Endocrine and Metabolic Disorders
The nurse and a client have just discussed the client's recent diagnosis of hypothyroidism and its causes and effects. Which statement indicates that the client needs further instruction?
"I just eat too much. That's why I'm depressed and overweight."
Which statement by a client indicates that he requires additional teaching regarding the relationship between diabetes mellitus and exercise?
"I should wait to eat until after I have finished exercising."
A 78-year-old client with type 2 diabetes needs a kidney transplant. The client's daughter volunteers to donate a kidney, but the client voices concerns about her daughter's health to the nurse. Which response by the nurse is appropriate?
"I'll notify your physician of your concerns and see if he can discuss the procedures with you."
A physician has ordered a check of glycosylated hemoglobin (HbA1c) levels for a client with diabetes. Which statement by the client regarding this test indicates that teaching has been effective?
"It's used to monitor the control of my disease."
A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?
"You'll need less insulin when you exercise or reduce your food intake."
The nurse administered isophane insulin suspension (NPH) to a diabetic client at 7 a.m. At what time would the nurse expect the client to be most at risk for a hypoglycemic reaction?
4 p.m.
Laboratory studies indicate that a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which laboratory test would the nurse prepare to perform to determine most conclusive diagnostic information about the client's glucose utilization?
A test of serum glycosylated hemoglobin (Hb A1c)
A 37-year-old client complains of muscle weakness, anorexia, and darkening of his skin. The nurse reviews his laboratory data and notes findings of low serum sodium and high serum potassium levels. The nurse recognizes these signs and symptoms as associated with which condition?
Addison disease
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. The nurse explains to the client that this diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?
Adrenal cortex
A nurse is reviewing data in the progress notes entry of a client with Addison disease. Based on the data, the nurse suspects which condition?
Adrenal crisis
Which of the following does the nurse incorporate in her teaching about the most common cause of hyperaldosteronism?
An adrenal adenoma
The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse
Which potentially serious complication may occur when a client is treated for hypothyroidism?
Angina or cardiac arrhythmia
During the first 24 hours after a client is diagnosed with addisonian crisis, which task should the nurse perform frequently?
Assess vital signs
The nurse is collecting data on a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine
Blood pressure of 176/88 mm Hg
A client with a history of gout is admitted to the medical-surgical unit. The nurse should expect to administer which medication to a client with gout?
Colchicine
A nurse is caring for a 30 year old female client who had a subtotal thyroidectomy to treat hyperthyroidism. What sign or sx could indicate bleeding at the incision site
Complaints of a tight dressing
The following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus
Confusion and seizures
A client's laboratory findings indicating excessive levels of adrenocortical hormones would correlate with which disease?
Cushing syndrome
Assessment of a client reveals thin extremities but an obese truncal area and a "buffalo hump" at the shoulder area. The client also complains of weakness and disturbed sleep. The nurse interprets this data as indicating which disorder?
Cushing syndrome
Which nursing diagnosis is appropriate for a client with Addison disease?
Deficient fluid volume
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client condition stabilizes the nurse evaluates the diabetes management regime. The client sees a physician every 4 week injects insulin after breakfast and dinner and measures blood glucose before breakfast and at bed time. Consequently the nurse should help formulate a nursing dx of
Deficient knowledge
Which disorder is suggested by polydipsia and large amounts of waterlike urine with a specific gravity of 1.003?
Diabetes insipidus
An appropriate nursing diagnosis for a client with Addison disease would include which assessment?
Fatigue
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and her eyes feeling "gritty." Thyroid function tests reveal the following: a thyroid-stimulating hormone (TSH) level of 0.02 units/ml, a thyroxine level of 20 g/dl, and a triiodothyronine level of 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these findings, the nurse would suspect:
Graves' disease
A 55-year-old client is admitted with hypoparathyroidism. When assessing the client, the nurse should expect to see which sign or symptom?
Hand twitching
Which instructions should be included in the discharge teaching plan for a client after a thyroidectomy for Graves' disease?
Have regular follow-up care.
Sodium and water retention in a client with Cushing syndrome contributes to which commonly seen disorders?
Hypertension and heart failure
The nurse is performing a physical assessment on a client. The nurse avoids forceful or repeated palpation of the thyroid gland of which condition?
Hyperthyroidism
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. The client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?
Hypocalcemia
Which combination of adverse effects must be carefully monitored when administering I.V. insulin to a client diagnosed with diabetic ketoacidosis?
Hypokalemia and hypoglycemia
A nurse reviewing the laboratory results on a clients chart notes finding if increased serum phosphate levels and decreased serum calcium levels. These findings indicate what condition?
Hypoparathyroidism
A client, age 23, is diagnosed with type 1 diabetes. The physician prescribes 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles the appropriate equipment, washes her hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use?
Inject 35 units of air into the NPH vial; inject 15 units of air into the regular insulin vial and withdraw 15 units of regular insulin; and withdraw 35 units of NPH.
The newly diagnosed diabetes mellitus client is to receive his first insulin dose. The nurse administers the insulin into his abdomen. How does absorption at the abdominal site compare to absorption at other sites?
Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
When assisting with the development of a care plan for a client with hyperthyroidism, the nurse would anticipate which treatment?
Irradiation of the thyroid
When caring for a client with a diagnosis of diabetes insipidus, which nursing intervention should be the nurse's priority?
Maintain adequate fluid intake
Which nursing intervention should be taken for a client who vomits 1 hour after taking his morning glyburide (DiaBeta)?
Monitor blood glucose closely and look for signs of hypoglycemia
A client with hypothyroidism who experiences trauma, emergency surgery, or severe infection is at risk for developing which condition?
Myxedema coma
The nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Correct
Diabetes insipidus is a disorder of which gland?
Pituitary gland
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?
Rapid, thready pulse
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes, which is controlled by tolazamide (Tolinase). The nurse reviews which important laboratory test for confirming HHNS?
Serum osmolarity
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse drug effect?
Tachycardia
A client has elevated levels of triiodothyronine (T3), thyroxine (T4), and calcitonin. The nurse is aware that these hormones are produced by which gland?
Thyroid gland
When preparing a client scheduled for a thyroid function test, the nurse questions the client about medications. Which medications contain iodine and could alter the results?
Topical antiseptics and multivitamins
A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
Trousseau's sign.
The nurse is collecting data on a client with hyperthyroidism. What findings should the nurse expect?
Weight loss, nervousness, and tachycardia
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. A student nurse asks what is this disorder caused by. The nurse would respond that "Cushing's syndrome is most likely caused by:
a corticotropin-secreting pituitary adenoma.
A client with a diagnosis of diabetes insipidus is being treated with desmopressin acetate (DDAVP). The client asks why he has been ordered this medication. The nurse plans her response based on the understanding that DDAVP
is a synthetic vasopressin
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:
myxedema coma
Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 units of regular insulin. The nurse should expect the dose's:
onset to be at 2:30 p.m. and its peak to be at 4 p.m.
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:
phosphorus.
The nurse is assigned to care for a postoperative client who has diabetes mellitus. During data collection, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:
suggest referral to a sex counselor or other appropriate professional
A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms?
• Numbness • Tingling • Muscle twitching and spasms
A 56-year-old female client is being discharged after having a thyroidectomy. Which discharge instructions are appropriate for this client? Select all that apply.
• Take thyroid replacement medication, as ordered. • Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician.
