Endocrine and Metabolic Disorders
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect a blood pressure of 130/70 mm Hg. a blood glucose level of 130 mg/dl (7.2 mmol/L). bradycardia. a blood pressure of 176/88 mm Hg.
a blood pressure of 176/88 mm Hg. Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
A client with hypothyroidism has started to take thyroid hormone replacement therapy and asks the nurse about the reason for feeling sad and depressed. What should the nurse tell the client? "The feelings of sadness and depression are caused by: the side effects of thyroid hormone replacement therapy and will diminish over time." a condition unrelated to hypothyroidism and require follow-up." having a chronic illness and are normal." low thyroid hormone levels and will improve with replacement therapy."
low thyroid hormone levels and will improve with replacement therapy." Hypothyroidism may contribute to sadness and depression. This client needs to know that these feelings may be related to low thyroid hormone levels and may improve with treatment. Replacement therapy does not cause depression. Depression may accompany chronic illness, but it is not "normal."
A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluids would be most appropriate? milk and diet soda water and eggnog chicken broth and juice coffee and milkshakes
chicken broth and juice Electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia, and hyperkalemia. Regular salted (not low salt) chicken or beef broth and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium.
The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. When conducting a focused assessment, what should the nurse should assess the client for? anorexia tachycardia weight gain cold skin
tachycardia Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism.
A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse? "I should stop attending group activities." "I will increase daily caloric consumption." "I will increase fiber and fluids in my diet." "I should stop taking the prescribed daily aspirin."
"I will increase fiber and fluids in my diet." Clients with hypothyroidism typically have constipation. A diet high in fiber and fluids can help prevent this. Group activities have nothing to do with the current issue. A nurse would not change medical prescriptions by telling the client to stop taking the prescribed aspirin. Increasing caloric consumption is not appropriate with hypothyroidism.
A nurse administered neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitus at 7 a.m. (0700). At what time should the nurse expect the client to be most at risk for hypoglycemia? 10 a.m.(1000) noon (1200) 4 p.m. (1600) 10 p.m. (2200)
4 p.m. (1600) NPH is an intermediate-acting insulin that peaks 8 to 12 hours after administration. Because the nurse administered NPH insulin at 7 a.m. (0700), the client is at greatest risk for hypoglycemia from 3 (1500) to 7 p.m. (1900).
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? arterial pH 7.25 plasma bicarbonate 12 mEq/L (12 mmol/L) blood glucose level 1,100 mg/dl (61.05 mmol/L) blood urea nitrogen (BUN) 15 mg/dl (0.82 mmol/L)
blood glucose level 1,100 mg/dl (61.05 mmol/L) HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl (33.33 mmol/L) in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." "The circulation in your feet can help us determine how severe your diabetes is." "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." "It's easier to get foot infections if you have diabetes."
"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." The nurse should make the client aware that diabetes affects sensation in the feet and that they might hurt their foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of their diabetes doesn't provide the client with complete information.
A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? "You must lie flat for 24 hours after surgery." "You must avoid coughing, sneezing, and blowing your nose." "You must restrict your fluid intake." "You must report ringing in your ears immediately."
"You must avoid coughing, sneezing, and blowing your nose." After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.
The nurse develops a teaching plan for the client about how to prevent the transmission of hepatitis A. Which discharge instruction is appropriate for the client? Spray the house to eliminate infected insects. Tell family members to try to stay away from the client. Ask family members to wash their hands frequently. Disinfect all clothing and eating utensils.
Ask family members to wash their hands frequently. The hepatitis A virus is transmitted via the fecal-oral route. It spreads through contaminated hands, water, and food, especially shellfish growing in contaminated water. Certain animal handlers are at risk for hepatitis A, particularly those handling primates. Frequent handwashing is probably the single most important preventive action. Insects do not transmit hepatitis A. Family members do not need to stay away from the client with hepatitis. It is not necessary to disinfect food and clothing.
Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? Anorexia. Dizziness. Rapid weight gain. Poor skin turgor.
Rapid weight gain. Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.
The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next? Contact the manager of the Food and Nutrition Department. Request that the dietitian discuss the drug-food interaction of repaglinide and grapefruit juice. Substitute a half grapefruit in place of grapefruit juice. Remove the grapefruit juice from the client's tray and bring another juice of the client's preference.
Remove the grapefruit juice from the client's tray and bring another juice of the client's preference. There is a drug-food interaction between repaglinide and grapefruit juice that may inhibit metabolism of repaglinide; the fresh grapefruit also interacts with repaglinide. It is not necessary that the dietitian inform the client of the drug-food interaction first. To contact the manager of the Food and Nutrition Department is not an intervention that will bring about prompt removal of the juice.
Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease? an abnormality in the body's mucus-secreting glands formation of fibrous cysts in various body organs failure of the pancreatic ducts to develop properly reaction to the formation of antibodies against streptococcus
an abnormality in the body's mucus-secreting glands CF is characterized by a dysfunction in the body's mucus-producing exocrine glands. The mucus secretions are thick and sticky rather than thin and slippery. The mucus obstructs the bronchi, bronchioles, and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine, resulting in poor digestion and poor absorption of various food nutrients. Fibrous cysts do not form in various organs. Cystic fibrosis is an autosomal recessive inherited disorder and does not involve any reaction to the formation of antibodies against streptococcus.
A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect? lower blood pressure concentration of urine normal insulin levels improved glucose metabolism
concentration of urine The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus.
A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? respiratory alkalosis metabolic alkalosis respiratory acidosis metabolic acidosis
metabolic alkalosis A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of thyroid storm. cretinism. myxedema coma. Hashimoto's thyroiditis.
myxedema coma. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
A nurse performs a fingerstick glucose-monitoring test for a client. The results are 49 mg/dL (2.7 mmol/L). Which clinical manifestations does the nurse assess for? polyuria, headache, and fatigue polyphagia and flushed, dry skin polydipsia, pallor, and irritability nervousness, diaphoresis, and confusion
nervousness, diaphoresis, and confusion Hypoglycemia is defined as a blood glucose level of less than 65 mg/dL. Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, lightheadedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, the condition may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and sodium. potassium. magnesium. phosphorus.
phosphorus. PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat? within 10 to 15 minutes after the injection. 1 hour after the injection. at any time because timing of meals with lispro injections is unnecessary. 2 hours before the injection.
within 10 to 15 minutes after the injection. Insulin lispro begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of lispro is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.
A child with type 1 diabetes is admitted to the emergency department with hot and dry skin, rapid and deep respirations, and a fruity odor to her breath. Which task, when performed by a new-graduate registered nurse (RN), requires the RN preceptor to intervene? assessment of child's vital signs every 15 min verification of child's prescription for IV insulin infusion providing encouragement to the child to drink some orange juice verification of child's glucose by finger stick
providing encouragement to the child to drink some orange juice The client is exhibiting symptoms that are consistent with hyperglycemia. The RN does not give any additional glucose. All of the other interventions are appropriate for this client. The new-graduate RN notifies the health care provider (HCP) about the assessment findings.
