exam 6

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? "Do you experience fatigue even if you have slept a long time?" "Do you have to get up at night to empty your bladder?" "Can you describe the amount of stress in your life?" "Have you experienced any headaches or sinus problems?"

"Do you experience fatigue even if you have slept a long time?"

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? "When I went to the washroom the last few days, my urine smelled odd." "No matter how much sleep I get, it seems to take me hours to wake up." "I've always been a fan of sweet foods, but lately I'm turned off by them." "Lately, I drink and drink and can't seem to quench my thirst."

"Lately, I drink and drink and can't seem to quench my thirst."

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? 1 month 3 months 6 months 9 months

3 months

A 34 year old female is diagnosed with hypothyroidism. Which signs and symptoms would the nurse expect to assess?( Select all that apply) A.Rapid pulse B.Decreased energy and fatigue C.Weight gain of 10 lbs. D.Fine, oily hair E.Constipation

A.Rapid pulse B.Decreased energy and fatigue E.Constipation

A client has a 20-year history of hypothyroidism and has not been compliant with taking thyroid replacement therapy. The client is brought into the ED and is given a diagnosis of myxedema coma. What signs and symptoms are consistent with this life-threatening event? hypoventilation All options are correct. hypotension hypothermia

All options are correct.

Polyuria in the client with diabetes is caused by A.a high renal threshold. B.osmotic diuresis. C.increased thirst. D.dehydration.

B.osmotic diuresis.

Which group is at the greatest risk for osteoporosis? African American women Men Caucasian women Asian women

Caucasian women

A client comes to the emergency department with diabetic ketoacidosis. The nurse should identify which of the following nursing diagnoses as a priority problem? A. Insomnia B. Ineffective health maintenance C. Imbalanced nutrition: Less than body requirements D.Deficient fluid volume

D.Deficient fluid volume

A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? Deficient fluid volume related to osmotic diuresis Imbalanced nutrition: Less than body requirements related to insulin deficiency Ineffective thermoregulation related to dehydration Decreased cardiac output related to elevated heart rate

Deficient fluid volume related to osmotic diuresis

Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast? Encourage midday snack. Delay dinner meal. Provide fewest amount of carbohydrates at lunch meal. Make sure breakfast is not delayed.

Encourage midday snack.

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? Diet and drug histories are related to the family history. It helps determine the client's general status. An allergy to iodine is inherited. Endocrine disorders can be inherited.

Endocrine disorders can be inherited.

What does a positive Chvostek's sign indicate? Hyponatremia Hypokalemia Hypocalcemia Hypermagnesemia

Hypocalcemia

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? Cholesterol Hemoglobin Creatinine Ketones

Ketones

A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results? 95 mg/dL (5.27 mmol/L) Between 70 and 75 mg/dL (3.9 to 4.16 mmol/L) Less than 70 mg/dL (3.7 mmol/L) Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L)

Less than 70 mg/dL (3.7 mmol/L)

A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? Levothyroxine (Synthroid) Liothyronine (Cytomel) Methimazole (Tapazole) Thyroid USP desiccated (Thyroid USP Enseals)

Levothyroxine (Synthroid)

signs of hyperglycemia

Polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, syncope

key symptoms of diabetes

Polyuria polydipsia polyphagia

oral corticosteroid

Prednisone

what type of insulin is administered for DKA and how is it administered

Regular through IV for control

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

Serum potassium level

symptoms of hypoglycemia

cold clammy skin tremmors/shaking nausea confusion irritability tachicardia/irregular heart rate

which part of the adrenal gland produces corticosteroids

cortex

improtant teaching to prevent hypoglycemia when taking medications

know when the insulin will peak so they can eat when the insulin will take effect

A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. "Buffalo hump" Thin extremities Purple striae "Moon face" Truncal obesity

"Buffalo hump" Thin extremities Purple striae "Moon face" Truncal obesity

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? "I will eat lots of chicken and dairy products." "I may stop taking this medication when I feel better." "I will see my ophthalmologist regularly for a check-up." "I will avoid friends and family members who are sick."

"I may stop taking this medication when I feel better."

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? "I always wear my medical identification bracelet." "I avoid exposure to the sun as much as possible." "I always carry hard candy to eat in case my blood sugar level drops." "I skip lunch when I don't feel hungry."

"I skip lunch when I don't feel hungry."

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Inject insulin into healthy tissue with large blood vessels and nerves." "Administer insulin into sites above muscles that you plan to exercise heavily later that day." "Rotate injection sites within the same anatomic region, not among different regions." "Administer insulin into areas of scar tissue or hypertrophy whenever possible."

"Rotate injection sites within the same anatomic region, not among different regions."

•Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus. Select all that apply •1. A major risk factor for complications is obesity and central abdominal obesity. •2. Supplemental insulin is mandatory for controlling the disease •3. Exercise increases insulin resistance •4. The primary nutritional source requiring monitoring in the diet is carbohydrates •5. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA)

1. A major risk factor for complications is obesity and central abdominal obesity. 4. The primary nutritional source requiring monitoring in the diet is carbohydrates 5. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA)

An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. A nurse provides instructions regarding the interaction of alcohol and metformin. When the nurse evaluates the client's understanding she notes that learning is evident because the client makes which of the following statements? 1." If I know I'll be having alcohol, I must not take metformin: I could develop lactic acidosis." 2. " If my physician approves, I may drink alcohol with my metformin" 3. Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain and rapid heartbeat." 4. " If I feel bloated, I should call my physician"

1." If I know I'll be having alcohol, I must not take metformin: I could develop lactic acidosis."

•A client with Graves' disease is treated with radioactive iodine (RAI) in the form of sodium iodide. Which of the following statements by the nurse will explain to the client how the drug works? • •1. "The radioactive iodine stabilizes the thyroid hormone levels before thyroidectomy." •2. "The radioactive iodine reduces uptake of thyroxine and thereby improves your condition." •3. The radio active iodine lowers the levels of thyroid hormones by slowing your body's production of them." •4. The radio active iodine destroys thyroid tissue so that thyroid hormones are no longer produced

4. The radio active iodine destroys thyroid tissue so that thyroid hormones are no longer produced

A diabetes nurse educator is presenting current recommendations for levels of caloric intake. What should the nurse describe? 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? 8.0% 7.5% 8.5% 6.5%

6.5%

what blood glucose levels indicates hypoglycemia

<60

What level should HgbA1c be below?

<7

Metabolic Syndrome (Syndrome X)

A genetic metabolic disorder characterized by diabetes, hypertension, atherosclerosis, centrally distributed obesity, and elevated blood lipids

Which statement is true regarding gestational diabetes? A glucose challenge test should be performed between 24 to 28 weeks. It occurs in the majority of pregnancies. There is a low risk for perinatal complications. Onset usually occurs in the first trimester.

A glucose challenge test should be performed between 24 to 28 weeks.

Which client would the nurse identify as having the greatest risk for osteoporosis? A 40-year-old overweight African American woman A 16-year-old male with a history of asthma A 20-year-old male athlete with repeated injuries A small-framed, thin 45-year-old white woman

A small-framed, thin 45-year-old white woman

The most common cause of Addison disease is: • •A. An autoimmune reaction. •B. Dietary deficiency of sodium and potassium. •C. Cancer •D. Viral infection of the pituitary gland.

A. An autoimmune reaction

•Patricia Fowler, a 55 year old patient, is admitted to the medical unit for complications of long-term, poorly controlled type 2 diabetes mellitus (DM). In addition to alterations in the serum glucose, you would expect to see which of the following lab abnormalities? •A. Elevated serum lipids •B. Metabolic alkalosis •C. Elevated liver enzymes •D. Low red blood cells count

A. Elevated serum lipids

A home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food or medication has been consumed for 36 hours. Which additional statement by the client indicates a need for further teaching? A."I need to stop my insulin." B."I need to increase my fluid intake." C."I need to call the physician because of these symptoms." D."I need to monitor my blood glucose every 3 to 4 hours

A."I need to stop my insulin."

Robert Jacobsen is seen at a community clinic for complaints of a wound on his foot that will hot heal. Upon examination, the wound appears to be infected. He indicates that he didn't even realize the wound was there until he removed his shoe and found his foot was bloody. Mr. Jacobsen is obese and is being treated for type 2 diabetes mellitus. Why is Mr. Jacobsen at risk for developing infections? Mark all that apply A.Vascular changes reduce blood flow to lower extremities B.Hyperglycemia promotes bacterial growth C.Impaired function of WBC D.Hyperglycemia causes alterations in skin integrity E.Decreased peripheral sensation reduces early warning signs

A.Vascular changes reduce blood flow to lower extremities B.Hyperglycemia promotes bacterial growth C.Impaired function of WBC E.Decreased peripheral sensation reduces early warning signs

3 key lab tests for DKA

ABG: expect Ph to be low Glucose: expect to be very high serum osmolarity: expect to be high

A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site? Abdomen Arms Thighs Upper buttock

Abdomen

A client with diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis? Monitor serum electrolytes and blood glucose levels. Administer isotonic fluid at a high volume. Administer glucose. Administer potassium replacements.

Administer glucose.

Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. Sugar is found only in dessert foods. The only diet change needed in the treatment of diabetes is to stop eating sugar.

An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.

A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client? Avoid hot-water bottles and heating pads. Examine feet weekly for redness, blisters, and abrasions. Dry feet vigorously after each bath. Avoid the use of moisturizing lotions.

Avoid hot-water bottles and heating pads.

The most appropriate diet for the client with Grave's disease would be: A. Soft B. High calorie C. Low sodium D. High roughage

B. High calorie

Mental status changes and muscle weakness in people with Addison disease are primarily cause by: • •A. Hyperkalemia •B. Hypoglycemia •C. Severe metabolic acidosis •D. Glucose intolerance

B. Hypoglycemia

The nurse counseling a client in the prevention of goiter in Hypothyroidism would suggest an increased intake of: A. Calcium B. Iodine C. Potassium D. Protein

B. Iodine--avoid foods with high salt content because it can interfere with the medications

The basal metabolic rate is unusually ____ with hypothyroidism. A. High B. Low C. Steady D. Variable

B. Low

Which of the following is a desired outcome in evaluating a new diabetic's understanding of teaching about insulin usage? A.After drawing up insulin from a vial, he adds an air bubble so as to clear the needle after injection. B.He carries some form of simple carbohydrate at all times. C.He recognizes that hunger and tremor signal a need for additional insulin. D.He knows that adding carbohydrate to the diet can produce an insulin reaction.

B.He carries some form of simple carbohydrate at all times.

The nurse is completing a health assessment of a 42 year old female with suspected Graves disease. The nurse should assess the client for: A.Anorexia B.Tachycardia C.Weight gain D.Cold skin

B.Tachycardia

Mrs. Bergstrum is a 60 year old client who has been newly diagnosed with noninsulin dependent diabetes Type II diabetes). She is 70 pounds overweight. What information should the nurse include in a teaching plan for Mrs. Bergstrum? A.Emphasize controlling her weight through a high protein diet. B.The role of exercise in improving blood glucose control. C.Oral hypoglycemic agents are less effective than insulin in managing blood glucose levels. D.Reaching her optimal weight will cure her disease.

B.The role of exercise in improving blood glucose control.

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? Serum bicarbonate of 19 mEq/L Blood pH of 6.9 Blood glucose level of 250 mg/dL PaCO2 of 40 mm Hg

Blood pH of 6.9

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. Fatigue and irritability Polyuria and polydipsia Wounds that heal slowly or respond poorly to treatment Blurred or deteriorating vision Sudden weight loss and anorexia

Blurred or deteriorating vision Fatigue and irritability Polyuria and polydipsia Wounds that heal slowly or respond poorly to treatment

Frank has been noncompliant with his diabetic regimen in the past. What test will give the best information regarding his compliance? A. Random blood sugar B. Test urine for glucosuria C. Glycosylated hemoglobin/ Hgb A1C D. Glucose tolerance test

C. Glycosylated hemoglobin/ Hgb A1C

Bobby Davies a 12 year old male is newly diagnosed with type 1 diabetes mellitus. Bobby's pathophysiologic state is most probably the result of: A. A familial, autosomal dominant gene defect B. Obesity and lack of exercise C. Immune destruction of the pancreas D. Hyperglycemia from eating too may sweets

C. Immune destruction of the pancreas

a client with type 1 diabetes mellitus has DKA. which of the following findings has the greatest effect on fluid loss A. Hypotension B. Decreased serum potassium level C. Rapid deep respirations D. Warm dry skin

C. Rapid deep respirations

Situation: Andrea Pitt's mother, Mary Vanderbush, was brought to the emergency department. Ms. Pitt found her mother at home unresponsive. Her pulse was very slow and skin was cool and dry. She had been increasingly depressed and confused over the last six to eight months. She suffered a heart attack about two years ago, but seemed to recover well. The physician had lab tests done, and made a tentative diagnosis of myxedema coma. She was admitted to the medical intensive care unit. •The physician plans to return Ms. Vanderbush to a normal thyroid state very gradually. What is the risk of a too rapid restoration to normal thyroid hormone levels? A.Serum electrolytes may be restored to normal too quickly, resulting in cerebral edema. B.Renal function may not be able to keep up with the increased need for fluid excretion as the edema resolves. C.If improved thyroid status causes a too rapid increase in demands for oxygen by the peripheral tissues, her compromised coronary circulation may be inadequate, causing another myocardial infarction. D.Too rapid a correction of her altered mental status may result in agitation and combative behavior.

C.If improved thyroid status causes a too rapid increase in demands for oxygen by the peripheral tissues, her compromised coronary circulation may be inadequate, causing another myocardial infarction.

•Situation: Andrea Pitt's mother, Mary Vanderbush, was brought to the emergency department. Ms. Pitt found her mother at home unresponsive. Her pulse was very slow and her skin was cool and dry. She had been increasingly depressed and confused over the last six to eight months. She suffered a heart attack about two years ago, but seemed to recover well. The physician had lab tests done, and made a tentative diagnosis of myxedema coma. She was admitted to the medical intensive care unit. • •Ms. Vanderbush's physician prescribed a broad spectrum IV antibiotic. The most likely reason for this medication is that A.She is at great risk for aspiration and a subsequent chemical pneumonia. B.She now has an indwelling Foley catheter, and is at risk for urinary tract infections. C.Many patients in myxedema coma have an infection as the stressor that precipitated the coma. D.She is in an area of the hospital where iatrogenic infections are a common problem.

C.Many patients in myxedema coma have an infection as the stressor that precipitated the coma.

C.D., who is a diabetic, wears heavy, well constructed shoes. At work, he stepped on a nail and it pierced his foot right through his leather shoe. He didn't notice the nail until later that evening when he was changing his shoes. What type of problem does this indicate? A.Retinopathy B.Nephropathy C.Neuropathy D.Peripheral vascular disease

C.Neuropathy

Julia Perez a 35 year old female is admitted to a medical surgical unit with Graves disease. Which of the following signs would the nurse expect to see upon admission? A.Weight gain, cold intolerance B.Slow heart rate; rash C.Skin hot and moist, rapid heart rate D. Constipation, confusion

C.Skin hot and moist, rapid heart rate

tests for hypothyroid

CBC for anemia Chem 8 to check fluid and electrolyte status Lipid panel: usually elevated due to low metabolism TSH, T4, T3 Thyroid antibodies

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? Sodium bicarbonate Potassium chloride Sodium phosphorus Calcium gluconate

Calcium gluconate

what medication to give IV if calcium becomes dangerously low

Calcium gluconate

signs of hypocalcemia

Chvostek's (cheek) Trousseau (blood pressures)

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density? Hypertension Cardiac disease Diabetes Compression fractures

Compression fractures

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? Eat a high-fiber diet. Drink plenty of fluids. Take the antidiabetic drugs regularly. Control blood glucose levels.

Control blood glucose levels.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? Hashimoto disease Cushing syndrome Addison disease Graves disease

Cushing syndrome

The body's inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions? • •A. Low levels of cortisol •B. High levels of ACTH •C. Hypersecretion of ADH •D. Aldosterone deficiency

D. Aldosterone deficiency

Which of the following is priority in patient education for all persons with diabetes regarding the prevention of hypoglycemia? A. Instructions in the use of glucagon B. Use of a fast acting carbohydrate C. Need to increase caloric consumption D. Peak time of glucose lowering medication/s

D. Peak time of glucose lowering medication/s

Who of the following is at highest risk for Type II diabetes mellitus? A.Nine year old boy with a history of repeated viral infections B.A 20 year old man whose mother has Type II C.A 32 year old woman in her third trimester of pregnancy D.A 52 year old woman who is 30 pounds overweight

D.A 52 year old woman who is 30 pounds overweight

Susan less has type 1 diabetes mellitus. She is admitted to the hospital with the following lab values: serum glucose 500 mg/dl ( high) , urine glucose and ketones 4+, arterial ph 7.20. her parents state that she has been sick with the "flu"for a week. Which of the following statements best explains her state. • A.Increased insulin levels promote protein breakdown and ketone formation B.Her uncontrolled diabetes has led to renal failure C.low serum insulin promotes lipid storage and corresponding release of ketones D.Insulin deficiency promotes lipid metabolism and ketone formation

D.Insulin deficiency promotes lipid metabolism and ketone formation

what is the difference between DKA and HHNK

DKA has quick onset, occurs mostly in type I, ketones present, low Ph HHNK slow onset, no ketones present, elevated Ph

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Decreased height Increased heel pain Bone spurs Diarrhea

Decreased height

A 30 year-old female client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the client's care? Disturbed body image related to changes in physical appearance Spiritual distress related to changes in cognitive function Powerlessness related to disease progression Decisional conflict related to treatment options

Disturbed body image related to changes in physical appearance

A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? Do not eliminate insulin when nauseated and vomiting. Reduce food intake and insulin doses in times of illness. Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L). Eat three substantial meals a day, if possible.

Do not eliminate insulin when nauseated and vomiting. The most important issue to teach clients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, and then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL (16.6 mmol/L).

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? Do not mix with other insulins. Glargine is rapidly absorbed and has a fast onset of action. Administer the total daily dosage in 2 doses. Draw up the drug first, then add regular insulin.

Do not mix with other insulins.

A client has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, the client's healthcare provider has diagnosed metabolic syndrome. What are the conditions contributing to the development of metabolic syndrome? Select all that apply. Elevated blood glucose levels Decreased low-density lipoproteins (LDL) Abdominal obesity Elevated high-density lipoproteins (HDL) Hypertension

Elevated blood glucose levels Abdominal obesity

The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis? Ensuring adequate calcium and vitamin D intake Undergoing assessment of serum calcium levels every year Having a DXA beginning at age 35 years Engaging in non-weight-bearing exercises daily

Ensuring adequate calcium and vitamin D intake

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? Finger Thigh Upper arm Forearm

Finger

You graduated 3 months ago and are working with a home care agency. Part of your case load is J.S. a 60 year old man suffering from chronic obstructive pulmonary disease (COPD); he is on home oxygen 2L for several years. He started on steroid therapy 2months ago (dexamethasone). On the way to visit J.S. you remember he has been progressively exhibiting S/S's of Cushing's syndrome. As you begin your assessment you note the following findings: Place a check mark in the blank next to the S/S that characterize Cushing's syndrome. •_____ Barrel chest •_____ Full looking face ( moon face) •_____ BP 180/94 •_____ Pursed lip breathing, especially when patient is stressed •_____ Thin arms and legs •_____ Bruising on both arms •_____ Acne •_____ Diminished breath sounds •_____ Truncal obesity with fat around clavicles and the neck •_____ Weakness and fatigue •_____ Impaired glucose tolerance

Full looking face ( moon face) BP 180/94 Thin arms and legs Bruising on both arms Acne Truncal obesity with fat around clavicles and the neck Weakness and fatigue Impaired glucose tolerance

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? Hydrocortisone Glucagon 50% dextrose Epinephrine

Glucagon

Lab values for diabetes diagnosis

Hgb A1c >6.5 2hr GTT or FBG >200

What test is preformed to monitor diabetic compliance

HgbA1c

what causes gestational diabetes

Hormonal changes

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? How to self-inject insulin How to monitor ketones daily How to control blood glucose through lifestyle modification with diet and exercise How to recognize signs of diabetic ketoacidosis

How to control blood glucose through lifestyle modification with diet and exercise

what should a nurse administer for DKA

IV fluids: because increased osmolarity causes polyuria and dehydration IV continuous insulin: Regular, provides control

The home care nurse is conducting client teaching with a client on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when should the home care nurse instruct the client to take the corticosteroids? At noon every day In the morning between 7 AM and 8 AM Prior to going to sleep at night In the evening between 4 PM and 6 PM

In the morning between 7 AM and 8 AM

The most common type of goiter is caused by lack of which of the following? Sodium Iodine Calcium Potassium

Iodine

The preferred preparation for treating hypothyroidism includes which of the following? Radioactive iodine Methimazole (Tapazole) Propylthiouracil (PTU) Levothyroxine (Synthroid)

Levothyroxine (Synthroid)

A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? Stop using tobacco in any form Undergo eye examinations regularly Have blood glucose levels checked annually Lose weight, if obese

Lose weight, if obese

What impact does excercise have on type II diabetes

Lowers insulin resistance Lowers cholesterol weight loss

A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does hyperosmolar nonketotic syndrome most often occur? Clients who are obese and who have no known history of diabetes Clients with type 1 diabetes and poor dietary control Adolescents with type 2 diabetes and sporadic use of antihyperglycemics Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Middle-aged or older people with either type 2 diabetes or no known history of diabetes

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? Hypotension Weight loss Moon face Pale thick skin

Moon face

addisonian crisis

N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP precipitated by physical or emotional stress or sudden withdrawal from corticosteroids treat with IV fluids, electrolyte replacment, and steroids

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? Evaluate the quality of the client's voice postoperatively, noting any drastic changes. Observe for swelling of the neck, tracheal deviation, and severe pain. Monitor laboratory values daily for elevated thyroid-stimulating hormone. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? Review the client's first hemoglobin A1C result after discharge. Ask the client to describe the process in detail. Provide a health education session reviewing the main points of insulin delivery. Observe the client drawing up and administering the insulin.

Observe the client drawing up and administering the insulin.

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? Cognitive problems Patient's ability to self-administer insulin Patient's history Patient's eating and sleeping habits

Patient's eating and sleeping habits The eating and sleeping habits of older adults differ from those of young or middle-aged persons. The nurse should take this into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent. The nurse should evaluate the patient's ability to self-administer insulin before developing a teaching program. Cognitive problems and patient history may not be taken into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent.

An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? A faulty heater Autonomic neuropathy Sudomotor neuropathy Peripheral neuropathy

Peripheral neuropathy

classifications of hyper and hypo glands

Primary: problem with glandular hormone production/release Secondary: problems with pituitary gland releasing hormones Tertiary: issues with cellular receptors receiving hormones Ectopic: other sites (cancer) releasing hormones

A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address? Management of diabetic ketoacidosis Recognition of hypoglycemia and hyperglycemia Signs and symptoms of diabetic nephropathy Effects of surgery and pregnancy on blood sugar levels

Recognition of hypoglycemia and hyperglycemia

What is the only insulin that can be given intravenously? Regular Ultralente NPH Lantus

Regular

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? Deficient knowledge about osteoporosis and the treatment regimen Acute pain related to fracture and muscle spasm Risk for injury related to fractures due to osteoporosis Risk for constipation related to immobility

Risk for injury related to fractures due to osteoporosis

A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to do what action? Take each dose of prednisone with a dose of calcium chloride. Take the drug concurrent with levothyroxine. Gradually replace the prednisone with an over-the-counter (OTC) alternative. Slowly taper down the dose of prednisone, as prescribed.

Slowly taper down the dose of prednisone, as prescribed.

The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? A diet high in fiber and plant-sourced fat Three large, bland meals a day A reduced calorie diet, high in nutrients Small, frequent meals, high in protein and calories

Small, frequent meals, high in protein and calories

Which is a strategy for lowering risk for osteoporosis? Increased age Smoking cessation Low initial bone mass Diet low in calcium and vitamin D

Smoking cessation

Why is TSH elevated in hypothyroidism?

TSH : regulates secretion of T3 and T4, circulating levels of T3 and T4 serve as a feedback mechanism to turn off the release of TSH, the thyroid gland in unable to produce T3 or T4 despite an increased TSH levels because the feedback mechanism is never turned off. The TSH continues to raise and the patient becomes increasingly symptomatic

The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? Determine whether the client has been using expired insulin. Administer a fluid challenge and have the test repeated. Ensure that the client receives a comprehensive assessment of liver function. Teach the client about actions to slow the progression of nephropathy.

Teach the client about actions to slow the progression of nephropathy.

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? Temperature of 102ºF Blood pressure 90/58 mm Hg Oxygen saturation of 96% Heart rate of 62

Temperature of 102ºF

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? The client has eaten but has not taken or received insulin. The client has not eaten but continues to take insulin or oral antidiabetic medications. The client has not been exercising. The client has not complied with the prescribed treatment regimen.

The client has not eaten but continues to take insulin or oral antidiabetic medications.

A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy? The client's diet should be low protein with ample fat. The client is at a decreased risk for development of thrombophlebitis and thromboembolism. The client is at an increased risk for developing infection. The client may experience short-term changes in cognition.

The client is at an increased risk for developing infection.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? Diabetic ketoacidosis Hypoglycemia Thyroid crisis Tetany

Thyroid crisis

Which of the following hormones would the nurse identify as being secreted by the thyroid gland? Somatotropin Parathormone Thyroxine Thymosin

Thyroxine

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? To restore liver glycogen and prevent secondary hypoglycemia To decrease the possibility of nausea and vomiting To stimulate her appetite To decrease the amount of glycogen in her system

To restore liver glycogen and prevent secondary hypoglycemia

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the child's pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes? Non-insulin-dependent diabetes Type 1 diabetes Type 2 diabetes Prediabetes

Type 1 diabetes

The greatest percentage of people have which type of diabetes? Impaired glucose tolerance Type 2 Type 1 Gestational

Type 2

main difference between type I and II diabetes

Type I doesn't produce insulin. autoimmune that destroys pancreatic B cells Type II insulin resistance. produces insulin but cannot use it

A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet? Vitamin D-fortified milk Green vegetables Bananas Red meat

Vitamin D-fortified milk

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Decrease the intake of vitamins A and D Walk or perform weight-bearing exercises Increase fiber in the diet Reduce stress

Walk or perform weight-bearing exercises

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? Weight loss, nervousness, and tachycardia Diaphoresis, fever, and decreased sweating Exophthalmos, diarrhea, and cold intolerance Weight gain, constipation, and lethargy

Weight loss, nervousness, and tachycardia

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? Maintenance of blood glucose levels between 180 and 200 mg/dl Weight reduction through diet and exercise An eye examination every 2 years until age 50 Smoking reduction but not complete cessation

Weight reduction through diet and exercise

what is the best place for insulin injections and why

abdomen because it is absorbed the best

hypofunction of adreanals signs (addisons)

abdominal pain/ nausea/vomiting/ diarrhea/weight loss fatigue headache sweating mood changes dark pigmentation of mucos membranes and skin folds hypotension hypoglycemia hyperkalemia hyponatremia

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? thymus function adrenal function thyroid function parathyroid function

adrenal function

what should you avoid while taking metformin because it can be very dangerous

alcohol

clinical manifestations of myxedema

all organ and metabolic functions sugnificantly slowed hypothermia hypoventalation bradycardia hypotension hyponatrimia hypoglycemia

what is hashimotos thyroiditis

autoimmune destruction of thyroid gland inflammation of the thyroid gland

what is an early indication of osteoporosis

back pain

what is more dangerous thyroid storm or myxedema

both are deadly

what does DKA and HHNK have in common

both have increased osmolarity

what is a physical sign of graves disease

bulging eyes

Jerry Green is a 13 year old who uses insulin to control his type 1 diabetes. During his gym class, he experiences hunger, light headedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: • •a. Hyperglycemia resulting from incorrect administration. •b. Dawn phenomenon caused by eating a snack before gym class. •c. Hypoglycemia caused by increased exercise. •d. Somogyi effect caused by insulin sensitivity

c. Hypoglycemia caused by increased exercise.

what should diabetics always have with them

carbohydrate snack to protect from hypoglycemia

adrenal medula secretes what hormones

catecholamines: epinephrine and norepinephrine

Treat adrenal insufficiency with

corticosteroids

A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client is ill by stating: a) I will stop taking my insulin if I'm too sick to eat b) I will decrease my insulin dose during times of illness and check my urine for WBC's. c) I will adjust my insulin dose according to the amount of food I eat d) I will notify my physician if my blood glucose level is higher than 250 mg/dL and check my urine for ketones

d) I will notify my physician if my blood glucose level is higher than 250 mg/dL and check my urine for ketones

A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the nurse plans to teach the client about the need to: a) Avoid infection b) Take in adequate fluids c) Prevent and recognize hypoglycemia d) Prevent and recognize hyperglycemia

d) Prevent and recognize hyperglycemia

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: systolic murmur at the left sternal border. decreased body temperature and cold intolerance. exophthalmos and conjunctival redness. flushed, warm, moist skin.

decreased body temperature and cold intolerance.

symptoms of hypothyroid

decreased metabolism: use caution with narcotics and anesthesia hypothermia hypoglycemia hypoventilation hypotension low blood pressure constipation bradycardia confusion slow speech goiter muscle weakness and fatigue

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: hypotension. deposits of adipose tissue in the trunk and dorsocervical area. weight gain in arms and legs. thick, coarse skin.

deposits of adipose tissue in the trunk and dorsocervical area.

discharge teaching for corticosteroids

do not stop taking suddenly, don't let them run out they need to be tapered down if not they will be at risk for Addisonian crisis take in the AM between 7 and 8 take with food

signs of hypothyroidism (slide)

dry coarse hair loss of eyebrow hair puffy face enlarged thyroid (goiter) slow heartbeat weight gain constipation brittle nails

risk factors for hyperthyroidism

female genetics age (20-40) increased iodine intake

what is an osteoporosis pt at risk for

fractures and falls (make sure call light is within reach)

what is a physical sign of hypothyroidism

goiter

signs of cushings syndrome

hair loss achne buffalo hump moon face increased body and facial hair central weight gain purple striae thin extremities slow wound healing

signs of hyper thyroidsim (slide)

hair loss bulging eyes sweating rapid heart rate weight loss frequent bowel movements warm moist palms tremor of fingers soft nails

A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau's sign. What does the nurse observe to verify this finding? hand flexing inward bulging forehead cardiac dysrhythmia moon face and buffalo hump

hand flexing inward

how to know if a newly diagnosed diabetic understands glucose monitoring and insulin injection teaching

have them teach you and watch them use glucometer and inject insulin

clinical manifestations of thyroid storm

hypertension, tachycardia, high fever, heart failure, arrhythmias, confusion, seizures

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: polyuria hypoglycemia blurred vision polydipsia

hypoglycemia

what is diabetes

inability to get insulin into the cells. can be autoimmune or an insulin resistance

what impact does smoking have on diabetes

increases vascular resistance: vassoconstrictor increases risk for athlerosclerosis

coticosteriod risk

infection

what could cause a thyroid storm

infection surgery acute stress

major reason why hypothyroidism goes undiagnosed?

it is confused with normal signs of aging

Diabetic teaching for sick days

keep monitoring glucose and taking insulin even if anorexia and vomiting

possible complication of thyroidectomy

low calcium

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? sleep/wake cycles metabolic rate fluid/electrolyte balance growth

metabolic rate

what medication is prescribed for type II diabetes when diet and exercises aren't enough to control it

metformin

what is it called when hypothyroid becomes deadly

myxedema

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: thyroid storm. Hashimoto's thyroiditis. myxedema coma. cretinism.

myxedema coma.

will a goiter go away after hypothyroid is corrected?

no

is increasing calcium intake sufficient to slow down osteoporosis

no, need to increase activity and vitamin D as well

what is exopthalmia

overstimulations of the sympathetic nervous system causes eye muscles to enlarge and does not decrease after hyperthyroidism is corrected

who is at greatest risk for developing type II diabetes

overweight increased age

what is the tumor of adrenal medula called

pheochromocytoma

other that primary physician what other doctors should a diabetic see annually?

podiatrist: because of neuropathy, poor wound healing, and thick hard to clip toenails opthamologist: because of increased risk for retinopathy

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: polyuria. anorexia. polydipsia. polyphagia.

polyphagia.

symptoms of DKA

polyuria, polydipsia, polyphagia dehydration hyperventalation blurred vision fatigue due to cellular starvation confusion irregular heart rate

what medications are used to treat thyroid storm

propylthiouracil strong iodine solutions (RAI) NO aspirin

A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: dry, waxy swelling and abnormal mucin deposits in the skin. a wide, staggering gait. protruding eyes and a fixed stare. more than 10 beats/minute difference between the apical and radial pulse rates.

protruding eyes and a fixed stare.

what medication is used to treat non-surgical hyperthyroid and how does it work

radioactive iodine RAI absorbed into the thyroid and destroys thyroid cells prop

what might contribute to development of osteoporosis

sedentary lifestyle low calcium and vitamin D intake

IV corticosteroid to treat addison's

solumedrol

what diet would be appropriate for graves disease

they need energy, increased metabolism proteins high calorie

which organ is impaced by graves disease

thyroid

severe exacerbation of hyperthyroidism

thyroid storm

addisons

too little corticosteroid

cushings

too much corticosteroid

how long does it take for adrenal glands to start producing corticosteroids again after corticosteriod treatment is complete

up to a year

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: walk barefoot at least once each day. wash and inspect the feet daily. use commercial preparations to remove corns. cut the toenails by rounding edges.

wash and inspect the feet daily.

what would help improve osteoporosis

weight baring excercises

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? protein metabolism weight loss carbohydrate intake blood glucose level

weight loss

A client with hyperthyroidism says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily, " Which of the following responses by the nurse would give the client the most accurate explanation of her behavior. •1. "Your behavior is caused by temporary confusion brought on by your illness." •2. "Your behavior is caused by the excess thyroid hormone in your system." •3. "Your behavior is caused by your worrying about the seriousness of your illness." •4. "Your behavior is caused by the stress of trying to manage a career and cope with illness.

•2. "Your behavior is caused by the excess thyroid hormone in your system."

nursing diagnosis' for diabetes

•Ineffective health maintenance •Deficient knowledge •Unstable Blood Sugars •Readiness for enhanced therapeutic regimen •Health seeking behavior

Patient teaching for synthroid

•Take one pill every day at the same time...usually 1 hr. before a meal...usually breakfast/ Consumption of levothyroxine with certain foods can significantly reduce its absorption. Thyroid hormones levels can decrease if you take your medication with foods -- or foods that contain -- soybean flour, cotton seed meal, walnuts, dietary fiber, calcium or calcium fortified juices. These foods should be avoided within hours of taking your medication. In addition, thyroid hormone levels may increase if you fast while on this medication. To avoid such fluctuations, levothyroxine should be administered on a consistent schedule, with regard to time of day and relation to meals, per your doctor's orders.