endocrine

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations? 1. Potassium iodide 2. Calcium gluconate 3. Magnesium sulfate 4. Potassium chloride

2

A client is admitted with a diagnosis of chronic adrenal insufficiency. When assigning a room, which roommate should be avoided because of the newly admitted client's condition? 1. client w/ pneumonia 2. client w/ fractured leg 3. client w/ brain attack 4. client w/ cholecystitis

1. Circulatory collapse can be caused by exposure to an infection or a cold or by overexertion of a client with chronic adrenocortical insufficiency (Addison disease). Roommates with a fractured leg, a brain attack, or cholecystitis are appropriate room assignments because they are not communicable infections.

A nurse explains to a client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing because blood glucose testing is: 1. more accurate 2. easier to perform 3. done by the client 4. not influenced by drugs

1. Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder. Whereas blood and urine testing is relatively simple, testing the blood involves additional knowledge. Both procedures can be done by the client. Whether or not it is influenced by drugs is not a factor. Although some urine tests are influenced by drugs, there are methods to test urine to bypass this effect.

The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that the teaching is understood when the client states, "Instead of asparagus, broccoli, and mushrooms, I can eat: 1.String beans, beets, or carrots." 2. Corn, lima beans, or dried peas." 3. Baked beans, potatoes, or parsnips." 4. Corn muffins, corn chips, or pretzels."

1. String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client? 1. thyroxine (t4) and xray film 2. TSH assay and triiodothyroine (t3) 3. thyroglobulin level and p02 4. protein bound iodine and sequential multichannel autoanalyzer (sma)

2. A decreased TSH assay together with an elevated T3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG), and is inadequate for diagnosis when used alone. PO2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

After a thyroidectomy, the client exhibits carpopedal spasm and some tremors. The client reports a sensation of tingling in the fingers and around the mouth. What medication should the nurse expect the health care provider to prescribe? 1. K+ iodine 2. Ca+ gluconate 3. MG+ sulfate 4. K+ chloride

2. After a thyroidectomy, the client exhibits carpopedal spasm and some tremors. The client reports a sensation of tingling in the fingers and around the mouth. What medication should the nurse expect the health care provider to prescribe?

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? 1. Have the client assessed for an enlarged prostate. 2. Obtain a urine specimen from the client to test for ketonuria. 3. Perform a finger stick to test the client's blood glucose level. 4. Assess the client's lower extremities for the presence of pitting edema.

3. The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention but of hyperglycemia.

A client is scheduled for a subtotal thyroidectomy. What equipment is most important for the nurse to have available when preparing for the client's return from surgery? 1. sandbags 2. hemostats 3. tracheotomy tray 4. NG suction

3. tracheotomy tray The possibility of respiratory complications caused by edema of the glottis or injury to the recurrent laryngeal nerve may require a tracheotomy. Sandbags are not necessary because the client may move the head when the neck is supported. Hemostats are not kept at the bedside; if hemorrhage occurs, it most likely will be internal, and the vessel cannot be clamped. Nasogastric suction usually is not necessary; clients rarely have a nasogastric tube.

A client is scheduled for a bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids? 1.Foster accumulation of glycogen in the liver 2.Increase the inflammatory action to promote scar formation 3.Facilitate urinary excretion of salt and water following surgery 4. Compensate for sudden lack of these hormones following surgery

4. Adrenal steroids help an individual adjust to stress. Unless received from external sources, there is no hormone available to cope with surgical stresses after an adrenalectomy. Glucose stores (glycogen) will be used by the body to adapt to surgery. Insulin is the hormone that facilitates conversion of glucose to glycogen. Steroids do not increase inflammatory reactions. Steroids will result in fluid retention, not loss.

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because it: 1. released slowly 2. difficult to crush 3. irritates mucosal 4. has an unpleasant taste if crushed

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

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. The nurse advises the client to: 1. skip oral hypoglycemic pill, drink fluids, stay in bed 2. avoid food, drink clear liquids, take daily temp, stay in bed 3. eat as much as possible, increase fluids, call office the next day 4. take oral hypoglycemic pill, warm fluids, perform serum glucose test before meals and at hour of sleep

4. Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration, and monitoring serum glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored. Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Telling the client to eat as much as possible, increase fluid intake, and call the office again the next day are incomplete instructions; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Eating as much as possible can precipitate hyperglycemia.

A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? 1. keoacidosis 2. somogyi phenomenon 3. hypoglycemic reaction 4. hypersmolar nonkeotic

1. Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

A client presents with chief complaints of unexplained weight gain and back pain from a compression fracture of the vertebrae. On assessment, there is truncal obesity with extremely thin extremities, a moon shaped face, a buffalo hump, thin hair, and adult acne. The symptoms described are suggestive of what disease? 1. addisons disease 2. cushings disease 3. multiple sclerosis 4. kaposis sarcoma

2. Common symptoms of Cushing's disease are weight gain, truncal obesity, buffalo hump, and moon face because of deposits of adipose tissue. The condition is caused by excess cortisol secretion caused by hypersecretion of adrenocorticotropic hormone (ACTH). Other characteristics are diabetes mellitus, muscle wasting, osteoporosis, ecchymosis, and slow healing of wounds. Addison's disease is adrenal insufficiency. Hypotension, dehydration, hypoglycemia, and hyperpigmentation of the skin are symptoms. Multiple sclerosis is a progressive disease involving destruction of the myelin sheath, leading to nerve damage. Kaposi's sarcoma is a cancer associated with acquired immunodeficiency syndrome (AIDS).

client w/ type 1 diabetes is diagnosed w/ diabetic ketoacidosis and initially treated w/ IV fluids followed by an IV bolus of regular insulin. The nurse anticipates that the health care provider will prescribe a continuous infusion of: 1. novolin L insulin 2. novolin R insulin 3. novolin N insulin 4. novolin U insulin

2. novolin R - only insulin that can be given IV

A nurse in the postanesthesia care unit is caring for a client who just had a thyroidectomy. For which client response is it most important for the nurse to monitor? 1. Urinary retention 2. Signs of restlessness 3. Decreased blood pressure 4. Signs of respiratory obstruction

4. The first and most important observation should be for respiratory obstruction. If this occurs, treatment must be instituted immediately. Urinary retention is a later concern; urinary retention will not occur in the immediate postoperative period. Signs of restlessness may result from the anesthesia; however, it is not life-threatening and usually passes. The blood pressure is not significantly affected by this type of surgery; however, surgery itself can influence blood pressure. If the blood pressure significantly increases, other symptoms of thyroid crisis (storm) will be present.