Endocrine Review
A nurse is educating a client who is prescribed metformin (Glucophage) for type II diabetes mellitus. Which of the following information should the nurse include?
"Take the medication with your meal."
An adult client diagnosed with type 2 diabetes mellitus says to a nurse, "How can I have diabetes?" Which of the following is an appropriate by the nurse?
"Type 2 diabetes involves insulin resistance with decreased insulin secretion." A nurse is collecting data from a client who the provider suspects may have syndrome of inappropriate antidiuretic hormone. When obtaining a medical history, the nurse should ask for additional information about which of the following conditions?
A nurse is caring for a client who is taking levothyroxine. Which of the following manifestations should suggest to the nurse that the client may have taken an overdose of levothyroxine?
Insomnia Too much levothyroxine will result in manifestations of hyperthyroidism. Insomnia is a manifestation of hyperthyroidism.
A nurse is reviewing the laboratory results for a client who has primary hyperparathyroidism. The nurse expects the which of the following findings is associated with this diagnosis?
An increased magnesium level: The magnesium level is increased with a diagnosis of primary hyperparathyroidism; therefore, this is the finding associated with this diagnosis.
A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of following HbA1c values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glycemic index
6.8% This value is within the expected reference range and indicates that the client is appropriately controlling his glycemic index. (<7%)
A nurse is caring for a client after a craniotomy for pituitary tumor who has developed diabetes insipidus. The client is receiving vasopressin (pitressin). The desired response to the medication is evident when the nurse observes which of the following findings?
A decrease in urine output: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Pitressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.
A nurse is discontinuing a course of prednisone for a client with an exacerbation of asthma. The nurse should taper the dose so that the client does not experience.
Adrenocortical insuffiency: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids may depress the body's normal adrenocortical activity, and abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.
A nurse is planning education for a female client who is at risk for developing type 2 diabetes mellitus. Which of the following increases the risk for developing type 2 diabetes?
Blood pressure of 138/98: The female client is at risk for type 2 diabetes mellitus with blood pressure greater than 130 mm Hg systolic and 85 mm Hg diastolic.
A nurse is preparing to perform a client's blood glucose monitoring. Identify the sequence of steps the nurse should follow.
Check expiration date on strips, perform a quality control test, perform hand hygiene, cleanse puncture site, apply blood sample onto test strip, document results: Check expiration date on test strips: When opening a new bottle of blood glucose monitoring test strips, the expiration date must be checked to ensure accurate test results. When using a bottle that has already been used, the expiration dates must also be checked. Expired test strips should not be used, as the sensitivity to the blood sample can be altered past the intended date of accuracy.Perform a quality control test: Many test strips have a code that must be entered into the glucose monitor, or the vial may contain a code key that must be inserted into the monitor when using a new bottle of test strips. For these types of devices, the test strip must match the code number or an inaccurate reading can result. A quality control test will verify the monitor is working accurately. The quality control test is performed the same way as a blood glucose test, except a special solution is used instead of blood. The monitor should be calibrated, and a quality control test should be performed when using a new bottle of test strips (or as indicated by the facility policy). Many facilities require a daily quality control test. Perform hand hygiene: Hand hygiene reduces the transfer of micro-organisms which could lead to inaccurate readings. Hand hygiene reduces the number of transient micro-organisms which can enter the puncture site and cause an infection. The nurse should wash hands and don gloves prior to performing the glucose test.Cleanse puncture site: The site should be cleansed with warm water and soap and allowed to dry. Alcohol can interfere with the results and should be avoided. The nurse should puncture the lateral side of the finger, which has less nerve endings but is vascular, to provide an adequate blood supply for testing. Apply blood sample onto test strip: The first drop of blood may have less red blood cells and more serous fluid, which can lead to an inaccurate reading. The nurse should wipe off the first drop of blood and lightly squeeze the finger without touching the puncture site to ensure an adequate-size droplet for testing. After a blood sample is obtained, apply a cotton ball over the puncture site. Document results: The nurse should process the strip reading. Remove gloves and wash hands.
A nurse is providing education on site rotation for insulin injections to a client who is newly diagnosed with type 1 diabetes mellitus. Which of the following reasons should the nurse include in the teaching for site rotation?
Decreases the risk for lipoatrophy with insulin injections. The nurse should educate the client to rotate injection sites in the same anatomic area to decrease lipoatrophy, which is a loss of fat under the skin in the area of the injections.
A nurse is caring for a client who is being evaluated for acromegaly. Which of the following should the nurse expect to find during assessment?
Diaphoresis, coarse facial features, enlarged distal extremities, muscle weakness: Acromegaly is a chronic metabolic disorder caused by an excess of growth hormone after normal growth of the skeleton and other organs is complete
A nurse is caring for a client who is newly diagnosed with diabetes mellitus and is prescribed glipizide (Glucotrol). When instructing the client about this medication, the nurse should describe its method of action with which of the following statements?
Glucotrol stimulates your pancreas to release adequate insulin." 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 beta cells of the pancreas.
A nurse is completing an assessment on a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?
Hyperpigmentation: Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.
A nurse is preparing to administer a prescribed does of 10 units of regular insulin and 20 units of NPH insulin to a client who has diabetes. The nurse should take which of the following actions first when mixing the two types of insulin?
Inject 20 units of air into the NPH insunlin bottle: Injecting 20 units of air into the NPH insulin bottle is correct.The first action the nurse should take is to inject 20 units of air into the NPH insulin bottle, because this is the intermediate-acting insulin.
A nurse is preparing to administer insulin lispro (Humalog) to a client who has type 1 diabetes mellitus. Which of the following nursing actions is appropriate?
Inject the insulin 15 minute before a meal: The appropriate nursing action is to administer the insulin 15 min before a meal because insulin lispro is a rapid-acting insulin and the client may develop hypoglycemia quickly if they don't eat.
A nurse is reinforcing teaching to a client who is a start therapy with regular insulin and NPH insulin (Humulin N). Which of the following should the nurse include in the teaching?
Keep the open vial of insulin at room temperature The client should keep the vial in use at room temperature to minimize tissue injury and the minimize the development of lipodystrophies.
A nurse is collecting data from a client who the provider suspects may have syndrome of inappropriate antidiuretic hormone. When obtaining a medical history, the nurse should ask for additional information about which of the following conditions?
Lung Cancer: A nurse is collecting data from a client who the provider suspects may have syndrome of inappropriate antidiuretic hormone. When obtaining a medical history, the nurse should ask for additional information about which of the following conditions?
A nurse is caring for a client who has hyperparathyroidism. Based on this diagnosis, the nurse is aware that the client is at risk for which of the following?
Pathologic fractures: Pathologic fractures is correct. Hyperparathyroidism results in the release of calcium and phosphate into the blood, thereby decreasing bone density. This places the client at risk for pathologic fractures. Dysphagia is correct. Based on the diagnosis of hyperparathyroidism, the client is not at risk for dysphagia.
A nurse is caring for a client who is in a myxedema coma. Which of the following is an appropriate action by the nurse?
Place the client on aspiration precautions: Placing the client on aspiration precautions is correct. The nurse should place the client on aspiration precautions due to the possible formation of edema in the larynx and thickening of the tongue.
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?
Regular (Humulin R): 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 hyperglycemia.
A nurse is providing dietary teaching for a client who has just learned that she has type 2 diabetes mellitus. The nurse should explain that which of the following sweeteners will add calories to the client's carbohydrate count?
Sorbitol: This nutritive sweetener provides calories just as sucrose does. However, it can have benefits for clients who must restrict caloric intake. This is because it causes less elevation in blood glucose levels than sucrose does. Sucralose, apartame, and acesulfame-K are non nutritive sweeteners
A nurse is caring for a client who has Addison's disease and is at risk for Addison crisis. Nursing care of this client should include which of the following nursing actions.
Take Daily Weights: Addison's disease is an endocrine disorder that occurs in all age groups and affects men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and unexposed parts of the body. Daily weight will alert the nurse that dehydration is occurring, which could indicate an impending crisis.
A nurse is discussing the care of a client who has type 1 diabetes mellitus with the assistive personnel. Which of the following situations should the nurse instruct the AP to report immediately?
The client refuses breakfast and requests to sleep: A client with diabetes mellitus type 1 will typically be receiving insulin just before breakfast, and missing a breakfast meal means that the client may experience hypoglycemia later in the morning. This situation needs to be reported to the nurse immediately. It is not unusual for a client with chronic disease to experience transient dizziness when changing positions, due to orthostatic hypotension.
A nurse is caring for a client who has been on levothyroxine (synthroid) for several months. If the dose of this medication has been adequate, the nurse should expect to see a decrease in the
Thyroid stimulating hormone: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.
A nurse is performing teaching with a client who has newly diagnosed type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following manifestations of hypoglycemia?
Vertigo, tachycardia, moist/clammy skin: A client who is newly diagnosed with type 2 diabetes mellitus should be taught to recognize the manifestations of hypoglycemia (decreased blood sugar) that may occur as a result of an insulin reaction, inadequate intake of glucose, or increased exercise. Manifestations of hypoglycemia include moist, clammy skin.
A nurse is caring for a client who is suspected of having diabetes insipidus and is scheduled for a water deprivation test. During the test, the nurse should know to frequently assess the client for the development of
hypotension: A client who has diabetes insipidus will continue to excrete urine even though there is no intake. Hypovolemia, with resulting hypotension, is possible.