EXAM #2 441

The nurse reviews a client's laboratory report and notes that the client's serum phosphorus (phosphate) level is 1.8 mg/dL (0.45 mmol/L). Which condition most likely caused this serum phosphorus level? A. Malnutrition B. Renal insufficiency C. Hypoparathyroidism D. Tumor lysis syndrome

ANSWER: A The normal serum phosphorus (phosphate) level is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.

Which client is at risk for the development of a sodium level at 130 mEq/L (130 mmol/L)? A. The client who is taking diuretics B. The client with hyperaldosteronism C. The client with Cushing's syndrome D. The client who is taking corticosteroids

ANSWER: A The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). A serum sodium level of 130 mEq/L (130 mmol/L) indicates hyponatremia. Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? A. Withdraws the NPH insulin first B. Withdraws the regular insulin first C. Injects air into NPH insulin vial first D. Injects an amount of air equal to the desired dose of insulin into each vial

ANSWER: A When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

The nurse is assessing a pregnant client with type 1 diabetes mellitus about an understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? A. "I will need to increase my insulin dosage during the first 3 months of pregnancy." B. "My insulin dose will probably need to be increased during the second and third trimesters." C. "Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." D. "My insulin needs will return to prepregnant levels within 7 to 10 days after birth if I am bottle-feeding."

ANSWER: A Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of the diabetes during pregnancy.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. A. Polyuria B. Headache C. Bone pain D. Nervousness E. Weight gain

ANSWER: A & C The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. A. Polyuria B. Polydipsia C. Concentrated urine D. Complaints of excessive thirst E. Specific gravity lower than 1.005

ANSWER: A, B, D, E A triad of clinical symptoms—polyuria, polydipsia, and excessive thirst—often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L).

The nurse is reviewing the pathophysiology of hypernatremia. The nurse correctly identifies which conditions as risk factors for hypernatremia? Select all that apply. A. Diarrhea B. Heart failure C. Diabetes insipidus D. Primary hyperaldosteronism5Syndrome of inappropriate antidiuretic hormone (SIADH)

ANSWER: A, C, D Sodium imbalance can result from a variety of causes. Hypernatremia can result from excess sodium intake, inadequate water intake, excess water loss, and certain diseases that contribute to excess water loss. Diarrhea can result in hypernatremia due to excess water loss via the gastrointestinal tract. Diabetes insipidus can result in hypernatremia due to excess diuresis related to the disruption in either the secretion of vasopressin from the hypothalamus (central diabetes insipidus) or the kidneys' inability to appropriately respond to vasopressin (nephrogenic diabetes insipidus). Either form of diabetes insipidus results in voiding large amounts of dilute urine. Primary hyperaldosteronism contributes to hypernatremia by increasing sodium reabsorption in the kidneys. Heart failure is more commonly associated with hyponatremia due to fluid overload. SIADH would result in fluid overload and dilutional hyponatremia, as large amounts of antidiuretic hormone would result in fluid retention. Therefore, options 1, 3 and 4 are correct.

The nurse is caring for a client with a serum sodium level of 149 mEq/L (149 mmol/L) concurrently experiencing fluid overload. Which clinical manifestations would the nurse expect? Select all that apply. A. Agitation B. Blood pressure 96/62 C. Intense thirst sensation D. Bilateral 3+ pedal edema E. Clear lung sounds bilaterally F. Weight gain of 7 pounds (3.2 kilograms) in 2 days

ANSWER: A, C, D, F A normal serum sodium level ranges between 135 mEq/L (135 mmol/L) and 145 mEq/L (145 mmol/L). Therefore, a serum sodium of 149 mEq/L is elevated and indicates hypernatremia. Clinical manifestations of hypernatremia with concurrent fluid overload include agitation, hypertension, increased thirst sensation, peripheral edema, pulmonary edema, and weight gain. Other clinical manifestations include restlessness, twitching, seizures, coma, and increased central venous pressure. Option 2 is incorrect because hypertension is indicative of hypernatremia with fluid overload. Option 5 is incorrect because pulmonary edema is common in this condition. Therefore, options 1, 3, 4, and 6 are correct.

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions would be included in the care plan for this client? Select all that apply. A. Monitor daily weight. B. Maintain a high-sodium diet. C.Maintain a low-potassium diet. D. Monitor intake and output. E. Assess extremities for edema.

ANSWER: A, D, E The client with Cushing's syndrome and a problem of excess fluid volume would be on daily weights and intake and output and have extremities assessed for edema. The client needs to be on a high-potassium, low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water.

The nurse notes that a client's total serum calcium level is 6.0 mg/dL (1.5 mmol/L). Which assessment findings would be anticipated in this client? Select all that apply. A. Tetany B. Constipation C. Renal calculi D. Hypotension E. Prolonged QT interval F. Positive Chvostek's sign

ANSWER: A, D, E, F The normal total serum calcium level is 9.0 to 10.5 mg/dL (2.25 to 2.75 mmol/L); thus, the client's results are reflective of hypocalcemia. The most common manifestations of hypocalcemia are caused by overstimulation of the nerves and muscles; therefore, tetany and the presence of Chvostek's sign would be expected. Calcium is needed by the heart for contraction. When the serum calcium level is decreased, cardiac contractility is decreased and the client will experience hypotension. A low serum calcium level could also lead to severe ventricular dysrhythmias and prolonged QT and ST intervals on the electrocardiogram.

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? A. "Do you have tremors in your hands?" B. "Are you experiencing pain in your joints?" C. "Do you notice swelling in your legs at night?" D. "Have you had problems with diarrhea lately?"

ANSWER: B Hyperparathyroidism is associated with the oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and, sometimes, pathological fractures. Tremors and diarrhea relate to assessment findings of hypoparathyroidism. Swelling in the legs at night is unrelated to hyperparathyroidism.

The nurse is caring for a client after insertion of an implanted insulin pump. Which statement by the client indicates a need for further instruction? A. "I would expect to gain less weight with this pump." B. "I need to make sure I still give my insulin before I eat." C. "This will help me to have better control of my blood sugar." D. "This pump delivers a continuous infusion of insulin throughout the day."

ANSWER: B Insulin devices are implanted in the abdomen either intraperitoneally or intravenously. They deliver a basal insulin infusion plus a bolus dose with meals. The client would not self-administer mealtime insulin when he or she has an insulin pump. These pumps allow for better glycemic control and cause less hypoglycemia and less weight gain. They can potentially improve the overall quality of life.

A hospitalized client with diabetes mellitus receives NPH insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration? A. 2 to 4 hours after administration B. 4 to 12 hours after administration C. 12 to 16 hours after administration D. 18 to 24 hours after administration

ANSWER: B NPH insulin is an intermediate-acting insulin. Its onset of action is 3 to 4 hours, it peaks in 4 to 12 hours, and its duration of action is 16 to 20 hours.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? A, Atenolol B. Prednisone C. Phenelzine D. Allopurinol

ANSWER: B Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client is at risk for developing the potassium deficit because of which situation? A. Sustained tissue damage B. Requires nasogastric suction C. Has a history of Addison's disease D. Takes Spironolactone daily

ANSWER: B The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client with hyperuricemia are at risk for hyperkalemia. The normal uric acid level for a female is 2.7 to 7.3 mg/dL (16 to 0.43 mmol/L) and for a male is 4.0 to 8.5 mg/dL (0.24 to 0.51 mmol/L). Hyperuricemia is a cause of hyperkalemia.

A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon for emergency home use. The client asks the home care nurse about the purpose of the medication. The nurse would instruct the client that the purpose of the medication is to treat which problem? A. Lipoatrophy from insulin injections B. Hypoglycemia from insulin overdose C. Hyperglycemia from insufficient insulin D. Lipohypertrophy from inadequate insulin absorption

ANSWER: B Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. Once consciousness has been regained, oral carbohydrates would be given. Lipoatrophy and lipohypertrophy result from insulin injections.

The nurse is caring for a client who is 2 days postoperative from abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin based on capillary blood glucose testing 4 times a day. A carbohydrate-controlled diet has been prescribed, but the client has not been eating. On entering the client's room, the nurse finds the client to be pale and diaphoretic. Which action is appropriate at this time? A. Call a code to obtain needed assistance immediately. B. Obtain a capillary blood glucose level and quickly perform a focused assessment. C. Ask the assistive personnel (AP) to stay with the client while obtaining a carbohydrate snack for the client to eat. D. Stay with the client and ask the AP to call the primary health care provider (PHCP) for a prescription for intravenous 50% dextrose.

ANSWER: B Diaphoresis and confusion are signs of moderate hypoglycemia. A likely cause of the client's change in condition could be related to the administration of insulin without the client eating enough food. However, an assessment is necessary to confirm the presence of hypoglycemia. The nurse would obtain a capillary blood glucose level to confirm the hypoglycemia and quickly perform a focused assessment to determine the extent and cause of the client's condition. Once hypoglycemia is confirmed, the nurse stays with the client and asks the AP to obtain the appropriate carbohydrate snack. A code is called if the client is not breathing or if the heart is not beating.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose needs to be taken if which symptoms develop? Select all that apply. A, Polyuria B. Shakiness C. Palpitations D. Blurred vision E. Light-headedness6Fruity breath odor

ANSWER: B, C, E Shakiness, palpitations, and light-headedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? A. Glipizide B. Metformin C. Repaglinide D. Regular insulin

ANSWER: B. Metformin Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of a contrast medium during the procedure. Metformin is excreted by the kidneys. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before and 48 hours after cardiac catheterization. Repaglinide is metabolized by the liver and excreted in bile. Glipizide is eliminated primarily by hepatic biotransformation.

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? A. "I need to avoid contact sports." B. "I would check my ankles for swelling." C. "I need to avoid foods high in potassium." D. "I need to check my blood glucose regularly."

ANSWER: C Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? A. A platelet count of 200,000 mm3 (200 × 109/L) B. blood glucose level of 99 mg/dL (5.5 mmol/L) C. potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) D. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

ANSWER: C The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, elevated plasma cortisol and adrenocorticotropic hormone levels among other abnormalities. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The nurse is caring for a client with a potassium level of 5.9 mEq/L and is assisting the client in choosing lunch. The nurse determines there is a need for further teaching if the client selects which food item from the menu? A. Eggplant parmesan B. Tuna sandwich on white bread C. Omelet with spinach, tomato, potatoes D. Pasta with marinara sauce and garlic bread

ANSWER: C A potassium level of 5.9 mEq/L (5.9 mmol/L) is elevated and is considered hyperkalemia. Therefore, the client needs to avoid high-potassium foods. High-potassium foods include apricots, avocado, banana, cantaloupe, dried fruits, grapefruit, honeydew melon, oranges, prunes, raisins, beans, butternut squash, broccoli, spinach, potatoes, tomatoes, peanut butter, yogurt, milk, chocolate, and granola. Eggplant, tuna, egg whites, and pasta are low-potassium foods. Therefore, since option 3 contains spinach, tomato, and potatoes, this is an inappropriate food choice for this client and indicates a need for further teaching.

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching? A. "I need to stay on the diabetic diet." B. "I need to perform glucose monitoring at home." C. "I need to avoid exercise because of the negative effects on insulin production." D. "I need to be aware of any infections and report signs of infection immediately to my obstetrician."

ANSWER: C Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or obstetrician's office. Signs of infection need to be reported to the obstetrician.

A client with diabetes mellitus received 20 units of Humulin N insulin subcutaneously at 0800. At what time would the nurse plan to assess the client for a hypoglycemic reaction? A. 1000 B. 1100 C. 1700 D. 2400

ANSWER: C Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

The nurse is providing education to a client with type 2 diabetes about starting insulin glargine to help with improved glycemic control. Which statement made by the client indicates understanding? A. "It has a distinct peak." B. "It can be given intravenously." C. "It has a decreased risk for hypoglycemia." D. "I don't have to perform fingerstick glucose monitoring."

ANSWER: C In contrast to other long-acting insulins, insulin glargine achieves blood levels that are relatively steady over 24 hours. As a result, there is less risk of hypoglycemia or hyperglycemia. The only insulins that can be administered intravenously are the short-acting insulins. All medications used to treat diabetes mellitus require blood glucose monitoring.

A client with diabetes mellitus calls the clinic and reports being nauseated during the night. The client asks the nurse if the morning insulin would be administered. Which is the most appropriate nursing response? A. Omit the insulin. B. Administer half of the prescribed dose. C. Administer the full dose as prescribed. D. Wait until noon before making a decision.

ANSWER: C When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the primary health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse.

A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse would include which priority intervention in the plan of care? A. Describe the use of loperamide. B. Restrict fluids to 1000 mL per day. C. Walk down the hall for 15 minutes 3 times a day. D. Describe the administration of aluminum hydroxide gel.

ANSWER: C Mobility of the client with hyperparathyroidism would be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids would not be restricted. Discussing the use of medications is not the priority with this client.

The nurse would implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. A. Administer regular insulin. B. Encourage the child to ambulate. C. Give the child a teaspoon of honey. D. Provide electrolyte replacement therapy intravenously. E. Wait 30 minutes and confirm the blood glucose reading. F. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

ANSWER: C & F Hypoglycemia is defined as a blood glucose level of less than 70 mg/dL (4 mmol/L). Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse needs to confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse needs to be prepared for this intervention. Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. A. Hypernatremia B. Signs of water deficit C. High urine osmolality D. Low serum osmolality E. Hypotonicity of body fluids F. Continued release of antidiuretic hormone (ADH)

ANSWER: C, D, E, F SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? A. An ampule of 50% dextrose B. NPH insulin subcutaneously C. IV fluids containing dextrose D. Phenytoin for the prevention of seizures

ANSWER: C. IV fluids containing dextrose Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse would expect to note which finding on assessment of the client. A. Unresponsive pupils B. Negative Chvostek's sign C. Hypoactive bowel sounds D. Positive Trousseau's sign

ANSWER: D Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. The remaining options are not related to the presence of hypocalcemia.

Insulin lispro (short-acting insulin) is prescribed for the client with diabetes mellitus, and the client is instructed to administer the insulin before meals. When would the nurse instruct the client to administer the insulin? A. 45 minutes before eating B. 60 minutes before eating C. 90 minutes before eating D. Immediately before eating

ANSWER: D Insulin lispro acts more rapidly than regular insulin and has a shorter duration of action. The effect of insulin lispro begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which would the nurse expect to note on assessment of the client? A. Hypotension and dizziness B. The presence of sunken eyes C. Dark, tanned skin D. A rounded "moonlike" appearance to the face

ANSWER: D With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic corticosteroid use, the person with Cushing's syndrome develops a rounded moonlike face; prominent jowls; red cheeks; and hirsutism on the upper lip, lower cheek, and chin. The remaining options are not associated with the assessment findings in Cushing's syndrome.

A nurse is providing teaching regarding acarbose. The nurse would tell the client that which expected side or adverse effect(s) may occur with this medication? A. Tachycardia and dizziness B. Hypoglycemia and diaphoresis C. Tinnitus and decreased hearing D. Abdominal distention and diarrhea

ANSWER: D Acarbose delays absorption of dietary carbohydrates and thereby reduces the rise in blood glucose after a meal. Its activity in the bowel promotes flatulence, cramping, and diarrhea. Acarbose does not have an effect on the heart. It may cause hypoglycemia and possibly associated diaphoresis, but this is not an expected side effect. Tinnitus and decreased hearing are side effects of aminoglycosides.

The nurse is interviewing a client with type 2 diabetes mellitus who is taking a sulfonylurea. Which statement by the client indicates an understanding of this treatment for this disorder? A. "I take oral insulin instead of shots." B. "By taking this medication, I am able to eat more." C. "When I become ill, I need to increase the number of pills I take." D. "The medications I'm taking help release the insulin I already make."

ANSWER: D Clients with type 2 diabetes mellitus have decreased or impaired insulin secretion. Oral hypoglycemic agents are given to these clients to facilitate glucose uptake. Insulin injections may be given during times of stress-induced hyperglycemia. Oral insulin is not available because of the breakdown of the insulin by digestion. Therefore, the remaining options are incorrect.

A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA? A. Blood glucose 500 mg/dL (27.8 mmol/L); arterial blood gases: pH 7.30, Paco2 50, Hco3- 26. B. Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, Paco2 40, Hco3- 22. C. Blood glucose 450 mg/dL (25.0 mmol/L); arterial blood gases: pH 7.48, Paco2 39, Hco3- 29. D. Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, Paco2 30, Hco3- 14.

ANSWER: D DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, and dehydration. The correct option is 4, as it represents an elevated blood glucose and the arterial blood gases (ABGs) indicate metabolic acidosis. Option 1 is incorrect, as the ABGs indicate respiratory acidosis; option 2 is incorrect, as the ABG values are within normal; and option 3 is incorrect, as the ABGs indicate metabolic alkalosis.

A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? A. Obtains a weight B. Takes the temperature C. Takes the blood pressure D. Checks the amount of urine output

ANSWER: D In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenously would be to assess the status of the urine output. Potassium chloride would never be administered in the presence of oliguria or anuria. If the urine output is less than 1 to 2 mL/kg/hr, potassium chloride would not be administered. Although options 1, 2, and 3 are appropriate assessments for a child with dehydration, these assessments are not related specifically to the IV administration of potassium chloride.

A client with type 2 diabetes mellitus presents to the primary health care provider's office with a glycosylated hemoglobin (HgbA1C) level of 10.5%. Which statement by the client indicates an understanding of this test and its results? A. "The results of the test are probably high because I ate a doughnut for breakfast this morning." B. "The results of the test are probably low because I had not eaten anything for 12 hours before my blood was drawn." C. "I know that I need to check my glycosylated hemoglobin before each meal and at bedtime, but I don't always do it. I will do it more regularly." D. "Well, I have 3 months to really work on watching my diet and lowering my blood sugar. My next glycosylated hemoglobin test will be better then."

ANSWER: D The HgbA1C test provides a measurement of glycemic control over the previous 2 to 3 months, with increases in the HgbA1C reflecting elevated blood glucose levels. An HgbA1C of less than 6% is recommended by most primary health care providers. Thus, option 4 is the correct answer. Options 1 and 2 are incorrect, as HgbA1C measures glycemic control over a few months, and thus having fasted for a long time or having just eaten something does not affect HgbA1C. Option 3 is incorrect because clients check their blood glucose levels, not their HgbA1C, before meals and at bedtime.

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action? A. Increase fluid intake. B. Document the complaints. C. Assess for urinary glucose. D. Assess urine specific gravity.

ANSWER: D After hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse would assess the specific gravity of the urine and notify the primary health care provider (PHCP) if the result is lower than 1.005. Although increasing fluid intake and documenting the complaints may be components of the plan of care, they are not initial actions. Additionally, the PHCP will prescribe increased fluids. Assessing for urinary glucose is unrelated to the client's condition.

Metformin is prescribed for a client with type 2 diabetes mellitus. The nurse would tell the client that which is the most common side or adverse effect of the medication? A. Weight gain B. Hypoglycemia C. Flushing and palpitations D. Gastrointestinal (GI) disturbances

ANSWER: D The most common side effect of metformin is GI disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; in fact, clients lose an average of 7 to 8 lb because the medication causes nausea and decreased appetite. Although flushing, palpitations, and hypoglycemia can occur, they are not the most common side effects.