MedSurg: Saunders Endocrine

A client has overactivity of the thyroid gland. The nurse should expect which finding? 1. Weight gain 2. Nutritional deficiencies 3. Low blood glucose levels 4. Increased body fat stores

Answer: 2. Nutritional deficiencies Rationale: Although the client may experience an increased appetite with overactivity of the thyroid gland, food intake does not meet energy demands, and nutritional deficiencies can develop. Weight loss occurs as a result of the increased metabolic activity. Glucose tolerance is decreased, and the client experiences hyperglycemia. Overactivity of the thyroid gland also causes increased metabolism, including fat metabolism. This leads to decreased levels of fat in the bloodstream, including cholesterol, and decreased body fat stores.

A hospitalized client is experiencing an episode of hypoglycemia. The client is lethargic and has no available intravenous (IV) access. Which medication should the nurse anticipate administering? 1. Insulin 2. Cortisone 3. Glucagon 4. Epinephrine

Answer: 3. Glucagon Rationale: Glucagon, a natural hormone secreted by the pancreas, is available as a subcutaneous injection to be given when a quick response to severe hypoglycemia is needed. Glucagon is useful in the unconscious hypoglycemic client without established IV access. The remaining options are incorrect treatments.

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. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

Answers: 1. Fever 2. Nausea 4. Tremors 5. Confusion Rationale: 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 client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? 1. "Are you rotating the injection site?" 2. "Are you aspirating before you inject the insulin?" 3. "Are you using a 1-inch needle to give the injection?" 4. "Are you placing an air bubble in the syringe before injection?"

Answer: 1. "Are you rotating the injection site?" Rationale: The client should be instructed that insulin injection sites should be rotated within 1 anatomical area before moving on to another area. This rotation process promotes uniform absorption of insulin and reduces the chances of irritation. The remaining options are not associated with the condition (skin leakage of insulin) presented in the question.

A nurse is assigned to care for a client with type 1 diabetes mellitus. During the shift, the nurse should monitor for which manifestation as a sign of hypoglycemia? 1. Tremors 2. Anorexia 3. Hot, dry skin 4. Muscle cramps

Answer: 1. Tremors Rationale: Decreased blood glucose levels trigger autonomic nervous system signs and symptoms, such as nervousness, irritability, and tremors. Hot, dry skin accompanies hyperglycemia. Anorexia and muscle cramps are unrelated to hypoglycemia.

A nurse is caring for a client after a thyroidectomy. Which specific emergency equipment should the nurse have available as it relates to this procedure? 1. Defibrillator 2. Tracheostomy tray 3. Dextrose 50% in water 4. Normal saline for intravenous bolus

Answer: 2. Tracheostomy tray Rationale: 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. The other supplies are not necessary specifically for thyroidectomy.

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1. Serum pH of 9.0 2. Absent ketones in the urine 3. Serum bicarbonate of 22 mEq/L (22 mmol/L) 4. Blood glucose level of 500 mg/dL (28.5 mmol/L)

Answer: 4. Blood glucose level of 500 mg/dL (28.5 mmol/L) Rationale: In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).

The nurse is assessing the learning readiness of a client newly diagnosed with diabetes mellitus. Which behavior indicates to the nurse that the client is not ready to learn? 1. The client asks if the spouse may attend the teaching session. 2. The client asks appropriate questions about what will be taught. 3. The client asks for written materials about diabetes mellitus before class. 4. The client complains of fatigue whenever the nurse plans a teaching session.

Answer: 4. The client complains of fatigue whenever the nurse plans a teaching session. Rationale: Physical symptoms can interfere with an individual's ability to learn and can indicate to the teacher that the student lacks motivation to learn if the symptoms repeatedly recur when teaching is initiated. The remaining options identify active client participation in learning.

A client received 5 units of insulin aspart subcutaneously just before eating lunch at 12:00 p.m. The nurse should assess the client for a hypoglycemic reaction at which times? 1. Between 1:00 and 3:00 p.m. 2. 10 minutes after administration 3. Between 4:00 p.m. and 12:00 a.m. 4. Between 8:00 and 10:00 p.m.

Answer: 1. Between 1:00 and 3:00 p.m. Rationale: Insulin aspart is a rapid-acting insulin. Its onset of action is 15 minutes; it peaks in 1 to 3 hours, and its duration of action is 3 to 5 hours. Hypoglycemic reactions are most likely to occur during peak time.

A client has returned to the nursing unit after a thyroidectomy. The nurse notes that the client is complaining of tingling sensations around the mouth, fingers, and toes. On the basis of these findings, the nurse should next assess the results of which serum laboratory study? 1. Sodium 2. Calcium 3. Potassium 4. Magnesium

Answer: 2. Calcium Rationale: After surgery on the thyroid gland, the client may experience a temporary calcium imbalance. This is due to transient malfunction of the parathyroid glands. The nurse also would assess for Chvostek's and Trousseau's signs. The correct treatment is administration of calcium gluconate or calcium lactate. The remaining options are unrelated to the client's complaints.

The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction? 1. "I need to eat foods high in potassium." 2. "I need to drink at least 2 to 3 L of fluid daily." 3. "I need to eat small, frequent meals and snacks if nauseated." 4. "I need to increase my intake of dietary items that are high in calcium."

Answer: 4. "I need to increase my intake of dietary items that are high in calcium." Rationale: The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption of calcium. Dietary restriction of calcium may be used as a component of therapy. The client should eat foods high in potassium, especially if the client is taking furosemide. Drinking 2 to 3 L of fluid daily and eating small, frequent meals and snacks if nauseated are appropriate instructions for the client.

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors

Answer: 1. Dry skin Rationale: Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining options are noted in the client with hyperthyroidism.

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1. Bradycardia 2. Flaccid paralysis 3. Tingling around the mouth 4. Absence of Chvostek's sign

Answer: 3. Tingling around the mouth Rationale: After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. Bradycardia, flaccid paralysis, and absence of Chvostek's sign are not signs of hypocalcemia.

The nurse is assessing a client who has a diagnosis of goiter. Which should the nurse expect to note during the assessment of the client? 1. An enlarged thyroid gland 2. The presence of heart damage 3. Client complaints of chronic fatigue 4. Client complaints of slow wound healing

Answer: 1. An enlarged thyroid gland Rationale: An enlarged thyroid gland develops in the client with goiter because of an excessive amount of thyroxine in the thyroid gland. Heart damage occurs with selenium deficiency. In addition, heart damage would not likely be noted during the nursing assessment. Further diagnostic tests in addition to the assessment would be necessary to determine heart damage. Chronic fatigue occurs with iron deficiency. Slow wound healing occurs with zinc deficiency.

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record? 1. Calcium level of 8 mg/dL (2.0 mmol/L) 2. Calcium level of 11.2 mg/dL (2.8 mmol/L) 3. Potassium level of 2.9 mEq/L (2.9 mmol/L) 4. Potassium level of 5.6 mEq/L (5.6 mmol/L)

Answer: 1. Calcium level of 8 mg/dL (2.0 mmol/L) Rationale: Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Therefore, if these laboratory values are altered, this suggests dysfunction of the parathyroid gland. When calcium levels are elevated (normal is 9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and phosphorous levels are decreased (normal is 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]) this suggests hyperparathyroidism. If the phosphorus level is elevated, the nurse should expect the calcium level to be low. Therefore, option 1 is the correct answer.

The nurse is providing dietary instructions to help with diabetes control for a client newly diagnosed with diabetes mellitus who will be taking insulin. The nurse should provide the client with which best instruction? 1. Eat meals at approximately the same time each day. 2. Adjust meal times depending on blood glucose levels. 3. Vary mealtimes if insulin is not administered at the same time every day. 4. Avoid being concerned about the time of meals as long as snacks are taken on time.

Answer: 1. Eat meals at approximately the same time each day. Rationale: Mealtimes must be approximately the same each day to maintain a stable blood glucose level. The client should not be instructed that mealtimes can be varied depending on blood glucose levels, insulin administration, or consumption of snacks.

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1. Fever and tachycardia 2. Pallor and tachycardia 3. Agitation and bradycardia 4. Restlessness and bradycardia

Answer: 1. Fever and tachycardia Rationale: Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever with temperatures greater than 100°F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.

A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL (2.28 mmol/L). Which medication should the nurse anticipate will be prescribed for the client? 1. Glucagon 2. Glyburide 3. Metformin 4. Regular insulin

Answer: 1. Glucagon Rationale: A blood glucose level lower than 50 mg/dL (2.85 mmol/L) is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Insulin would lower the client's blood glucose and would not be an appropriate treatment for hypoglycemia. Glyburide and metformin are oral hypoglycemic agents used to treat type 2 diabetes mellitus and would not be given to a client with hypoglycemia. In addition, an oral medication would not be administered to an unconscious client.

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1. Obtain dark glasses for the client. 2. Lubricate the eyes with tap water every 2 to 4 hours. 3. Administer methimazole every 8 hours around the clock. 4. Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.

Answer: 1. Obtain dark glasses for the client. Rationale: Because photophobia (light intolerance) accompanies this disorder, wearing dark glasses is helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client would be at risk for developing an eye infection because the solution is not sterile. Methimazole is a thyroid inhibitor, but medication therapy for Graves' disease does not help to alleviate the clinical manifestation of exophthalmos. There is no need to avoid straining or heavy lifting with exophthalmos.

During physical examination of a client, which finding is characteristic of hypothyroidism? 1. Periorbital edema 2. Flushed, warm skin 3. Hyperactive bowel sounds 4. Heart rate of 120 beats/min

Answer: 1. Periorbital edema Rationale: Because cellular edema occurs in hypothyroidism, the client's appearance is changed. Nonpitting edema occurs, especially around the eyes and in the feet and hands. Knowing this should direct you to option 1. Flushed, warm skin; hyperactive bowel sounds; and tachycardia (heart rate >100 beats/min) are clinical manifestations of hyperthyroidism, which occurs as a result of excess thyroid hormone secretion, resulting in a hypermetabolic state.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

Answer: 1. Polyuria Rationale: Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus.

A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate

Answer: 1. Polyuria Rationale: Classic signs and symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. It is important to regularly assess the client for hyperglycemia to prevent the development of more serious complications, such as diabetic ketoacidosis. The remaining options are not manifestations of hyperglycemia.

A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse should ask the client if which measure is taken? 1. Rotating sites for injection 2. Administering the insulin at a 45-degree angle 3. Cleaning the skin with alcohol before each injection 4. Aspirating for blood before injection into the subcutaneous tissue

Answer: 1. Rotating sites for injection Rationale: Lipodystrophy (hypertrophy of subcutaneous tissue at the injection site) occurs in some clients with diabetes mellitus when injection sites are used for a prolonged period. Therefore, clients are instructed to adhere to a plan of rotating injection sites to avoid tissue changes. Angle of insulin administration, cleansing with alcohol, and aspiration do not produce this complication.

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex

Answer: 1. Thyroid Rationale: The thyroid gland is responsible for a number of metabolic functions in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic function places a demand on the cardiovascular system for a higher cardiac output. A client with increased activity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-stimulating hormone. Antidiuretic hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1. "I should limit my fluids to 1 liter per day." 2. "I should use my treadmill or go for walks daily." 3. "I should follow a moderate-calcium, high-fiber diet." 4. "My alendronate helps to keep calcium from coming out of my bones."

Answer: 1."I should limit my fluids to 1 liter per day." Rationale: In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secretion. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorption (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to 2 liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical activity, particularly weight-bearing activity, minimizes bone resorption and helps to protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Clients should follow a moderate-calcium, high-fiber diet. Even though serum calcium is already high, clients should follow a moderate-calcium diet because a low-calcium diet will surge PTH. Calcium causes constipation, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorption. In bone resorption, bone is broken down and calcium is deposited into the serum.

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1. "Cortisol will be secreted." 2. "Aldosterone will be secreted." 3. "Additional glucagon will be produced." 4. "Adrenocorticotropic hormone production will increase."

Answer: 2. "Aldosterone will be secreted." Rationale: Aldosterone is the primary mineralocorticoid that is produced and secreted in response to lowered blood volume. Cortisol is a glucocorticoid. Glucagon is produced by the pancreas and functions to oppose the action of insulin in regulating blood glucose levels. Adrenocorticotropic hormone is produced by the pituitary gland and stimulates the adrenal cortex to produce glucocorticoids and mineralocorticoids.

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? 1. "Do you have tremors in your hands?" 2. "Are you experiencing pain in your joints?" 3. "Do you notice swelling in your legs at night?" 4. "Have you had problems with diarrhea lately?"

Answer: 2. "Are you experiencing pain in your joints?" Rationale: Hyperparathyroidism is associated with oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and, sometimes, pathological fractures. Tremors and diarrhea relate to assessment findings of hypoparathyroidism. Swelling in the legs at night is unrelated to hyperparathyroidism.

The nurse has provided instructions to the client with hyperparathyroidism regarding home care measures to manage the symptoms of the disease. Which statement by the client indicates a need for further instruction? 1. "I should avoid bed rest." 2. "I need to avoid doing any exercise at all." 3. "I need to space activity throughout the day." 4. "I should gauge my activity level by my energy level."

Answer: 2. "I need to avoid doing any exercise at all." Rationale: The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to avoid bed rest and use energy levels as a guide to activity. The client also should be instructed to avoid high-impact activity or contact sports.

The nurse has provided home care measures to the client with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further instruction? 1. "I should always wear a MedicAlert bracelet." 2. "I should perform my exercise at peak insulin time." 3. "I should always carry a quick-acting carbohydrate when I exercise." 4. "I should avoid exercising at times when a hypoglycemic reaction is likely to occur."

Answer: 2. "I should perform my exercise at peak insulin time." Rationale: The client should be instructed to avoid exercise at peak insulin time because this is when a hypoglycemic reaction is likely to occur. If exercises are performed at this time, the client should be instructed to eat an hour before the exercise and drink a carbohydrate liquid. The remaining options are correct statements regarding exercise, insulin, and diabetic control.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I should not exercise since I am taking insulin." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "NPH is a basal insulin, so I should exercise in the evening."

Answer: 2. "The best time for me to exercise is after breakfast." Rationale: Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps to control blood glucose levels. A hypoglycemic reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10- to 15-gram carbohydrate snack, and they should check their blood glucose level before exercising. Option 1 is incorrect because clients with diabetes should exercise, though they should check with their health care provider before starting a new exercise program. Option 3 in incorrect; clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Options 4 is incorrect; NPH insulin in an intermediate-acting insulin, not a basal insulin.

The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the nurse that he is planning to eat dinner at a local restaurant this week. The client asks the nurse if eating at a restaurant will affect diabetic control and if this is allowed. Which nursing response is most appropriate? 1. "You are not allowed to eat in restaurants." 2. "You should order a half-portion meal and have fresh fruit for dessert." 3. "If you plan to eat in a restaurant, you need to skip the lunchtime meal." 4. "You should increase your daily dose of insulin by half on the day that you plan to eat in the restaurant."

Answer: 2. "You should order a half-portion meal and have fresh fruit for dessert." Rationale: Clients with diabetes mellitus are instructed to make adjustments in their total daily intake to plan for meals at restaurants or parties. Some useful strategies include ordering a half-portion, salads with dressing on the side, fresh fruit for dessert, and baked or steamed entrees. Clients are not instructed to skip meals or increase their prescribed insulin dosage.

The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1. A client with hypothyroidism 2. A client with Graves' disease who is having surgery 3. A client with diabetes mellitus scheduled for a diagnostic test 4. A client with diabetes mellitus scheduled for debridement of a foot ulcer

Answer: 2. A client with Graves' disease who is having surgery Rationale: Thyrotoxicosis usually is seen in clients with Graves' disease in whom the symptoms are precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, delivery, or major surgery. It also must be recognized as a potential complication after thyroidectomy. The client conditions in the remaining options are not associated with thyrotoxicosis.

The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 1. Maintain an endotracheal tube for 24 hours. 2. Administer a continuous mist of room air or oxygen. 3. Place the client in a flat position with the head and neck immobilized. 4. Use only a rectal thermometer for temperature measurement.

Answer: 2. Administer a continuous mist of room air or oxygen. Rationale: Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucous secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required.

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Bulging eyeballs 3. Periorbital edema 4. Coarse facial features

Answer: 2. Bulging eyeballs Rationale: Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. 4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

Answer: 2. Convey empathy, trust, and respect toward the client. Rationale: Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client's anxiety. The nurse should not ignore the client's anxious feelings. Anxiety needs to be managed before meaningful client education can occur.

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complication should be included on the list? 1. Shakiness 2. Increased thirst 3. Profuse sweating 4. Decreased urine output

Answer: 2. Increased thirst Rationale: The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse sweating and shakiness would be noted in a hypoglycemic condition.

A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse should anticipate that which substance will be elevated? 1. Glucose 2. Ketones 3. Glucagon 4. Lactate dehydrogenase

Answer: 2. Ketones Rationale: Ketones are a byproduct of fat metabolism. When this process occurs to an extreme, the resulting condition is called ketoacidosis. The remaining options are not associated with the breakdown of fats.

The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention should the nurse include in the plan of care? 1. Maintain a supine position. 2. Monitor neck circumference every 4 hours. 3. Maintain a pressure dressing on the operative site. 4. Encourage deep-breathing exercises and vigorous coughing exercises.

Answer: 2. Monitor neck circumference every 4 hours. Rationale: After thyroidectomy, neck circumference is monitored every 4 hours to assess for the occurrence of postoperative edema. The client should be placed in an upright position to facilitate air exchange. A pressure dressing is not placed on the operative site because it may restrict breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. The nurse should assist the client with deep-breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1. Unresponsive pupils 2. Positive Trousseau's sign 3. Negative Chvostek's sign 4. Hyperactive bowel sounds

Answer: 2. Positive Trousseau's sign Rationale: Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. The remaining options are not related to the presence of hypocalcemia.

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis? 1. Urine is negative for ketones. 2. Serum potassium is 6.8 mEq/L (6.8 mmol/L). 3. Serum osmolality is 260 mOsm/kg (260 mmol/kg) H20. 4. Arterial blood gas values are pH 7.52, PCO2 44 mm Hg, HCO3- 30 mEq/L (30 mmol/L).

Answer: 2. Serum potassium is 6.8 mEq/L (6.8 mmol/L). Rationale: Movement of hydrogen ions from the extracellular to the intracellular fluid promotes the movement of potassium from intracellular to extracellular fluid. Thus, the serum potassium level will rise. The value in option 2 is greater than the normal range of 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The presence of ketones in urine would be expected, and the serum osmolality would be elevated to reflect dehydration (the serum osmolality in option 3 is decreased). The client with DKA experiences metabolic acidosis (not metabolic alkalosis as noted in option 4).

The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse should ensure that which piece of medical equipment is at the client's bedside? 1. Cardiac monitor 2. Tracheotomy set 3. Intermittent gastric suction device 4. Underwater seal chest drainage system

Answer: 2. Tracheotomy set Rationale: Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a paramount concern for the nurse managing the care of a postoperative client who has had a parathyroidectomy. An emergency tracheotomy set is routinely placed at the bedside of the client who has undergone this type of surgery, in anticipation of this complication. The items in the remaining options are not specifically needed with this surgical procedure.

The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions? 1. "I expect to experience some tingling of my toes, fingers, and lips after surgery." 2. "I will definitely have to continue taking antithyroid medications after this surgery." 3. "I need to place my hands behind my neck when I have to cough or change positions." 4. "I need to turn my head and neck front, back, and laterally every hour for the first 12 hours after surgery."

Answer: 3. "I need to place my hands behind my neck when I have to cough or change positions." Rationale: The client is taught that tension needs to be avoided on the suture line; otherwise hemorrhage may develop. One way of reducing incisional tension is to teach the client how to support the neck when coughing or being repositioned. Likewise, during the postoperative period the client should avoid any unnecessary movement of the neck. That is why sandbags and pillows frequently are used to support the head and neck. Any postoperative tingling in the fingers, toes, and lips probably is due to injury to the parathyroid gland during surgery, resulting in hypocalcemia. These signs and symptoms need to be reported immediately. Removal of the thyroid does not mean that the client will be taking antithyroid medications postoperatively. Thyroid replacement medications are necessary.

The nurse is providing instructions regarding home care measures to a client with diabetes mellitus and instructs the client about the causes of hypoglycemia. The nurse determines that additional instruction is needed if the client identifies which as a cause of hypoglycemia? 1. Omitted meals 2. Increased intensity of activity 3. Decreased daily insulin dosage 4. Inadequate amount of fluid intake

Answer: 3. Decreased daily insulin dosage Rationale: Decreasing the dose of insulin will lead to hyperglycemia. Causes for hypoglycemic reactions include delayed consumption of meals and lack of necessary amounts of food. Other causes include the administration of excessive insulin or oral hypoglycemic medications, vomiting associated with illness, and strenuous exercise, which may potentiate the action of insulin.

A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. Which is the appropriate nursing intervention? 1. Offer water only until the client is able to tolerate solid foods. 2. Withhold all fluids until vomiting has ceased for at least 4 hours. 3. Encourage the client to take 8 to 12 oz of fluid every hour while awake. 4. Maintain a clear liquid diet for at least 5 days before advancing to solids.

Answer: 3. Encourage the client to take 8 to 12 oz of fluid every hour while awake. Rationale: Small amounts of fluid may be tolerated, even when vomiting is present. The nurse should encourage liquids containing glucose and electrolytes every hour. The remaining options will not provide the adequate intake needed by the client with diabetes mellitus.

A nurse is caring for a client with thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse should assess for which sign or symptom? 1. Bradycardia 2. Constipation 3. Hypertension 4. Low-grade temperature

Answer: 3. Hypertension Rationale: Thyroid storm is an acute, life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Clinical manifestations of thyroid storm include systolic hypertension, tachycardia, diarrhea, and a fever as high as 106°F. Other manifestations include abdominal pain, dehydration, extreme vasodilation, stupor rapidly progressing to coma, atrial fibrillation, and cardiovascular collapse. Bradycardia, constipation and low-grade temperature are not a part of the clinical picture in thyroid storm.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

Answer: 3. IV fluids containing dextrose Rationale: Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.

The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse should instruct the client that which is the first step in this procedure? 1. Draw up the correct dosage of NPH insulin into the syringe. 2. Draw up the correct dosage of regular insulin into the syringe. 3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4. Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

Answer: 3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. Rationale: The initial step in preparing an injection of insulin that is a mixture of NPH and regular insulin is to inject air into the NPH insulin bottle equal to the amount of insulin prescribed. The client would then be instructed to inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular insulin would then be withdrawn, followed by the NPH insulin. Contamination of regular insulin with NPH insulin will convert part of the regular insulin into a longer acting form.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

Answer: 3. Intravenous infusion of normal saline Rationale: The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? 1. It indicates nerve damage. 2. The hoarseness is permanent. 3. It is normal during this time and will subside. 4. It will worsen before it subsides, which may take 6 months.

Answer: 3. It is normal during this time and will subside. Rationale: Hoarseness in the postoperative period usually is the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. The other options are incorrect.

A nurse is assisting a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which is most important to include in the plan of care? 1. Test urine for ketone levels. 2. Eat 6 small meals per day. 3. Monitor blood glucose levels frequently. 4. Receive appropriate follow-up health care.

Answer: 3. Monitor blood glucose levels frequently. Rationale: Client education after DKA should emphasize the need for home glucose monitoring 2 to 4 times per day. Instructing the client to notify the health care provider when illness occurs is also important. The presence of urine ketones indicates that DKA has occurred already. The client should eat well-balanced meals with snacks as prescribed.

A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL. The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? 1. Hyponatremia 2. Rise in serum pH 3. Presence of ketone bodies 4. Elevated serum bicarbonate level

Answer: 3. Presence of ketone bodies Rationale: DKA is marked by the presence of excessive ketone bodies. As a result of the acidosis, the pH and serum bicarbonate level would decrease. Hyponatremia is not related to DKA.

The nurse is caring for a client admitted to the hospital with uncontrolled type 1 diabetes mellitus. In the event that diabetic ketoacidosis (DKA) does occur, the nurse anticipates that which medication would most likely be prescribed? 1. Glucagon 2. Glyburide 3. Regular insulin 4. Neutral protamine Hagedorn (NPH) insulin

Answer: 3. Regular insulin Rationale: Giving regular insulin by the intravenous route is the treatment of choice for DKA. A short-acting insulin is the only insulin that can be given intravenously because it can be titrated to the client's blood glucose levels. Glucagon is used to treat hypoglycemia because it increases blood glucose levels, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus; both agents are inappropriate. NPH insulin is an intermediate-acting insulin and therefore is not appropriate for treatment of DKA.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2. Level of hoarseness 3. Respiratory distress 4. Edema at the surgical site

Answer: 3. Respiratory distress Rationale: Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? 1. Try to exercise before mealtimes. 2. Administer insulin after exercising. 3. Take a blood glucose test before exercising. 4. Exercise is best performed during peak times of insulin.

Answer: 3. Take a blood glucose test before exercising. Rationale: A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtime places the client at risk for hypoglycemia. Insulin should be administered as prescribed.

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), temperature of 101°F (38.3°C), pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

Answer: 3. Temperature Rationale: In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1. To treat thyroid storm 2. To prevent cardiac irritability 3. To treat hypocalcemic tetany 4. To stimulate release of parathyroid hormone

Answer: 3. To treat hypocalcemic tetany Rationale: Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.

The nurse has provided dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse should instruct the client that it is acceptable to include which item in the diet? 1. Fish 2. Cereals 3. Vegetables 4. Meat and poultry

Answer: 3. Vegetables Rationale: The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. Vegetables are allowed in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals.

A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse should include which priority intervention in the plan of care? 1. Describe the use of loperamide. 2. Restrict fluids to 1000 mL per day. 3. Walk down the hall for 15 minutes 3 times a day. 4. Describe the administration of aluminum hydroxide gel.

Answer: 3. Walk down the hall for 15 minutes 3 times a day. Rationale: Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids should not be restricted. Discussing the use of medications is not the priority with this client.

The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 1. "I will check my blood glucose level every day at 5:00 p.m." 2. "I will check my blood glucose level 1 hour after each meal." 3. "I will check my blood glucose level 2 hours after each meal." 4. "I will check my blood glucose level before each meal and at bedtime."

Answer: 4. "I will check my blood glucose level before each meal and at bedtime." Rationale: The most effective and accurate measure for testing blood glucose is to test the level before each meal and at bedtime. If possible and feasible, testing should be done during the nighttime hours. { The very best time to check blood glucose level is during acute illness. During times of infection; illness, &/or when a pt has a high blood glucose level, pt needs more insulin & ↑ the frequency of checking blood glucose levels &/or finger stick (Q 4-6 hours)}. Checking the level after the meal will provide an inaccurate assessment of diabetes control. Checking the level once daily will not provide enough data to control the diabetes mellitus.

The 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 makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

Answer: 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)." Rationale: During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the HCP if the level is higher than 250 mg/dL (14.2 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the HCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

A client with type 1 diabetes mellitus is having trouble remembering the types, duration, and onset of the action of insulin. The client tells the nurse that family members have not been supportive. Which response by the nurse is best? 1. "What is it that you don't understand?" 2. "You can't always depend on your family to help." 3. "It's not really necessary for you to remember this." 4. "Let me go over the types of insulins with you again."

Answer: 4. "Let me go over the types of insulins with you again." Rationale: Reinforcement of knowledge and behaviors is vital to the success of the client's self-care. All of the other options do not address the need for client instructions and are not therapeutic responses.

A client with diabetes mellitus has been instructed in the dietary exchange system. The client asks the nurse if bacon is allowed in the diet. Which nursing response is most appropriate? 1. "Bacon is not allowed." 2. "Bacon is much too high in fat." 3. "Bacon may be eaten if you eliminate 1 meat item from your diet." 4. "One strip of bacon may be eaten if you eliminate 1 teaspoon of butter."

Answer: 4. "One strip of bacon may be eaten if you eliminate 1 teaspoon of butter." Rationale: Bacon is a component of the fat group in the exchange system. One teaspoon of butter is equal to 1 teaspoon of margarine, 1 teaspoon of any oil, 1 tablespoon of salad dressing, 1 strip of bacon, 5 large olives, or 10 whole peanuts.

After client education about the importance of sunscreen use and active vitamin production via the skin, the nurse determines that the client understands the teaching when which statement is made? 1. "Vitamin B is activated in the outer layer of the skin by the sun." 2. "Vitamin E deficiency occurs from lack of exposure to sunlight." 3. "Vitamin K can be depleted if exposed to excess ultraviolet light." 4. "Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight."

Answer: 4. "Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight." Rationale: Vitamin D is activated in the epidermis by ultraviolet (UV) light, such as sunlight. Once activated, it is distributed by the blood to the gastrointestinal tract to promote uptake of dietary calcium. The vitamins in the remaining options are neither activated nor depleted by UV light, such as sunlight.

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Apply a monitor for an electrocardiogram. 4. Administer short-duration insulin intravenously.

Answer: 4. Administer short-duration insulin intravenously. Rationale: Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration (normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.

The nurse is reviewing the health care provider's (HCP's) prescriptions for a client with a diagnosis of diabetes mellitus who has been hospitalized for treatment of an infected foot ulcer. The nurse expects to note which finding in the HCP's prescriptions? 1. A decreased-calorie diet 2. An increased-calorie diet 3. A decreased amount of NPH insulin daily insulin 4. An increased amount of NPH insulin daily insulin

Answer: 4. An increased amount of NPH insulin daily insulin Rationale: Infection is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress, such as when an infection is present, an increase in the dose of insulin will be required to facilitate the transport of excess glucose into the cells. The client will not necessarily need an adjustment in the daily diet.

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 1. Soak the feet in hot water. 2. Avoid using a mild soap on the feet. 3. Always have a podiatrist cut the toenails. 4. Apply a moisturizing lotion to dry feet but not between the toes.

Answer: 4. Apply a moisturizing lotion to dry feet but not between the toes. Rationale: The client is instructed to 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. The client should be instructed to wash the feet daily with a mild soap. The client may 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.

The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 1. Infertility 2. Gynecomastia 3. Sexual dysfunction 4. Body image changes

Answer: 4. Body image changes Rationale: Because of the location of the incision in the neck area, many clients are afraid of thyroid surgery for fear of having a visible large scar postoperatively. Having all or part of the thyroid gland removed will not cause the client to experience gynecomastia. Sexual dysfunction and infertility could occur if the entire thyroid is removed and the client is not placed on thyroid replacement medications.

A young man with type 1 diabetes mellitus tells the nurse that he might lose his job because he has been having frequent hypoglycemic reactions. His boss thinks that he is drunk during these episodes and that he has been drinking on the job. Which action by the nurse would best assist this client to meet his needs? 1. Ask the client if he indeed has been drinking at work. 2. Ask the client what he does to treat his hypoglycemia. 3. Contact the local employment office to help him find another job. 4. Examine factors with the client that may be causing frequent hypoglycemic episodes.

Answer: 4. Examine factors with the client that may be causing frequent hypoglycemic episodes. Rationale: Hypoglycemic reactions present as adrenergic symptoms of tremor, shakiness, and nervousness that are comparable or alike to the signs of alcohol intoxication. The best strategy to assist the client to meet his needs is to decrease the episodes of hypoglycemia by first identifying and then eliminating those factors that precipitate this event. Asking the client if he has been drinking at work and contacting the local employment office are inappropriate. Asking the client what he does to treat his hypoglycemia is not directly related to the subject, factors that may cause frequent hypoglycemic episodes.

A client with type 2 diabetes mellitus is complaining of polydipsia, polyuria, weight loss, and weakness. Laboratory results indicate a blood glucose level of 800 mg/dL (45.7 mmol/L) and nonketosis. The nurse reviews the health care provider's documentation and expects to note which diagnosis? 1. Hypoglycemia 2. Pheochromocytoma 3. Diabetic ketoacidosis (DKA) 4. Hyperosmolar hyperglycemic syndrome (HHS)

Answer: 4. Hyperosmolar hyperglycemic syndrome (HHS) Rationale: HHS is seen primarily in clients with type 2 diabetes mellitus, who experience a relative deficiency of insulin. The onset of signs and symptoms may be gradual. Manifestations may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. In HHS, the client is nonketotic. The clinical manifestations noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical manifestations. DKA typically occurs in type 1 diabetes mellitus.

A client with type 2 diabetes mellitus has a blood glucose level greater than 600 mg/dL (34.3 mmol/L) and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider's documentation and expects to note which diagnosis? 1. Hypoglycemia 2. Pheochromocytoma 3. Diabetic ketoacidosis (DKA) 4. Hyperosmolar hyperglycemic syndrome (HHS)

Answer: 4. Hyperosmolar hyperglycemic syndrome (HHS) Rationale: HHS is seen primarily in clients with type 2 diabetes mellitus, who experience a relative deficiency of insulin. The onset of signs and symptoms may be gradual. Manifestations may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. The clinical manifestations noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical manifestations. DKA typically occurs in type 1 diabetes mellitus.

A client has begun medication therapy with propylthiouracil. The nurse should assess the client for which condition as an adverse effect of this medication? 1. Joint pain 2. Renal toxicity 3. Hyperglycemia 4. Hypothyroidism

Answer: 4. Hypothyroidism Rationale: Propylthiouracil is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. Propylthiouracil is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia.

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? 1. It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals. 2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. 4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

Answer: 4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal. Rationale: An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin subcutaneously throughout the day and night. The client can self-administer an additional bolus dose from the pump before each meal as needed. Short-duration insulin

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? 1. Platelets 2. Muscle tissue 3. Adipose tissue 4. Red blood cells (RBCs)

Answer: 4. Red blood cells (RBCs) Rationale: With chronic high circulating blood glucose levels, some glucose binds irreversibly onto RBCs and remains there for the life of the cell. The average life span of an RBC is 120 days. The measurement of glycosylated hemoglobin A (HbA1c), which detects glucose binding on the RBC membrane, is expressed as a percentage. Glucose does not bind onto platelets in diabetes mellitus. One of the problems in diabetes is that muscle and adipose cells may be unable to transport glucose across cell membranes.

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL (39.1 mmol/L). Which intervention should the nurse anticipate to be prescribed initially for the client? 1. Glyburide via the oral route 2. Glucagon via the subcutaneous route 3. Insulin aspart via the subcutaneous route 4. Regular insulin via the intravenous (IV) route

Answer: 4. Regular insulin via the intravenous (IV) route Rationale: The client is most likely in diabetic ketoacidosis (DKA). Regular insulin via the IV route is the preferred treatment for DKA. Regular insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus. Insulin aspart is a short-acting insulin and is not appropriate for the emergency treatment of DKA.

A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which concept? 1. Always keep insulin vials refrigerated. 2. Ketones in the urine signify a need for less insulin. 3. Increase the amount of insulin before excessive exercise. 4. Systematically rotate insulin injections within 1 anatomical site.

Answer: 4. Systematically rotate insulin injections within 1 anatomical site. Rationale: Injection sites should be rotated systematically within 1 anatomical site. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. If ketones are found in the urine, it may indicate the need for additional insulin. Insulin doses should not be adjusted or increased before excessive exercise.

A client with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis and a serum glucose level of 789 mg/dL (45 mmol/L). The health care provider (HCP) prescribes 10 units of regular insulin by intravenous (IV) bolus, followed by a continuous insulin infusion at a rate of 5 units/hr. The pharmacy sends 500 mL of normal saline solution containing 50 units of regular insulin. After administering the IV bolus of 10 units of regular insulin, the nurse sets the infusion pump flow rate of the normal saline solution containing 50 units of regular insulin to infuse at how many milliliters per hour to deliver 5 units/hr? Fill in the blank.

Answer: 50 mL Formula: H (on hand): V (vehicle)::(desired dose):X (unknown) 50 units:500 mL::5 units:X 50X = 2500 X = 50 mL Rationale: This is a dosage calculation problem. Because the HCP does not prescribe a specific IV rate (mL/hr), the nurse needs to determine how many milliliters of the normal saline solution contain 5 units of insulin. The IV infusion pump is set at mL per hour. Use the ratio and proportion method for dosage calculation using the information contained in the question.

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. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

Answers: 1. Polyuria 3. Bone pain Rationale: 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. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

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. 1. Viruses 2. Genetic factors 3. Autoimmune factors 4. Human leukocyte antigen (HLA) 5. Primary failure of glucagon secretion

Answers: 1. Viruses 2. Genetic factors 3. Autoimmune factors 4. Human leukocyte antigen (HLA) Rationale: Viruses and autoimmune factors are thought to play a role in the development of type 1 diabetes mellitus. Other causes of type 1 diabetes mellitus include genetic factors, specifically the presence of HLA. This factor is found in many clients with type 1 diabetes mellitus. The problem with type 1 diabetes mellitus is destruction of the beta cells. It is not caused by a primary failure of glucagon secretion.

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. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level

Answers: 2. Comatose state 3. Deep, rapid breathing 5. Elevated blood glucose level Rationale: Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat metabolism, build up and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

Answers: 2. Maintain a patent airway. Rationale: Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

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. 1. Irritability 2. Periorbital edema 3. Coarse, brittle hair 4. Slow or slurred speech 5. Abdominal distention 6. Soft, silky, thinning hair

Answers: 2. Periorbital edema 3. Coarse, brittle hair 4. Slow or slurred speech 5. Abdominal distention Rationale: The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. The client may exhibit skin manifestations, such as coarse, brittle hair; thick, brittle nails; coarse, scaly skin; delayed wound healing; periorbital edema; and face puffiness. Neuromuscular manifestations include lethargy, slow or slurred speech, and impaired memory. Gastrointestinal manifestations include complaints of constipation, weight gain, and abdominal distention. Irritability and soft, silky, thinning hair on the scalp are manifestations of hyperthyroidism.

The nurse should include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

Answers: 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. Rationale: The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1. Iodine 2. Calcium 3. Phosphorus 4. Magnesium

Answer: 1. Iodine Rationale: Adequate dietary iodine is needed to produce T3and T4. The other requirements for adequate T3and T4 production are an intact thyroid gland and a functional hypothalamus-pituitary-thyroid feedback system. The remaining options are not responsible for the abnormal amounts of circulating T3 and T4.

A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 1. Laryngeal stridor 2. Difficulty voiding 3. Mild incisional pain 4. Absence of bowel sounds

Answer: 1. Laryngeal stridor Rationale: During the early postoperative period, the nurse carefully observes the client for signs of bleeding, which may cause swelling and compression of adjacent tissues. Laryngeal stridor results from compression of the trachea and is a harsh, high-pitched sound heard on inspiration and expiration. Laryngeal stridor is an acute emergency, necessitating immediate attention to avoid complete obstruction of the airway. The other options describe usual postoperative problems that are not life threatening.

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 1. Polyuria 2. Diarrhea 3. Polyphagia 4. Weight gain

Answer: 1. Polyuria Rationale: Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis, making polyuria the correct option. The other manifestations listed are not associated with this disorder.

A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1. The client needs immediate education before discharge. 2. The client requires follow-up teaching regarding the administration of oral antidiabetics. 3. The client's statement is inaccurate, and he or she should be scheduled for outpatient diabetic counseling. 4. The client's statement is inaccurate, and he or she should be scheduled for educational home health visits.

Answer: 1. The client needs immediate education before discharge. Rationale: If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the HCP should be notified. The client's statement indicates a need for immediate education to prevent hyperosmolar hyperglycemic syndrome (HHS), a life-threatening emergency. Although all of the other options may be true, the most appropriate analysis is that the client requires immediate education.

The family of a bedridden client with type 2 diabetes mellitus and chronic kidney disease calls the nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question should the nurse ask the family to determine a possible problem? 1. "What is the client's urine output?" 2. "What is the client's capillary blood glucose level?" 3. "Has there been any change in the dietary intake?" 4. "Have you increased the amount of fluids provided?"

Answer: 2. "What is the client's capillary blood glucose level?" Rationale: 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 remaining options will not assist in determining a possible problem.

The clinic nurse is providing instructions to a client with diabetes mellitus about the signs and symptoms of hypoglycemia. The nurse should tell the client that which would be noted in a hypoglycemic reaction? 1. Thirst 2. Hunger 3. Polydipsia 4. Increased urine output

Answer: 2. Hunger Rationale: Signs and symptoms of hypoglycemia include hunger, nervousness, anxiety, dizziness, blurred vision, sweaty palms, confusion, and tingling and numbness around the mouth. Polydipsia (thirst) and increased urine output are noted in the client with hyperglycemia.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

Answer: 2. Inadequate fluid volume Rationale: An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the information in the question.

The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperosmolar hyperglycemic syndrome (HHS). The nurse recognizes that the hyperglycemia associated with this disorder results from which occurrence? 1. Increased use of glucose 2. Overproduction of insulin 3. Increased production of glucose 4. Increased osmotic movement of water

Answer: 3. Increased production of glucose Rationale: Hyperglycemia results from decreased use and increased production of glucose. Increased use of glucose and overproduction of insulin would most likely cause hypoglycemia. Option 4 is incorrect.

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. 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Dry mouth 5. Flushed, dry skin 6. Moist mucous membranes

Answers: 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Dry mouth 5. Flushed, dry skin Rationale: Clinical manifestations of DKA include polyuria (frequent urination); polydipsia (excessive thirst); polyphagia (excessive hunger); dry mouth; and flushed, dry skin. The client with DKA experiences dehydration. Therefore, option 6 would not be noted.

A client visits the health care provider's office for a routine physical examination and reports a new onset of intolerance to cold. Since hypothyroidism is suspected, which additional information would be noted during the client's assessment? 1. Weight loss and tachycardia 2. Complaints of weakness and lethargy 3. Diaphoresis and increased hair growth 4. Increased heart rate and respiratory rate

Answer: 2. Complaints of weakness and lethargy Rationale: Weakness and lethargy are the most common complaints associated with hypothyroidism. Other common symptoms include intolerance to cold, weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss.

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. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

Answers: 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face Rationale: Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

A 33-year-old female client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 1. Amenorrhea 2. Menorrhagia 3. Metrorrhagia 4. Dysmenorrhea

Answer: 1. Amenorrhea Rationale: Amenorrhea or a decreased menstrual flow occurs in the client with Graves' disease. Menorrhagia, metrorrhagia, and dysmenorrhea are also disorders related to the female reproductive system; however, they are not typical manifestations of Graves' disease.

The nurse is reviewing the record of a client who was admitted to the hospital with a diagnosis of ovarian cancer. A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client? 1. "Flush the toilet at least 3 times after use." 2. "Increase intake of fruits with a core, such as apples and pears." 3. "Avoid contact with pregnant women, infants, and children for 3 months." 4. "Use disposable eating utensils, plates, and cups for the next 6 months."

Answer: 1. "Flush the toilet at least 3 times after use." Rationale: Bodily fluids contain the radioactive material, so others should be shielded from possible exposure. Clients should at best have a dedicated toilet for use during the first 2 weeks and should also flush 3 times after use. Some radioactivity will be in the saliva for about the first week, so during this time fruits with cores that will become contaminated should be avoided. Disposable eating utensils should also be used during this period of time. Contact with pregnant women, infants, and children is avoided for the first week and then a distance of 3 feet (1 meter) or more should be maintained and exposure should be limited to 1 hour per day.

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? 1. 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. 2. 0300 blood glucose 68 mg/dL (3.8 mmol/L) and 0700 blood glucose 200 mg/dL (11.1 mmol/L). Instruct to increase amount of evening insulin. 3. 0300 blood glucose 190 mg/dL (10.6 mmol/L) and 0700 blood glucose 240 mg/dL (13.3 mmol/L). Instruct to decrease amount of evening insulin. 4. 0300 blood glucose 190 mg/dL (10.6 mmol/L) and 0700 blood glucose 240 mg/dL (13.3 mmol/L). Instruct to increase amount of evening insulin.

Answer: 1. 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. Rationale: 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. Thus, option 1 is the correct answer (hypoglycemia during the night and hyperglycemia in the morning, which is treated by decreasing the evening dose of insulin). Option 2 is incorrect because it instructs the client to increase the evening dose of insulin. Options 3 and 4 are incorrect because the nighttime blood glucose levels indicate hyperglycemia, which would indicate dawn phenomenon.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? 1. Glycosylated hemoglobin of <6% 2. Presence of ketones in the urine 3. Presence of albumin in the urine 4. Fasting blood glucose level of 150 mg/dL (8.57 mmol/L)

Answer: 1. Glycosylated hemoglobin of <6% Rationale: This measurement of glycosylated hemoglobin (HgbA1C) detects glucose binding on the red blood cell (RBC) membrane and is expressed as a percentage. It measures glucose for the life of the RBC, which is 120 days. A HgbA1C of <6% is acceptable. The fasting blood glucose level should be 110 mg/dL (6 mmol/L). The urine should be free of both ketones and albumin.

A client is admitted with a serum glucose level of 650 mg/dL (37.14 mmol/L) and diabetic ketoacidosis (DKA) is suspected. Which additional laboratory result does the nurse identify as being supportive of DKA? 1. Ketones in urine 2. Lactic dehydrogenase (LDH) of 200 U/L 3. pH of 7.52 on arterial blood gas (ABG) analysis 4. Blood urea nitrogen (BUN) of 10 mg/dL (3.6 mmol/L)

Answer: 1. Ketones in urine Rationale: Ketones are a byproduct of fat metabolism. When this process occurs to the extreme, it is termed ketoacidosis. Ketone bodies are a product of fat metabolism, and the presence of moderate to high urine ketones (hyperketonuria) indicates a severe lack of insulin, such as in DKA. Options 2, 3, and 4 are incorrect. BUN of 10 mg/dL (3.6 mmol/L) is a normal value, as normal is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Elevations in LDH (normal is 100 to 190 U/L) can be indicative of heart failure, hemolytic disorders, hepatitis dysfunction, myocardial infarction, pulmonary embolus, or skeletal muscle damage. In acidotic conditions the pH will be decreased (normal is 7.35 to 7.45).

A client with diabetes mellitus has a blood glucose level of 50 mg/dL (2.85 mmol/L) and reports feeling hungry and shaky. Which should the nurse provide the client? 1. 3 oz of 2% milk 2. 4 oz of apple juice 3. 2 oz of orange juice 4. A teaspoon of granulated sugar

Answer: 2. 4 oz of apple juice Rationale: When a client is exhibiting symptoms of mild hypoglycemia, the nurse should provide the client with 15 g of a simple carbohydrate to quickly increase the blood glucose level. One half cup of apple juice is equivalent to 15 g of carbohydrates. The items in the remaining options do not provide a sufficient amount of carbohydrate.

A home health nurse is visiting a client with type 1 diabetes mellitus. The client tells the nurse that he is not feeling well and has had a "respiratory infection" for the past week, which seems to be getting worse. After interviewing the client, what should be the initial nursing action? 1. Document the assessment data. 2. Check the client's blood glucose. 3. Notify the health care provider (HCP). 4. Obtain the client's sputum for culture and sensitivity.

Answer: 2. Check the client's blood glucose. Rationale: Uncontrolled hyperglycemia may lead to the production of ketones, thus leading to diabetic ketoacidosis (DKA), a life-threatening condition. The most common precipitating factor for development of DKA is infection. Assessment data should be documented but are not a priority. The HCP may need to be notified if the client's blood glucose is elevated and the client has other symptoms of DKA or a respiratory infection. After determining the client's blood glucose, the nurse should obtain a sputum sample if the client is expectorating yellow, green, or bloody secretions.

A client who visits the health care provider's office for a routine physical examination reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse should check for which manifestations? 1. Weight loss and thinning skin 2. Complaints of weakness and lethargy 3. Diaphoresis and increased hair growth 4. Increased heart rate and respiratory rate

Answer: 2. Complaints of weakness and lethargy Rationale: Weakness and lethargy are common complaints associated with hypothyroidism. Other common symptoms include weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss.

The nurse is caring for a client who is 2 days postoperative from abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin based on capillary blood glucose testing 4 times a day. A carbohydrate-controlled diet has been prescribed, but the client has not been eating. On entering the client's room, the nurse finds the client to be pale and diaphoretic. Which action is appropriate at this time? 1. Call a code to obtain needed assistance immediately. 2. Obtain a capillary blood glucose level and quickly perform a focused assessment. 3. Ask the unlicensed assistive personnel (UAP) to stay with the client while obtaining a carbohydrate snack for the client to eat. 4. Stay with the client and ask the UAP to call the health care provider (HCP) for a prescription for intravenous 50% dextrose.

Answer: 2. Obtain a capillary blood glucose level and quickly perform a focused assessment. Rationale: Diaphoresis and confusion are signs of moderate hypoglycemia. A likely cause of the client's change in condition could be related to the administration of insulin without the client's eating enough food. However, an assessment is necessary to confirm the presence of hypoglycemia. The nurse would obtain a capillary blood glucose level to confirm the hypoglycemia and quickly perform a focused assessment to determine the extent and cause of the client's condition. Once hypoglycemia is confirmed, the nurse stays with the client and asks the UAP to obtain the appropriate carbohydrate snack. A code is called if the client is not breathing or if the heart is not beating.

A client's laboratory results indicate the serum calcium is 12 mg/dL (3 mmol/L) and the serum phosphorous is 2.1 mg/dL (0.697 mmol/L). Based on these findings, the nurse suspects imbalance of which hormone? 1. Thyroid hormone 2. Parathyroid hormone 3. Follicle-stimulating hormone 4. Adrenocorticotropic hormone

Answer: 2. Parathyroid hormone Rationale: Parathyroid hormone is responsible for maintaining serum calcium and phosphorous levels within normal range. Knowledge of normal ranges for serum calcium (9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and serum phosphorous (3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]) is needed to determine that the client's calcium is elevated and phosphorus is decreased, consistent with hyperparathyroidism. Thyroid hormone is responsible for maintaining a normal metabolic rate in the body. Follicle-stimulating hormone and adrenocorticotropic hormone are produced by the anterior pituitary gland. They are responsible for growth and maturation of the ovarian follicle and stimulation of the adrenal glands, respectively.

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible complication of thyroid surgery? 1. Increased serum sodium level 2. Increased serum glucose level 3. Decreased serum calcium level 4. Decreased serum albumin level

Answer: 3. Decreased serum calcium level Rationale: Hypocalcemia may occur if the parathyroid glands are removed or damaged or if their blood supply is impaired during thyroid surgery, resulting in decreased parathyroid hormone (PTH) levels and leading to decreased serum calcium levels. Serum sodium, albumin, and glucose levels are not affected by thyroid surgery.

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? 1. Bradycardia 2. Constipation 3. Hyperreflexia 4. Low-grade temperature

Answer: 3. Hyperreflexia Rationale: Clinical manifestations of thyroid storm include a fever as high as 106°F, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation, hypotension, atrial fibrillation, and cardiovascular collapse.

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? 1. Unsteady gait 2. Slurred speech 3. Increased thirst 4. Cold, clammy skin

Answer: 3. Increased thirst Rationale: A clinical manifestation of hyperglycemia is increased thirst secondary to dehydration and frequent urination. Unsteady gait; slurred speech; and cold, clammy skin would most likely be noted in hypoglycemia.

The nurse is providing education to a client with type 2 diabetes mellitus. The nurse explains in layperson's language the physiological mechanism behind hypoglycemia. Which response by the client determines that teaching has been successful? 1. "My body cannot make insulin." 2. "My body has decreased epinephrine levels." 3. "My body decreases release of cortisol, which is a stress hormone." 4. "My body increases glucagon production to fight low blood sugars."

Answer: 4. "My body increases glucagon production to fight low blood sugars." Rationale: Glucagon is secreted from the alpha cells in the pancreas in response to declining blood glucose levels. At the same time, hypoglycemia triggers increased cortisol release, increased epinephrine release, and decreased secretion of insulin. {Glucagon, Epinephrine, Cortisol (steroids), and Growth Hormone, all increase blood glucose level} Options 1, 2, and 3 are not physiological mechanisms that take place to combat the decrease in the blood glucose level.

The nurse is interviewing a client with type 2 diabetes mellitus who is taking a sulfonylurea. Which statement by the client indicates an understanding of this treatment for this disorder? 1. "I take oral insulin instead of shots." 2. "By taking this medication, I am able to eat more." 3. "When I become ill, I need to increase the number of pills I take." 4. "The medications I'm taking help release the insulin I already make."

Answer: 4. "The medications I'm taking help release the insulin I already make." Rationale: Clients with type 2 diabetes mellitus have decreased or impaired insulin secretion. Oral hypoglycemic agents are given to these clients to facilitate glucose uptake. Insulin injections may be given during times of stress-induced hyperglycemia. Oral insulin is not available because of the breakdown of the insulin by digestion. Therefore, the remaining options are incorrect.

A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA? 1. Blood glucose 500 mg/dL (27.8 mmol/L); arterial blood gases: pH 7.30, PaCo2 50, HCO3- 26. 2. Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, PaCo2 40, HCO3- 22. 3. Blood glucose 450 mg/dL (25.0 mmol/L); arterial blood gases: pH 7.48, PaCo2 39, HCO3- 29. 4. Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, PaCo2 30, HCO3- 14.

Answer: 4. Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, PaCo2 30, HCO3- 14. Rationale: DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, and dehydration. The correct option is 4, as it represents an elevated blood glucose and the arterial blood gases (ABGs) indicate metabolic acidosis. Option 1 is incorrect, as the ABGs indicate respiratory acidosis; option 2 is incorrect, as the ABG values are within normal; and option 3 is incorrect, as the ABGs indicate metabolic alkalosis.

The nurse is monitoring a diabetic client with a blood glucose level of 400 mg/dL (22.2 mmol/L). Which clinical manifestation would indicate diabetic ketoacidosis (DKA)? 1. Bradycardia 2. Cool, clammy skin 3. Lower extremity edema 4. Rapid, deep respirations

Answer: 4. Rapid, deep respirations Rationale: DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, and dehydration. The correct option is 4. This is because the body's compensatory response to the metabolic acidosis is to increase carbon dioxide (CO2) excretion by the lungs through deep, rapid breathing (Kussmaul respirations). Options 1, 2, and 3 are incorrect, as clients with DKA are dehydrated and thus have an increased heart rate and dry, scaly skin and do not have lower extremity edema.

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? 1. Endoscopy 2. Electrocardiogram 3. Stool for occult blood 4. Serum thyroid-stimulating hormone (TSH)

Answer: 4. Serum thyroid-stimulating hormone (TSH) Rationale: 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 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. 1. Hemoglobin A1C of 6.5% 2. Waist circumference of 36 inches 3. Triglycerides 160 mg/dL (1.81 mmol/L) 4. Consistent systolic blood pressures <130 mm Hg 5. Serial fasting glucose levels of 120 mg/dL (6.85 mmol/L), 132 mg/dL (7.54 mmol/L), and 128 mg/dL (7.31 mmol/L)

Answers: 1. Hemoglobin A1C of 6.5% 3. Triglycerides 160 mg/dL (1.81 mmol/L) 5. Serial fasting glucose levels of 120 mg/dL (6.85 mmol/L), 132 mg/dL (7.54 mmol/L), and 128 mg/dL (7.31 mmol/L) Rationale: Features of metabolic syndrome include abdominal obesity: waist circumference of 40 inches (100 cm) or more for men; hyperglycemia: fasting blood glucose level of 110 mg/dL (6 mmol/L) or more or on medication treatment for elevated glucose; abnormal hemoglobin A1C: >6.0%; hypertension: systolic blood pressure of 130 mm Hg or more or diastolic blood pressure of 85 mm Hg or more or on medication treatment for hypertension; hyperlipidemia: triglyceride level of 160 mg/dL or more or on medication treatment for elevated triglycerides, normal triglyderides is 40 to 160 mg/dL (0.45 to 1.81 mmol/L); high-density lipoprotein cholesterol less than 40 mg/dL for men: normal is >40 mg/dL (>1.55 mmol/L). The client's risk factors include elevated triglyceride level, elevated hemoglobin A1C, and elevated fasting blood glucose levels.

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. 1. Wear closed-toe shoes. 2. Soak feet in hot water twice a day. 3. Massage lanolin lotion between the toes. 4. Cut toenails straight across and file the edges. 5. Pat feet dry gently, especially between the toes.

Answers: 1. Wear closed-toe shoes. 4. Cut toenails straight across and file the edges. 5. Pat feet dry gently, especially between the toes. Rationale: People with diabetes mellitus are at high risk for foot ulcerations and resultant lower extremity amputations. The development of diabetic foot complications can be the result of a combination of microvascular and macrovascular diseases that place the client at risk for injury and serious infection. Options 1, 4, and 5 are correct, as measures should be taken to teach clients how to prevent foot ulcers and injury. These measures include wearing closed-toe shoes to protect the feet and toes (especially for those with peripheral neuropathy), cutting toenails straight across and filing the edges to avoid sharp toenail edges and cutting the skin of the toe, and drying the feet gently and thoroughly (including between the toes) to prevent maceration of the skin and infections. Option 2 is incorrect, as clients with diabetes should avoid hot water due to neuropathy and possible burns. Option 3 is incorrect, as lotion between the toes is not advised; it is necessary to keep the area between the toes dry to avoid maceration and infections.

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? 1. Slurred speech 2. Increased thirst 3. Increased appetite 4. Increased urination

Answer: 1. Slurred speech Rationale: A client who has a blood glucose level of less than 70 mg/dL (4 mmol/L) is considered to be hypoglycemic. A clinical manifestation of hypoglycemia is slurred speech.

The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifestations are associated with this complication? 1. Slow pulse; lethargy; warm, dry skin 2. Elevated pulse; lethargy; warm, dry skin 3. Elevated pulse; shakiness; cool, clammy skin 4. Slow pulse, confusion, increased urine output

Answer: 3. Elevated pulse; shakiness; cool, clammy skin Rationale: Signs and symptoms of mild hypoglycemia include tachycardia; shakiness; and cool, clammy skin. The remaining options do not specify the manifestations of hypoglycemia.

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diet. Which statement, if made by the client, indicates a need for further teaching? 1. "I'll eat a balanced meal plan." 2. "I need to drink diet soft drinks." 3. "I'll snack on fruit instead of cake." 4. "I need to purchase special dietetic foods."

Answer: 4. "I need to purchase special dietetic foods." Rationale: It is important to emphasize to the client and family that they are not eating a diabetic diet but rather a balanced meal plan. Adherence to nutritional principles is an important component of diabetic management, and an individualized meal plan should be developed for the client. It is not necessary for the client to purchase special dietetic foods.

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. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

Answers: 1. Tremors 3. Irritability 4. Nervousness Rationale: Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the manifestations of hypoglycemia. In hypoglycemia, usually the client feels hunger.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

Answers: 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur. Rationale: The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the HCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

The 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 has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the health care provider (HCP) because of these symptoms."

Answer: 1. "I need to stop my insulin." Rationale: When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the HCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones during illness.

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. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

Answers: 2. Shakiness 3. Palpitations 5. Lightheadedness Rationale: 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.