Exam 2 Med-Surge

Which symptom would the nurse monitor for in a client with Addison disease?

Hypoglycemia

Which unique response is associated with diabetic ketoacidosis (DKA) that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Kussmaul respirations

Eating lots of sugar will cause type 2 DM

false

Physiologic stress frequently causes hypoglycemia

false

T/F: Weight loss can cure diabetes

false

•Change blood tubing within ___ hrs

4

What is the reason the nurse would monitor a client with a diagnosis of Cushing syndrome for symptoms of diabetes mellitus?

Glucocorticoids accelerate the process of gluconeogenesis.

•Change propofol (Diprovan) tubing every __ to __ hrs

6-12

•Change IVF tubing every ___ hours

72

What hormones are released by the anterior pituitary gland?

ACTH, TSH, GH, female hormones

What is the basic difference between Addison's disease and Cushing's disease?

Addisons: Adrenal insufficiency Cushings: adrenal excessive cortisol

What complications should you watch for immediately postop thyroidectomy?

Airway obstruction

What is important to know before a patient has radioactive uptake scan?

Allergies shellfish, iodine intake

What type of hormone is insulin?

Anabolic Hormone (storage)

If someone has head trauma DO NOT GIVE THEM A _________ SOLUTION!

HYPTONIC

Name 4 organs that can be affected by DM.

Heart/Eyes/Kidneys/Feet

When educating patient about Type 2 diabetes what should you discuss. Name at least 4 things you should teach about

BS monitoring, Medication therapy, Diet/Exercise, Complication

What are the macrovascular complications associated with uncontrolled diabetes?

CAD, CVA, PVD

Which hormone is responsible for altered serum calcium concentrations?

Calcitonin and parathyroid hormone

What manifestations would the nurse include when teaching a client about ketoacidosis?

Confusion, excessive thirst, fruity-scented breath

What hormones are associated with Addison's disease?

Cortisol ACTH

A client reports unexplained weight gain and back pain from a compression fracture of his vertebrae. On assessment, the nurse notes truncal obesity with excessively thin extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. Which disease process would the nurse anticipate incorporating into the plan of care?

Cushings disease

Which assessment finding would indicate to the nurse that a client may have a hyperfunctional thyroid gland?

Diarrhea and weight loss

if BS is < 80 prior to exercise what should you teach a patient to do

Eat a snack prior to exercise

What action affects insulin secretion?

Eating

When assessing a client with diabetes insipidus, which sign would the nurse anticipate finding?

Excessive thirst, dry mucous membranes, decreased urine specific gravity

Infiltration

IV cannula dislodges and perforates the wall of the vein

What nursing interventions can you list for myxedema coma:

IV fluids, warming blanket (to help cold intolerance), space their activities out, watch for respiratory depression.

A client is admitted with a head injury and has large amounts of clear, colorless urine draining from the urinary catheter. Which physiological response is possibly causing the increased urine output?

Inadequate antidiuretic hormone (ADH) secretion

The nurse would monitor a client for which manifestation indicating a thyroid storm?

Increased HR and temperature.

Which parameter would the nurse monitor to evaluate the effectiveness of desmopressin acetate (DDAVP) administered to a client with diabetes insipidus?

Intake and output.

An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus?

Ketones

Which complication of diabetes would the nurse assess for in a client with a long history of the disease?

Leg ulcers, loss of visual acuity, prolonged capillary refill in the toes, and decreased sensation in the lower extremities.

What organ releases glucagon?

Liver

Which sign or symptom might the nurse identify when assessing a client with hyperthyroidism?

Menstrual irregularities, flushed appearance, and short attention span

What PH disorder is associated with DKA?

Metabolic Acidosis

What is the major role of the thyroid gland

Metabolism

When insulin increases it moves glucose where?

Muscle cells and liver/fat cells.

What is important to tell patients when taking Alpha-Glucosidase Inhibitors

Must take with first bite of meal

A client who is 60 lbs more than the ideal body weight is admitted to the hospital with a diagnosis of type I diabetes. Which concept would the nurse include in teaching about diabetes when discussing strategies to lose weight?

Obesity leads to insulin resistance.

What organ's function or lack there of that causes diabetes?

Pancreas

What substance is released in response to low serum levels of calcium?

Parathyroid hormone

What conditions result in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?

Pituitary Cushing Syndrome

What kind of scan must a patient have to get their thyroid checked?

Radioactive scan.

The nurse is educating the client newly diagnosed with type II diabetes on oral antidiabetic medications. Which instruction would the nurse include in the teaching plan?

The client should obtain a finger-stick blood glucose reading before each meal, the teaching plan should include signs and symptoms of hypoglycemia, the teaching plan should include sick day rules.

What gland secretes calcitonin?

Thyroid Gland

The nurse is caring for a client who is prescribed desmopressin acetate. Which is the expected outcome in the client?

Urine output: 3 L/day

Which manifestation would the nurse expect a client with a diagnosis of Cushing syndrome to exhibit?

Weakness, hypertension, truncal obesity

Which type of diabetes is genetic

both

A patient has been ordered 15 u NPH insulin in addition to 10 u Novolog R insulin to be given with meals. Which should be drawn up first?

clear to cloudy

Hormone associated with Addison's Disease:

cortisol

What is the pathologic cause of Type 1 DM?

destruction of beta cells

Fight or flight is is the role of:

epinephrine

Phlebitis

inflammation of the vein

What ocular pathological condition of that occurs with diabetes

retinopathy

Extravasation

same as infiltration, but the infusing solution is an irritant or is caustic which can cause necrosis

What does beta cells do

secrete insulin

What is important to know before a pt. has a radioactive scan:

shellfish allergy

Addisons Disease occurs when...

the adrenal glands do not produce enough of the hormones cortisol or aldosterone (mineralcorticoids), resulting in hyponatremia, hypovolemia, and hyperkalemia.

T/F: Greater than 50% of LE amputations are performed on diabetics.

true

Veins cannot be used in patients with history of:

•Mastectomy •Axillary lymph node dissection •Lymphedema •Paralysis of upper extremities •Dialysis graft or fistulas

What class of oral anti-diabetic agents is contraindicated with ETOH use and CKI?

Biguanides

Which laboratory results support the nurse's suspicion that a client diagnosed with type I diabetes is experiencing ketoacidosis?

Blood glucose of 300 mg/10 mL, blood pH of 7.20

Which finding would be expected in a client with a history of hypothyroidism?

Cold intolerance, lethargy and fatigue, hemoglobin 11.2 g/dL, 15 lb weight gain, HR 59 beats/min

A patient's lab on routine physical exam revealed fasting blood sugar=140. What's an appropriate intervention for this patient

Consider repeating at FBS, Order HgbA1c, start SBGM, education about diabetes

A nurse is caring for a client with Addison disease. Which dietary modification should the nurse include in the client's teaching plan?

Consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium.

Name the 5 Hs of a pheochromcytoma.

Hypertension, Headache, Hyperhidrosis, Hypermetabolism, Hyperglycemia

What hormone is secreted that affects blood sugars?

Insulin

Which complication of diabetes would the nurse suspect when a healthcare provider prescribes one tube of glucose gel for a client with type I diabetes?

Insulin-induced hypoglycemia

What urinalysis finding is an indicator that blood sugar is not well controlled?

Ketonuria

What is the role of adrenal cortex?

Release of cortisol and aldosterone.

What is the adrenal medulla's role

Release of neurotransmitters

Which outcome is the main focus of treatment for a client with Addison Disease?

Restoration of electrolyte balance

Which eye problem is the leading cause of blindness in clients with diabetes?

Retinopathy

What are the microvascular complications associated with uncontrolled diabetes?

Retinopathy, Nephropathy

What type insulin should be used with sliding scale formula and what is the formula?

Short acting insulin BS-100/40

The nurse is providing immediate postoperative care to a client who had a thyroidectomy. The nurse would monitor for a client for which clinical manifestation?

Signs of respiratory obstruction

What nursing interventions can you list for someone with myxedema coma?

Space activities, keep warm, avoid constipation, watch for respiration depression

What is Chvostek's sign?

Spasm of the facial nerve that occurs with tap the cheek associated with hypocalcemia

Which body mechanism related to infectious processes is impaired as a result of Addisons disease?

Stress response

Which complication would the nurse be concerned about if there is removal of the parathyroid glands during a thyroidectomy?

Tetany

Which information will the nurse teach a client with thyroid cancer who is scheduled for a thyroidectomy?

Thyroxine replacement therapy will be required indefinitely.

What are normal blood sugar values for fasting, postprandial and hgbA1c?

fasting <126, postprandial <200 and hgba1c <6.5%

What is breaking down in metabolic acidosis?

fat

What is pathologic cause of Type 2 DM?

insulin resistance, impaired insulin secretion, overworked beta cells

A client's fasting plasma glucose levels are being evaluated. The nurse identifies that the client is considered to be a diabetic if the results are within which range?

126 to 140 mg/dL (7.0-7.8 mmol/L)

•Change lipid tubing every ___ hrs

24

What is basal insulin dosing mean and what it the peak of this type of insulin

24 hours dosing/No peak

A client is diagnosed with Cushing syndrome. The nurse would monitor the client for which cardiovascular complication?

Hypertension

The nurse administers vasopressin to a client and recalls that the medication is which type of hormone?

Antidiuretic hormone

When teaching a patient about injecting insulin what site should he avoid if he exercises daily

Arms/Legs

What type of cell secretes insulin and where is it located in the pancreas?

Beta Cells in the Islets of Langerhans

Name 3 physical characteristics of a patient with hyperthyroidism

Exophthalmos, goiters, nervousness, apprehensive, facial flushing, tachycardia, heat intolerance, weight loss, diarrhea

What is the ADA recommendation for % of fat/pro/carb per meal?

FAT 20-30%, PRO 10-20%, CARB 50-60%

What serum lab provides the most accurate representation of blood sugar control?

HgbA1c

The nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). With which diagnosis is this associated?

Myxedema

A type 2 DM has been changed from Metformin (Biguanide) to Litaglutide Glucagon-Like Peptide 1 Agonist or GLP-1). What is important to tell patient about his new medication regimen

New med is daily injection not oral

What two physical characteristics of Type 2 DM patient that is not characteristic of Type 1 DM

Obesity & Age

An older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. In addition to sodium, which electrolyte would the nurse be most concerned about?

Potassium

The nurse identifies a decrease in serum sodium when reviewing the laboratory reports of an older client with diarrhea. A decrease in which additional electrolyte is a cause for great concern for this client?

Potassium

Which common cause of diabetic ketoacidosis would the nurse consider when caring for a postoperative client with diabetes?

Presence of infection

Which purpose would adding potassium chloride to IV solution of a pt. with diabetic ketoacidosis serve?

Prevents hypokalemia

A new diagnosed Type 2 DM tells the nurse he doesn't want to buy insulin he can just use his wife's because she is diabetic. What 2 things indicate this patient needs education

Type 2 and do not use med not prescribed to you

What conditions can precipitate thyroid storm?

Untreated hyperthyroidism, Stress, Infection, and patients who are post radioactive iodine treatment

A female client asks the nurse whether she should be tested for osteoporosis. Which statements reflect current advise regarding the prevention of osteoporosis?

"A bone mineral density test is the only way to diagnose osteoporosis" and "postmenopausal women and all adults over the age of 65 should be tested for osteoporosis"