7-Endocrine (part 2)

A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? 0720 0730 0745 0815

0745 (*cuz regular=30-60 min to work)

A nurse is preparing to administer ticarcillin / clavulanate 3.1 g by intermittent IV bolus over 30 min. Available is ticarcillin / clavulanate 3.1 g in 50 mL 0.9% sodium chloride (NSS). The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

100 mL/hr

A nurse is preparing to administer lactated Ringer's 400 mL IV bolus to infuse over 3 hr. The drop factor of the manual IV tubing is 20 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

44 gtt/min

A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.) Polyuria Blurred vision Polydipsia Tachycardia Moist, clammy skin

Blurred vision Tachycardia Moist, clammy skin

A nurse in an emergency department is caring for a 52-year-old male client. The client reports new onset of thirst and increased hunger. Client states they need to urinate frequently during the day and wake up 2 to 3 times during the night to urinate. 1 cm (0.4 in) stage 2 pressure injury noted on plantar area of left foot. Client states pressure injury has been present for 2 weeks and is not healing. Client's BMI is 30 Diagnostic Results HbA1c 6.6% (4% to 5.9%)Fasting blood glucose 120 mg/dL (70 mg/dL to 110 mg/dL)HDL 25 mg/dL (greater than 45 mg/dL)Triglyceride 275 mg/dL (40 mg/dL to 160 mg/dL)Prostate-specific antigen (PSA) 2.4 ng/mL (0 ng/mL to 2.5 ng/mL)

The nurse should request a referral with a registered dietician and request a prescription for an insulin stimulator because the client is most likely experiencing type 2 diabetes mellitus. The nurse should monitor the client's serum glucose and glycosylated hemoglobin assay to regulate the client's glucose level and assess the client's progress.

A nurse is admitting an older adult client who has diabetic neuropathy with painful, burning feet. Which of the following interventions should the nurse anticipate the health care provider to prescribe? a) Place a bed cradle on the client's bed. b) Inspect the client's feet once weekly. c) Apply graduated compression stockings to the client's lower extremities. d) Put a heating pad on the client's feet.

a) A bed cradle can reduce pain for a client who has diabetic neuropathy by preventing sheets from touching hypersensitive skin.

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect? a) Tingling of the extremities b) Hypoactive deep tendon reflexes. c) Shortened QT intervals. d) Constipation

a) (lo Ca = less of a wall to block elect sig to cells....so lots elect sig goes to cells="tingling") A serum calcium level of 7.6 mg/dL is below the expected reference range, indicating hypocalcemia. A client who undergoes a total thyroidectomy is at risk for parathyroid injury which can lead to hypocalcemia. The nurse should monitor the client for reports of tingling and numbness of the extremities and around the mouth, muscle tremors, cramps and cardiac dysrhythmias.

A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? a) Graham crackers b) 1 tsp sugar c) 4 oz diet soda d) 4 oz skim milk

a) After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes.

A nurse is caring for a client who is diabetic and reports a headache, restlessness, fatigue, and hunger. Then nurse should identify that the client is likely experiencing which of the following conditions? a) Hypoglycemia b) Hyperglycemia c) Neuropathy d) Hypokalemia

a) Hypoglycemia is a complication of diabetes indicating a blood glucose level less than 70 mg/dL. It can occur when excessive insulin or oral hypoglycemic are administered, with excessive physical activity, or when too little food is consumed. The manifestations of hypoglycemia include sweating, tremor, tachycardia, palpitations, headache, fatigue, nervousness, and hunger.

A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching? a) Keep the open vial of insulin at room temperature. b) Inject the insulin into a large muscle. c) Aspirate the medication prior to administration. d) Administer the insulin in two separate injections.

a) The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy.

A nurse is teaching a client who is taking metformin XR for type II diabetes mellitus. Which of the following instructions should the nurse include in the teaching? a) "Take the medication with a meal." b) "You may crush or chew the medication." c) "This medication may cause an increase in perspiration." d) "This medication may turn your urine orange."

a) The client should take metformin with a meal to avoid hypoglycemia and GI upset, and to provide the most absorption of the medication.

A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? a) 6.3% b) 7.8% c) 8.5% d) 10%

a) The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecting such things as eyesight and kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.

A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL? a) Administer 15 g of carbohydrates. b) Retest the blood glucose level. c) Administer 1 mg of glucagon IM. d )Administer IV dextrose.

a) The first step in preventing the client's blood glucose level from dropping further is to administer 15 to 20 g of carbohydrates. A client who is awake and can swallow can consume carbohydrates, such as glucose tablets or glucose gel, 120 mL (4 oz) of orange juice, 240 mL (8 oz) of skim milk, 6 saltine crackers, 3 graham crackers, or 6 to 10 hard candies.

A nurse is assessing a client who has Graves' disease. The nurse should expect which of the following laboratory results? a) Decreased thyroid-stimulating hormone (TSH) level b) Decreased triiodothyronine (T3) level c) Decreased thyroxine (T4) level d) Decreased thyroid-stimulating immunoglobulins (TSI) percentage

a) The nurse should expect a TSH level below the expected reference range in a client who has Graves' disease.

A nurse is assessing a client who is admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis? a) Provide a quiet, low-stimulus environment. b) Administer aspirin as prescribed for any sign of hyperthermia. c) Keep the client NPO. d) Observe the client carefully for signs of hypocalcemia.

a) Thyroid crisis can occur in response to a stressor, so the nurse should minimize stressful stimuli in the client's environment.

A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority? a) Give the client 15 to 20 g of carbohydrate. b) Monitor the client for hypoglycemia. c) Complete an incident report. d) Notify the nurse manager.

b) (***ADOPIE....always assess 1st...to then see your interventions) The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism? a) A client who has a butterfly rash on his face. b) Moon face c) A client who has a positive Chvostek's sign. d) A client who has muscle hypertrophy.

b) s/s of cushing's dis A client who has a moon face and fat pads on his neck, back and shoulders is exhibiting manifestations of hypercortisolism or Cushing's syndrome.

A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect? a) Malignant hypertension b) Acetone odor to breath c) Cheyne-Stokes breathing d) Blood glucose level below 40 mg/dL

b) Because of the lack of insulin, the body is unable to use glucose and instead breaks down fats resulting in excessive ketones. The large amount of ketones causes the body to become acidotic and causes a fruity, or acetone odor to the breath

A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia? a) Bradycardia b) Cool, clammy skin c) Vomiting d) Fruity odor on the client's breath

b) Cool, clammy skin is a manifestation of hypoglycemia.

A patient with type 1 DM is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease. He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastroesophageal reflux disease. He takes a dose of glargine insulin every evening. This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? a) The albuterol b) The corticosteroid c) The antibiotics d) The proton pump inhibitor

b) Corticosteroids antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose.

A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide? a) "Glipizide absorbs the excess carbohydrates in your system." b) "Glipizide stimulates your pancreas to release insulin." c) "Glipizide replaces insulin that is not being produced by your pancreas." d) "Glipizide prevents your liver from destroying your insulin."

b) Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? a) Assess for hypoglycemia 4 hr after the insulin injection. b) Inject the insulin 15 min before a meal. c) Monitor for polyuria. d) Administer with short-acting insulin.

b) The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.

A nurse is providing teaching to a female client who has type 2 diabetes and a new prescription for pioglitazone. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) a) Expect urine to be darkened. b) Monitor weight daily. c) Increase calcium intake. d) Use oral contraceptives to avoid pregnancy. e) Take tablets whole.

b, c

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? a) Cimetidine b) Dextromethorphan c) Prednisone d) Atorvastatin

c) Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? a) Grapefruit juice b) Milk c) Alcohol d) Coffee

c) The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction, such as nausea, headache, and hypoglycemia.

A nurse is teaching about self-monitoring to a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? a) "I will check my urine once a day for ketones." b) "I will notify my provider if pre-meal glucose is 120 mg/dL." c) "I will check my blood glucose every 4 hours when I am sick." d) "I will check blood glucose every 5 minutes when lightheaded."

c) The client should follow specific guidelines when sick. The nurse should instruct the client to monitor blood glucose every 3 to 4 hr and continue to take insulin or oral antidiabetic agents. The client should consume 4 oz of sugar-free, noncaffeinated liquid every 30 min to prevent dehydration and eet carbohydrate needs through soft food if possible. If not, the client should consume liquids equal to usual carbohydrate content. The nurse should also instruct the client to test urine for ketones and report to provider if they are abnormal (the level should be negative to small).

A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH? a) Osteoarthritis b) Lung cancer c) Liver cirrhosis d) Dyspepsia

c) The nurse should ask the client if he has a history of lung cancer because some of the treatment options for small cell lung cancer can cause secretion of antidiuretic hormone. This results in the body retaining water and can cause the syndrome of inappropriate antidiuretic hormone (SIADH).

A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take? a) Give the insulin at 0700. b) Give the insulin when the breakfast tray arrives. c) Give the insulin 30 min after breakfast with the client's other routine medicines. d) Give the insulin at 0730.

d) (*reg insulin works 30-60 min after giving....so give it 30-60 min before breakfast....so cells are able to take in the sugar form the food they eat) Regular insulin has an onset of 30 to 60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin.

A nurse is reviewing the laboratory results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism? a) A client who has a vitamin D of 25 ng/mL b) A client who has a magnesium of 1.8 mEq/L c) A client who has a calcium of 9.8 mg/dL d) A client who has a phosphate of 5.7 mg/dL

d) This level is above the expected reference range of 3.0 to 4.5 mg/dL. Phosphorus levels are increased in a client who has hypoparathyroidism.

A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider? a) Glucocorticoid medications b) Dextrose 5% in 0.45% sodium chloride c) Oral hypoglycemic medications d) 0.9% sodium chloride IV bolus

d) (*IV=fast...cuz glucose is SUPER high!!!...need it lowered fast!) The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.

A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin? a) Insulin glargine has a duration of 3 to 6 hr. b) Insulin glargine has a duration of 6 to 10 hr. c) Insulin glargine has a duration of 16 to 24 hr. d) Insulin glargine has a duration of 18 to 24 hr.

d) (*long acting...only used once a day)

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? a) "Have an eye examination once per year." b) "Examine your feet carefully every day." c) "Wear compression stockings daily." d) "Maintain stable blood glucose levels."

d) Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.

A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include? a) "Discard the medication if it is cloudy." b) "Briskly shake the medication before filling the syringe." c) "Take this medication15 minutes before meals." d) "Eat a snack 8 hours after taking this medication."

d) NPH insulin peaks in 6 to 14 hr after dosing. The client is at risk for hypoglycemia and might require a snack at this time. Clients should check blood glucose 8 to 10 hr after administration of NPH insulin, and if hypoglycemic, consume a small snack of 15 g of carbohydrates, followed by rechecking of the blood glucose in 15 min.

A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? a) NPH insulin b) Insulin glargine c) Insulin detemir d) Regular insulin

d) Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? a) "I am to take my blood sugar reading after meals." b) "Insulin allows me to eat ice cream at bedtime." c) "A weight reduction program will make me hypoglycemic." d) "I give the insulin injections in my abdominal area."

d) The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following statements by the client indicates a need for further teaching? a) "I will change the needle every 3 days." b) "I should store all unused insulin in the refrigerator." c) "If I skip lunch, I will skip my mealtime dose of insulin." d) "I will use insulin glargine in my insulin pump."

d) The client should use a short-acting insulin in the insulin pump. The insulin pump is designed to administer rapid-acting or short-acting insulin 24 hr a day. Insulin glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24-hr period.

A nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care? a) Measure blood glucose levels every 4 hr. b) Administer a diuretic. c) Initiate fluid restrictions. d) Check urine specific gravity.

d) The nurse should check the client's urine specific gravity to monitor urine concentration in a client who has diabetes insipidus. A client who has diabetes insipidus has a urine specific gravity of less than 1.005.

A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take? a) Turn the client ever 4 hr. b) Check the client's blood pressure every 2 hr. c) Initiate measures to cool the client. d) Place the client on aspiration precautions.

d) The nurse should place the client on aspiration precautions because the client can have decreased mental status and is at risk for laryngeal edema and tongue thickening.