endocrine stuff

A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA?

Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, PaCo2 30, HCO3- 14. The correct option is 4, as it represents metabolic acidosis

arterial blood gas values

pH: 7.35-7.45 (pH <7.35 acidic, pH >7.45 aklaline Paco2: 35-45 Pao2: 80-100 HCO3-: 22-26 Sao2: 95%- 100%

thyroid storm

this acute life threatening condition occurs in a client with uncontrollable hyperthyroidism. It can be caused by manipulation of the thyroid gland during surgery and the release of thyroid hormone into the bloodstream it also can occur from severe infection and stress. antithyroid medications beta blockers, glucocorticoids, and iodides may be administered to the client before thyroid surgery to its occurrence.

Myxedema coma

this rare but serious disorder results from persistently low thyroid production. coma can be precipitated by acute illness rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia of the use of sedative and opioid analgesics

A client with a diagnosis of Addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply.

Hypotension Hyperkalemia

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood?

"I should eat foods that have a lot of potassium in them." A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply.

-Polyuria ( excessive urination) - Polydipsia (excessive thirst) - Polyphagia - Dry mouth - Flushed, dry skin

The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements should the nurse include in the discharge teaching instructions? Select all that apply.

"Include adequate fiber and fluids in your diet." "Wear slip-on shoes rather than those that need to be tied." "Brushing your teeth will not be permitted for at least 2 weeks after surgery." "Contact your health care provider immediately if you develop any headache, fever, or neck stiffness."

The nurse caring for a male client newly admitted to the hospital with a diagnosis of pneumonia suspects that the client is also at risk for metabolic syndrome if which characteristics have been identified in this client? Select all that apply.

-Hemoglobin A1C of 6.5% -Triglycerides 160 mg/dL (1.81 mmol/L) - Serial fasting glucose levels of 120 mg/dL, 132 mg/dL, and 128 mg/dL abnormal hemoglobin A1C: >6.0% triglyceride level of 160 mg/dL or more normal glucose level 70-110

A nursing instructor is teaching the class about Addison's disease. The instructor determines that the class understands the disease process if they indicate which are affected in this disease? Select all that apply.

- Androgens (hormones responsible for the male/female features and reproduction) - Glucocorticoids - Mineralocorticoids In Addison's disease, all three classes of corticosteroids are affected: glucocorticoids, mineralocorticoids, and androgens.

The nurse teaches a class on foot care for clients diagnosed with diabetes mellitus. Which instructions should the nurse include in the class? Select all that apply.

- Wear closed-toe shoes. - Cut toenails straight across and file the edges. - Pat feet dry gently, especially between the toes.

When teaching the client with adrenal insufficiency about cortisone, the nurse should include which items? Select all that apply.

-Take the medication with food. - Increase intake of potassium-rich foods. - Stay away from people with active infections. - Notify the health care provider if illness occurs or surgery is anticipated. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection; therefore, the client should avoid contact with clients who are ill. Taking the medication with food helps prevent stomach upset. Individuals may need an increase in dosage during illness or times of stress (surgery).

Thyroidectomy complications

After thyroidectomy, airway obstruction, although not common, can occur. This is considered an emergency situation. If this develops, emergency management needs to occur and oxygen, suction equipment, and a tracheostomy tray should be immediately available at the bedside.

Phosphorus level

3.0 to 4.5

calcium level

9 to 10.5

hypophysectomy

A hypophysectomy is the surgical removal of the pituitary gland to treat cancerous or benign tumors.

The nurse should include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply.

A thyroid-releasing inhibitor will be prescribed. Encourage the client to consume a well-balanced diet.

hypophysectomy

After hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess the specific gravity of the urine and notify the health care provider (HCP) if the result is lower than 1.005

one cause of diabetes insipidus

Central diabetes insipidus. Damage to the pituitary gland or hypothalamus from surgery, a tumor, a head injury or an illness can cause central diabetes insipidus by affecting the usual production, storage and release of ADH. An inherited genetic disease can also cause this condition.

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is an acute complication of type 2 diabetes mellitus leading to hyperglycemia and dehydration. Headache, polydipsia, and increasing lethargy can be caused by the dehydration

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply.

Diarrhea may occur secondary to the metformin. The repaglinide is not taken if a meal is skipped. The repaglinide is taken 30 minutes before eating. A simple sugar food item is carried and used to treat mild hypoglycemia episodes.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply.

Feeling cold Loss of body hair Persistent lethargy Puffiness of the face

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply.

Fever Nausea Tremors Confusion Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit a sign of thyroid storm. Which is an early indicator of this complication?

Hyperreflexia

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply.

Hypoglycemia may be experienced before dinnertime. The insulin should be administered at room temperature. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.

A client's serum blood glucose level is 389 mg/dL (22.2 mmol/L). The nurse would expect to note which as an additional finding when assessing this client?

Increased thirst A clinical manifestation of hyperglycemia is increased thirst secondary to dehydration and frequent urination

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply.

Irritability Complaints of nausea Sodium level of 128 mEq/L (128 mmol/L) Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg Findings consistent with a diagnosis of adrenal insufficiency include nausea, vomiting, and diarrhea; hyponatremia; salt craving; hyperkalemia; and orthostatic hypotension. Irritability and depression

A client with a recent history of total thyroidectomy has developed iatrogenic hypoparathyroidism. Which observed findings does the nurse determine are associated with the hypoparathyroidism? Select all that apply

Laryngospasm

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply.

Monitor daily weight. Monitor intake and output. Assess extremities for edema. The client with Cushing's syndrome and a problem of excess fluid volume should be on daily weights and intake and output and have extremities assessed for edema. He or she should be maintained on a high-potassium, low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water.

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms should the nurse monitor for? Select all that apply.

Moon face Hypertension Truncal obesity A client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon face, truncal obesity, and a buffalo hump fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain

The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifestations might the nurse expect to note on examination of this client? Select all that apply.

Periorbital edema Coarse, brittle hair Slow or slurred speech Abdominal distention

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply.

Polyuria Bone pain The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply.

Red meats Whole-grain cereals Carbonated beverages

Which assessment finding is characteristic of a client with hypoparathyroidism?

Serum phosphorus of 5 mg/dL (1.61 mmol/L); serum magnesium of 0.9 mEq/L (0.9 mmol/L) remember phosphorus and calcium work in the inverse if calcium is high phosphorus is low

A client's serum blood glucose level is 48 mg/dL (2.74 mmol/L). The nurse would expect to note which as an additional finding when assessing this client?

Slurred speech

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply.

The signs and symptoms of hypoadrenalism The signs and symptoms of hyperadrenalism Instructions to take the medications exactly as prescribed The importance of maintaining regular outpatient follow-up care The nurse should emphasize the importance of continuing medications, consulting with the health care provider (HCP) before purchasing any over-the-counter medications,

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply.

Tremors Irritability Nervousness

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply.

Viruses Genetic factors Autoimmune factors Human leukocyte antigen (HLA)

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority?

Vital signs Pheochromocytoma is a catecholamine-producing tumor. Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness.

Which findings should raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply.

- Urine specific gravity is 1.001. - Serum osmolality is 320 mOsm/kg (320 mmol/kg) of water. - Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours. High serum osmolality levels may be caused by: Too little water in the body (dehydration). Signs of diabetes insipidus include low urine specific gravity (<1.005), high serum osmolality (>300 mOsm/kg of water), and increased urine output from a deficiency of antidiuretic hormone

Thyroid storm sign & symptoms

- elevated temperature - tachycardia - systolic hypertension - nausea, vomiting, and diarrhea - agitation, tremors, anxiety - irritability, agitation, restlessness, confusion, seizures as the condition progresses - delirium and coma

Hypothryoidism signs & symptoms

- lethargy and fatigue - weakness, muscle aches, paresthesia - intolerance to cold - weight gain - dry skin, dry hair and loss of body hair - bradycardia - constipation - generalized puffiness and edema around the eyes and face (myxedema) - forgetfulness and loss of memory - menstrual disturbances - goiter may or may not be present - cardiac enlargement tendency to develop heart failure

thyroid storm interventions

- maintain a patent airway and adequate ventilation - administer antithyroid medications, iodides propranolol, and glucocorticoids as prescribed - monitor vital signs - monitor continually for cardiac dysrhythmias - administer nonsalicylate antipyretics as prescribed (salicylates increase free thyroid hormone levels) - use a cooling blanket to decrease temperature as prescribed

hyperthyroidism sign & symptoms

- personality changes such as irritability, agitation, and mood swings - nervousness and fine tremors of the hands - heat intolerance - weight loss - smooth, soft skin and hair - palpitations, cardiac dysrhthmias, such as tachycardia or atrial fibrillation - diarrhea - protruding eyeballs (exophthalmos) - diaphoresis - hypertension - enlarged thyroid gland (goiter)

diabetic foot care

- use a moisturizing lotion on the feet and avoid applying lotion between the toes. - The client should be instructed not to soak the feet and should avoid hot water to prevent burns - wash the feet daily with a mild soap - cut the toenails straight across and even with the toe itself and would consult a podiatrist if the toenails are thick or hard to cut or if vision is poor.

Addison's disease (adrenal insufficiency)

-nausea - vomiting, - diarrhea - hyponatremia - salt craving - hyperkalemia - orthostatic hypotension

The nurse is caring for a client diagnosed with type 1 diabetes mellitus experiencing the Somogyi effect. Which blood glucose results and treatment would the nurse expect?

0300 blood glucose 68 mg/dL (3.8 mmol/L) and 0700 blood glucose 200 mg/dL (11.1 mmol/L). Instruct to decrease amount of evening insulin. With the Somogyi effect, hyperglycemia occurs in the morning as a result of hypoglycemia during the night from too much evening insulin. Treatment includes having a bedtime snack, decreasing the amount of evening insulin, or both.

resp A client is admitted to an intensive care unit with a diagnosis of acute respiratory distress syndrome (ARDS). The nurse expects which assessment finding?

Altered mental status Altered mental status is secondary to cerebral hypoxia, which accompanies ARDS; cognition and level of consciousness are reduced.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply.

Comatose state Deep, rapid breathing Elevated blood glucose level

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply.

High urine osmolality 4.Low serum osmolality 5.Hypotonicity of body fluids 6.Continued release of antidiuretic hormone (ADH)

Hyperadrenalism

Hyperadrenalism is the name for when an individual has too high levels of adrenal hormones in the blood. The adrenal gland is part of the endocrine system and is responsible for producing hormones such as cortisol, aldosterone, androgenic steroids, epinephrine, and norepinephrine.

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply.

Leukocytosis Urinary output of 800 mL/hour Clear drainage on nasal dripper pad Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose.

The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? Select all that apply.

Monitor for changes in mentation. Encourage fluid intake of at least 3000 mL per day. Monitor vital signs, skin turgor, and intake and output. The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase intake of sodium, protein, and complex carbohydrates and fluids. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required. Mentation, vital signs, skin turgor and intake and output should be monitored for signs of fluid volume deficit.

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply.

Polyuria (excessive urination) Polydipsia (excessive thirst) Complaints of excessive thirst Specific gravity lower than 1.005 (urine is dilute) A triad of clinical symptoms-polyuria, polydipsia, and excessive thirst-often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L)

During health history taking, the client complains of weight loss and diarrhea and says that he can "feel my heart beating in my chest." The nurse anticipates that which diagnostic test will most likely be prescribed by the health care provider (HCP) in order to determine the underlying condition leading to the client's signs and symptoms?

Serum thyroid-stimulating hormone (TSH) A client with increased activity of the thyroid gland exhibits weight loss as a result of the higher metabolic rate, increased frequency of bowel movements or diarrhea, and an increased pulse rate, which account for the client's complaint of feeling his heart beating in his chest. Therefore, a TSH level should be drawn to validate hyperthyroidism. The TSH level will be decreased in hyperthyroid states.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Select all that apply.

Shakiness Palpitations Lightheadedness Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.