A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a byproduct of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia and hyperglycemia because of central nervous system irritation.

A client is injured in a motor vehicle accident and is admitted to the critical care unit. Twelve hours later the client complains of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed, and an emergency splenectomy is scheduled. What should the nurse emphasize when preparing the client for surgery?

D. The presence of abdominal drains for several days after the surgery RATIONALE: Drains usually are inserted into the splenic bed to facilitate removal of fluid that may lead to abscess formation. Splenectomy has a low mortality rate (5%) except when multiple injuries are present (15% to 40%). Bleeding occurs more commonly with splenic repair than with removal. Educating the client about the risks associated with surgery is the responsibility of the primary healthcare provider. There is no need to frighten the client unnecessarily.

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. What does the nurse determine as the main difference between newly diagnosed type 1 and type 2 diabetes?

C. In type 1 diabetes long-term complications are not present at the time of diagnosis. RATIONALE: Clinical presentation of type 1 diabetes is characterized by acute onset, and therefore there is no time to develop the long-term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. Clinical presentation of type 1 diabetes is rapid, not slow, as pancreatic beta cells are destroyed by an autoimmune process; in type 2 diabetes, the body is still producing some insulin, and therefore the onset of signs and symptoms is slow. In type 1 diabetes, clients are generally lean or have an ideal weight; 80% to 90% of clients with type 2 diabetes are overweight. Type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications; oral medications are used for type 2 diabetes because some insulin is still being produced.