exam 3

The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? Select all that apply. 1)Dry skin 2)Irritability 3)Palpitations 4)Weight loss 5)Constipation 6)Cold intolerance

1)Dry skin 5)Constipation 6)Cold intolerance

Which signs/symptoms would the nurse expect to note when collecting data on a client with Addison's disease? 1)Edema and weight gain 2)Hypotension and vomiting 3)Obesity and muscle hypertrophy 4)Hirsutism and excessive hunger

2)Hypotension and vomiting Rationale:Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in the remaining options are not associated with Addison's disease.

A pregnant client tells the nurse that she has been craving "unusual foods." On further data collection, the nurse discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Which laboratory result indicates a physiological consequence of a result of this practice? 1)Hematocrit 37% 2)Glucose 86 mg/dL 3)Hemoglobin 9.1 g/dL 4)White blood cell count 12,400/mm3

3)Hemoglobin 9.1 g/dL Rationale:Pica cravings often lead to iron deficiency anemia, resulting in a lowered hemoglobin. The other three laboratory values are within normal limits for the pregnant woman.

A client with aldosteronism has been instructed on spironolactone treatment. Which client statement indicates that the client needs further teaching about the medication? 1)"My potassium level will increase." 2)"This medication will make me void frequently." 3)"My blood pressure should get back to normal." 4)"This medication will decrease my blood glucose."

4)"This medication will decrease my blood glucose." Rationale:Spironolactone is a potassium-retaining diuretic. It does not lower blood glucose. Spironolactone counteracts the effect of aldosterone, promotes sodium and water excretion, decreases circulating volume, and therefore decreases blood pressure and inhibits the excretion of potassium.

A client in labor has an underlying diagnosis of sickle cell anemia. During labor the client is at high risk for sickling crisis. The nurse would take which action to assist in preventing a crisis from occurring during labor? 1)Reassure the client. 2)Maintain strict asepsis. 3)Prevent bearing down. 4)Administer oxygen as prescribed.

4)Administer oxygen as prescribed. Rationale:During the labor process, the client is at high risk for being unable to meet the oxygen demands of labor and becoming unable to prevent sickling. An intervention to prevent sickle cell crisis during labor includes administering oxygen as needed.

A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon hydrochloride for emergency home use. The client asks the nurse about the purpose of the medication. The nurse tells the client that the purpose of the medication is to treat which aspect of diabetes? 1)Lipoatrophy from insulin injections 2)Hypoglycemia from insulin overdose 3)Hyperglycemia from insufficient insulin 4)Lipohypertrophy from inadequate insulin absorption

2)Hypoglycemia from insulin overdose Rationale: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 injection. Once consciousness has been produced, oral carbohydrates should be given.

The nurse is caring for a client with pheochromocytoma. The client is scheduled for an adrenalectomy. During the preoperative period, the priority nursing action would be to monitor which criterion? 1)Vital signs 2)Intake and output 3)Urine for glucose and acetone 4)Blood urea nitrogen (BUN) level

1)Vital signs Rationale:Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all of the options are accurate nursing interventions for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs, particularly the blood pressure.

The nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide. The nurse reinforces dietary instructions to the client. Which are appropriate instructions? Select all that apply. 1)Increase dietary intake of calcium. 2)Drink at least 2 to 3 L of fluid daily. 3)Increase dietary intake of potassium. 4)Decrease dietary intake of phosphorus. 5)Eat sparsely when experiencing nausea.

2)Drink at least 2 to 3 L of fluid daily. 3)Increase dietary intake of potassium. Rationale:The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption. This is aided by the sufficient intake of fluids. Dietary restriction of calcium may be used as a component of therapy. The parathyroid is responsible for calcium production, and the term hyperparathyroidism can be indicative of an increase in calcium. The client should eat foods high in potassium, especially if the client is taking furosemide. Limiting nutrients is not advisable. Remember the inverse relationship between calcium and phosphorus.

The licensed practical nurse is assisting the registered nurse (RN) in the care of a child who is receiving a blood transfusion and notifies the RN if the child displays which signs/symptoms of fluid overload? Select all that apply. 1)Chills 2)Itching 3)Back pain 4)Dry cough 5)Distended neck veins

4)Dry cough 5)Distended neck veins Rationale:Signs/symptoms of a circulatory overload include: dyspnea, precordial pain, wheezing, cyanosis, dry cough, and distended neck veins. Signs/symptoms of a transfusion reaction include chills, itching, rash, fever, headache, and pain in the back.

A client newly diagnosed with diabetes mellitus is having difficulty learning the technique of blood glucose measurement. The nurse would teach the client to do which action to perform the procedure properly? 1)Wash the hands first using cold water. 2)Puncture the center of the finger pad. 3)Puncture the finger as deeply as possible. 4)Let the arm hang dependently and milk the digit.

4)Let the arm hang dependently and milk the digit. Rationale:Before doing a finger stick for blood glucose measurement, the client should first wash the hands. Warm water should be used to stimulate the circulation to the area. The finger is punctured near the side, not the center, because there are fewer nerve endings along the side of the finger. The puncture is only deep enough to obtain an adequately sized drop of blood; excessively deep punctures may lead to pain and bruising. The arm should be allowed to hang dependently, and the finger may be milked to promote obtaining a good-sized blood drop.

A client is diagnosed with disseminated intravascular coagulopathy (DIC). The nurse would become concerned with which laboratory values? Select all that apply. 1)Increased D-dimer 2)Decreased hemoglobin 3)Increased platelet count 4)Decreased fibrinogen level 5)Decreased prothrombin level

1)Increased D-dimer 2)Decreased hemoglobin 4)Decreased fibrinogen level Rationale:DIC laboratory studies will reveal a decreased hemoglobin and low platelet count. The prothrombin and activated partial thromboplastin times will be increased. The fibrinogen level is reduced, and the fibrin degradation products level is increased. The D-dimer result is elevated.

The nurse is caring for a client with a diagnosis of hypoparathyroidism. The nurse reviews the client's laboratory results and notes that the calcium level is extremely low. The nurse would expect to note which sign/symptom on data collection? 1)Unresponsive pupils 2)Positive Trousseau's sign 3)Negative Chvostek's sign 4)Hyperactive bowel sounds

2)Positive Trousseau's sign Rationale:Hypoparathyroidism is related to a lack of parathyroid hormone secretion or to 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 positive Chvostek's and Trousseau's signs, which indicate potential tetany.

Which statement by the client would cause the nurse to suspect that the thyroid test results drawn on the client this morning may be inaccurate? 1)"I had a radionuclide test done 3 days ago." 2)"When I exercise I sweat more than normal." 3)"I drank some water before the blood was drawn." 4)"That hamburger I ate before the test sure tasted good."

1)"I had a radionuclide test done 3 days ago." Rationale:Recent radionuclide scans performed before the test can affect thyroid laboratory results. There are no food, fluid, or activity restrictions required for this test.

A client with a partial right adrenalectomy is placed on corticosteroid replacement therapy. Which data would indicate that the client is experiencing an adverse effect related to the pharmacological treatment? 1)Dry mouth 2)Tarry stools 3)Hypotension 4)Hypoglycemia

2)Tarry stools Rationale:Glucocorticoids increase gastric secretion, and this can result in peptic ulcers and gastrointestinal bleeding. A sign of gastrointestinal bleeding is the presence of tarry (black) stools. Corticosteroids increase the blood glucose. Hypotension and a dry mouth are not side effects of corticosteroid therapy.

A client with diabetes mellitus calls the clinic and tells the nurse that she has been nauseated during the night. The client asks the nurse if the morning insulin would be administered. Which is the appropriate nursing response? 1)Omit the insulin. )2Administer the full dose as prescribed. 3)Administer half of the prescribed dose. 4)Wait until noon before making a decision.

2Administer the full dose as prescribed. Rationale:When a diabetic client 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.

The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring? 1)Constipation 2)Temperature of 96.6° F 3)Blood pressure of 80/60 mm Hg 4)Heart rate of 44 beats per minute

3)Blood pressure of 80/60 mm Hg Rationale:Signs/symptoms associated with thyroid storm include a fever as high as 106° F (41.1° C), severe tachycardia, profuse diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hyperreflexia, abdominal pain, diarrhea, and dehydration. With this disorder, the client's condition can rapidly progress to coma and cardiovascular collapse.

The nurse is caring for a client with pheochromocytoma. Which data are indicative of a potential complication associated with this disorder? 1)A urinary output of 50 mL/hr 2)A coagulation time of 5 minutes 3)Congestion heard on auscultation of the lungs 4)A blood urea nitrogen (BUN) level of 20 mg/dL

3)Congestion heard on auscultation of the lungs Rationale:The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, heart failure (HF), increased platelet aggregation, and stroke. Death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic aneurysm. Congestion heard on auscultation of the lungs is indicative of heart failure (HF). A urinary output of 50 mL/hr is an appropriate output; the nurse would become concerned if the output were less than 30 mL/hr. A coagulation time of 5 minutes is normal. A BUN level of 20 mg/dL is a normal finding.

During an initial prenatal visit, the nurse notes that the primary health care provider documents that the client is experiencing iron deficiency anemia. Which client data support this finding? Select all that apply. 1)Reports of fatigue 2)Pink mucous membranes 3)Increased vaginal secretions 4)Hemoglobin level of 10.2 g/dL 5)Increased frequency of voiding

1)Reports of fatigue 2)Pink mucous membranes Rationale:Anemia is a common problem in pregnancy and is characterized by a hemoglobin level of less than between 10.5 and 11 g/dL. Iron deficiency anemia and folic acid deficiency are two common types of anemia that present a concern during pregnancy. Although fatigue may be seen in some pregnant women, its presence may reflect complications caused by decreased oxygen supply to vital organs, thus supporting the laboratory findings. The other options are normal observations during pregnancy.

The home care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client, prescribed repaglinide and metformin, asks the nurse to explain these medications. The nurse would reinforce which instructions to the client? Select all that apply. 1)Diarrhea can occur secondary to metformin. 2)The repaglinide is not taken if a meal is skipped. 3)The repaglinide is taken 30 minutes before eating. 4)Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. 5)Muscle pain is an expected side effect of metformin and may be treated with acetaminophen. 6)Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

1)Diarrhea can occur secondary to metformin. 2)The repaglinide is not taken if a meal is skipped. 3)The repaglinide is taken 30 minutes before eating. 4)Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Rationale:Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide, and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it also might signify a more serious condition that warrants PHCP notification, not the use of acetaminophen.

A client asks the nurse about metabolic syndrome and what it means. The teaching plan would include which characteristics that define metabolic syndrome? Select all that apply. 1)The triglyceride level is not considered in the diagnosis of metabolic syndrome. 2)Blood pressure is elevated with systolic values greater than 130 mm Hg and diastolic values greater than 85 mm Hg. 3)Fasting blood glucose levels are greater than 200 mg/dL, or the client is taking medication for glucose control. 4)The client has abdominal obesity with a waist greater than 40 inches in males and greater than 35 inches in females. 5)High density lipoprotein (HDL) cholesterol is greater than 40 mg/dL for males or 50 mg/dL in females or on drug treatment.

2)Blood pressure is elevated with systolic values greater than 130 mm Hg and diastolic values greater than 85 mm Hg. 4)The client has abdominal obesity with a waist greater than 40 inches in males and greater than 35 inches in females. Rationale:Metabolic syndrome is a condition in which the client has metabolic factors that put the client at risk for developing diabetes type 2 and cardiovascular disease. Abdominal obesity with increased waist measurements (males greater than 40 inches, females greater than 35 inches) is part of the syndrome, as is elevated blood pressure with systolic elevation greater than 130 mm Hg and diastolic greater than 85 mm Hg. Blood glucose levels are greater than 100 mg/dL, not 200 mg/dL. Triglyceride levels are part of the metabolic syndrome, and levels greater than 150 mg/dL are part of the syndrome. High density lipoprotein (HDL) cholesterol is less than 40 mg/dL in males and 50 mg/dL in females in the syndrome. HDL is the good cholesterol and should be greater than 35 mg/dL.

The nurse is assisting in caring for a client immediately following an abdominal surgical procedure who lost a significant amount of blood during surgery. Which findings would indicate a sign of a potential complication? Select all that apply. 1)Absent bowel signs 2)Increasing restlessness 3)A pulse rate of 108 beats per minute 4)A blood pressure (BP) of 88/58 mm Hg 5)Increasing pain unrelieved by analgesics

2)Increasing restlessness 3)A pulse rate of 108 beats per minute 4)A blood pressure (BP) of 88/58 mm Hg 5)Increasing pain unrelieved by analgesics Rationale:Shock that occurs after surgery is most often related to hypovolemia secondary to hemorrhage or inadequate fluid replacement. Increasing restlessness noted in a client is a sign that requires continuous and close monitoring because it could indicate shock. The client may have increasing pain from a buildup of blood internally. Vital sign changes that eventually occur include a drop in BP and an increased pulse rate. Absent bowel sounds are normal in the immediate postoperative period following abdominal surgery. The restlessness may progress to other signs of shock quickly. Remember that early treatment improves the outcome.

A client diagnosed with diabetes mellitus has a foot infection and is prescribed antibiotic therapy with an aminoglycoside. The nurse collects data from the client and notes that the client has a hearing loss. The nurse would take which action next? 1)Give the medication but at half the prescribed dose. 2)Inform the registered nurse (RN) about the hearing loss. 3)Have the client drink extra water to avoid toxic side effects. 4)Suggest a peak and trough to ensure safe medication administration.

2)Inform the registered nurse (RN) about the hearing loss. Rationale:A preexisting hearing loss is a contraindication for the administration of aminoglycosides because these medications can cause ototoxicity and irreversible hearing loss. The nurse should report the findings to the RN to protect the client's safety. The RN will in turn notify the primary health care provider.

A client with diabetes mellitus visits a healthcare clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 mg/dL to 200 mg/dL (10.2 mmol/L to 11.4 mmol/L). Which medication, added to the client's regimen, may have contributed to the hyperglycemia? 1)Atenolol 2)Prednisone 3)Phenelzine 4)Allopurinol

2)Prednisone Rationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a ß-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 caring for a client with diabetes mellitus who is scheduled to have a right below-knee amputation. The nurse assesses which factors that can put this client at risk for amputation? Select all that apply. 1.Psoriasis 2.Bony deformity 3.Limited joint mobility 4.Peripheral neuropathy 5.Peripheral vascular disease 6.History of skin ulcers or previous amputation

2.Bony deformity 3.Limited joint mobility 4.Peripheral neuropathy 5.Peripheral vascular disease 6.History of skin ulcers or previous amputation Rationale:Certain conditions place clients with diabetes at increased risk for amputation. These factors include peripheral neuropathy, limited joint mobility, bony deformity, peripheral vascular disease, and a history of skin ulcers or previous amputation. The nurse needs to observe for changes that indicate peripheral neuropathy or vascular insufficiency.

The nurse would expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1)Provide a cool environment for the client. 2)Instruct the client to consume a high-fat diet. 3_Instruct the client about thyroid replacement therapy. 4)Encourage the client to consume fluids and high-fiber foods. 5)Inform the client that iodine preparations will be prescribed to treat the disorder. 6)Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

3_Instruct the client about thyroid replacement therapy. 4)Encourage the client to consume fluids and high-fiber foods. 6)Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.' Rationale:The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormones and providing measures to support the signs and symptoms related to a decreased metabolism. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. The client often has cold intolerance and requires a warm environment. The client would notify the PHCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone. Iodine preparations are used to treat hyperthyroidism. These medications decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone.

A calcium supplement is prescribed for a client diagnosed with hypoparathyroidism in the management of hypocalcemia. The client arrives at the clinic for a follow-up visit and complains of chronic constipation, and the nurse reinforces instructions to the client about measures to alleviate the constipation. Which comment by the client would indicate a need for further teaching? 1)"I need to increase my daily fluid intake." 2)"I need to increase my intake of high-fiber foods." 3)"I need to increase my activity level as tolerated." 4)"I need to add 0.5 ounce of mineral oil to my daily diet."

4)"I need to add 0.5 ounce of mineral oil to my daily diet." Clients taking antihypocalcemic medications should be instructed to avoid the use of mineral oil as a laxative because it decreases vitamin D absorption, and vitamin D is needed to assist in the absorption of calcium. Options 1, 2, and 3 are basic measures to alleviate constipation.

A client informs the nurse that she has been taking acarbose as prescribed. The nurse determines that a therapeutic effect of the medication has occurred if which laboratory value is noted? 1)A serum lipase of 100 units/L 2)A sodium level of 140 mEq/L 3)A blood urea nitrogen (BUN) level of 15 mg/dL 4)A 2-hour postprandial serum glucose of 120 mg/dL

4)A 2-hour postprandial serum glucose of 120 mg/dL Rationale:Acarbose is an oral antidiabetic medication used as an adjunct to diet to lower blood glucose in clients with type 2 diabetes mellitus whose hyperglycemia cannot be managed by diet alone. All of the laboratory values presented in the options are within a normal value. Lipase level monitors pancreatic activity. Sodium is an electrolyte. The BUN measures renal function. A 2-hour postprandial serum glucose of 120 mg/dL would identify a therapeutic effect of the medication.

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which is the most reliable indicator of hypoglycemia? 1)Sweating 2)Tachycardia 3)Nervousness 4)Low blood glucose level

4)Low blood glucose level Rationale:β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

A client with diabetes mellitus visits the health care clinic. The client previously had been well controlled with glyburide, but recently the fasting blood glucose has been running 180 to 200 mg/dL. Which medication, if added to the client's regimen, may be contributing to the hyperglycemia? 1)Atenolol 2)Allopurinol 3)Prednisone 4)Phenelzine

3)Prednisone Rationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 3, a beta blocker, and option 2, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents causing increased levels of the oral medications, which can lead to hypoglycemia.

The nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique would provide data necessary to support the admitting diagnosis? 1)Auscultation of lung sounds 2)Inspection of facial features 3)Percussion of the thyroid gland 4)Palpation of the adrenal glands

2)Inspection of facial features Rationale:Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and a blank expression that are characteristic of myxedema. The techniques in the remaining options will not reveal any data that would support the diagnosis of myxedema.

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates the need for further teaching? 1)"I'll eat a balanced meal plan." 2)"I need to drink diet soft drinks." 3)"I need to buy special dietetic foods." 4)"I will snack on fruit instead of cake."

3)"I need to buy special dietetic foods." Rationale:It is important to emphasize to the client and family that they are not eating a diabetic diet, but rather following a balanced meal plan. Adherence to nutrition principles is an important component of diabetic management, and an individualized meal plan should be developed for the client. It is not necessary for the client to purchase special dietetic foods.

The nurse is caring for a client newly diagnosed with diabetes mellitus. The client asks the nurse whether eating at a restaurant will affect the diabetic control and whether this is allowed. Which nursing response is appropriate? 1)"You really should not eat in restaurants."\ 2)"If you plan to eat in a restaurant, you need to avoid carbohydrates." 3)"You should order a half-portion meal and have fresh fruit for dessert." 4)"You should increase your daily dose of insulin by half on the day you plan to eat out."

3)"You should order a half-portion meal and have fresh fruit for dessert." Rationale:Clients with diabetes mellitus are instructed to make adjustments in their total daily intake to plan for meals at restaurants or parties. Some useful strategies include ordering half portions, salads with dressing on the side, fresh fruit for dessert, and baked or steamed entrées. Clients are not instructed to avoid any food group or to increase their prescribed insulin dosage.

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which primary health care provider's prescription noted on the record indicates the need for clarification? 1)Instruct the client to avoid blowing the nose. 2)Monitor vital signs and neurological status. 3)Apply a loose dressing if any clear drainage is noted. 4)Instruct the client about the need for a Medic-Alert bracele

3)Apply a loose dressing if any clear drainage is noted. Rationale:The nurse should observe for clear nasal drainage; constant swallowing; and a severe, persistent, generalized, or frontal headache. These signs and symptoms indicate cerebrospinal fluid leak into the sinuses. If clear drainage is noted following this procedure, the primary health care provider needs to be notified immediately.

A comatose client with an admitting diagnosis of diabetic ketoacidosis (DKA) has a blood glucose value of 368 mg/dL, arterial pH of 7.2, arterial bicarbonate of 14 mEq/L, and is positive for serum ketones. The diagnosis is supported by which noted data? Select all that apply. 1)Shakiness 2)Hypertension 3)Fruity breath odor 4)Rapid, deep breathing 5)Dry mucous membranes

3)Fruity breath odor 4)Rapid, deep breathing 5)Dry mucous membranes Rationale:Diabetic ketoacidotic coma is usually identified with a fruity breath odor; dry, cracked mucous membranes; hypotension; and rapid, deep breathing. Hypoglycemia is identified by cool, clammy skin; shakiness; and hunger.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. The appropriate nursing response to the client is based on which information? 1)A higher dosage is required. 2)The medication may need to be changed. 3)Full therapeutic effect may take 1 to 3 weeks. 4)Full therapeutic effect may take up to 4 months.

3)Full therapeutic effect may take 1 to 3 weeks. Rationale:Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the appropriate response is to inform the client that full therapeutic effect may take 1 to 3 weeks.

A client is diagnosed with hyperparathyroidism. The nurse teaching the client about dietary alterations to manage the disorder tells the client to limit which food in the diet? 1)Bananas 2)Oatmeal 3)Ice cream 4)Chicken breast

3)Ice cream Rationale:The client with hyperparathyroidism is likely to have elevated calcium levels. This client should reduce intake of dairy products such as milk, cheese, ice cream, or yogurt. Apples, bananas, chicken, oatmeal, and pasta are low-calcium foods.

A client has been diagnosed with hypoparathyroidism. Which food groups should be included in the diet? 1)High in phosphorus and low in calcium 2)Low in phosphorus and low in calcium 3)Low in phosphorus and high in calcium 4)High in phosphorus and high in calcium

3)Low in phosphorus and high in calcium Rationale:Hypoparathyroidism results in hypocalcemia. A therapeutic diet for this disorder is one that is high in calcium but low in phosphorus because these two electrolytes have inverse proportions in the body. All of the other options are unrelated to this disorder and are incorrect.

An older client with a history of hyperparathyroidism and severe osteoporosis is hospitalized. The nurse caring for the client plans to address which problem first? 1)Constipation 2)Urinary retention 3)The possibility of injury 4)Need for teaching about the disorder

3)The possibility of injury Rationale:The client with severe osteoporosis as a result of hyperparathyroidism is at risk for injury as a result of pathological fractures that can occur from bone demineralization. The client may also have a risk for constipation from the disease process, but this is a lesser priority than client safety. The client may or may not have urinary elimination problems depending on other factors in the client's history. There is no information in the question to support whether the client needs teaching.

Somatrem is administered to a client with pituitary dwarfism. Which is the expected therapeutic effect of this medication? 1)To promote weight gain 2)To increase bone density 3)To stimulate linear growth 4)To decrease the mobilization of fats

3)To stimulate linear growth Rationale:Somatrem is a growth stimulator used in the long-term treatment of growth failure resulting from growth hormone deficiency. It stimulates linear growth and increases the number and size of muscle cells and red cell mass. It affects carbohydrate metabolism by antagonizing the action of insulin, increasing mobilization of fats, and increasing cellular protein synthesis.

A hospitalized client with type 1 diabetes mellitus received NPH and regular insulin 2 hours ago at 7:30 am. The client calls the nurse and reports that he is feeling hungry, shaky, and weak. The client ate breakfast at 8:00 and is due to eat lunch at noon. List in order of priority the actions that the nurse should take. Arrange the actions in the order that they should be performed. All options must be used. 1.Take the client's vital signs. 2.Retest the client's blood glucose level. 3.Check the client's blood glucose level. 4.Give the client half a cup of fruit juice to drink. 5.Give the client a small snack of carbohydrate and protein. 6.Document the client's complaints, the actions taken, and the outcome.

3.Check the client's blood glucose level. 4.Give the client half a cup of fruit juice to drink. 1.Take the client's vital signs. 2.Retest the client's blood glucose level. 5.Give the client a small snack of carbohydrate and protein. 6.Document the client's complaints, the actions taken, and the outcome. Rationale:The client is experiencing symptoms of mild hypoglycemia. If symptoms such as hunger, irritability, shakiness, or weakness occur, the nurse first would check the client's blood glucose level to verify that the client is experiencing hypoglycemia. After this is verified, the nurse would give the client 10 to 15 g of carbohydrates and then retest the blood glucose level in 15 minutes. In the meantime, the nurse would check the client's vital signs. The nurse would give the client another food item containing 10 to 15 g of carbohydrate if the client's symptoms do not resolve. Otherwise, the nurse would provide a small snack of carbohydrates and protein if the client's next scheduled meal is more than an hour away from the time of the occurrence. After treatment and the resolution of the hypoglycemic event, the nurse would document the occurrence, the actions taken, and the outcome.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding would the nurse expect to note as confirming this diagnosis? 1)Coma 2)Decreased urine output 3)Increased respirations and an increase in pH 4)Elevated blood glucose and low plasma bicarbonate

4)Elevated blood glucose and low plasma bicarbonate Rationale:In DKA, the arterial pH is less than 7.35, plasma bicarbonate is less than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria and Kussmaul's respirations. Coma may occur if DKA is not treated, but coma would not confirm the diagnosis.

A client is brought to the emergency department with suspected diabetic ketoacidosis (DKA). Which finding would the nurse note as being consistent with this diagnosis? 1)High serum glucose level and an increase in pH 2)Decreased urine output and Kussmaul's respirations 3)Low serum potassium and high serum bicarbonate level 4)High serum glucose level and low serum bicarbonate level

4)High serum glucose level and low serum bicarbonate level Rationale:In DKA the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The arterial pH is low (less than 7.35.) The plasma bicarbonate is also low. The client would exhibit polyuria and Kussmaul's respirations. The potassium level usually is elevated as a result of dehydration.

The nurse is planning to instruct a client with diabetes mellitus who has hypertension about "sick day management." Which beverage does the nurse avoid putting on a list of easily consumed carbohydrate-containing beverages for use when the client cannot tolerate food orally? 1)Cola 2)Ginger ale 3)Apple juice 4)Mineral water

4)Mineral water Rationale:Diabetic clients should take in approximately 15 g of carbohydrate every 1 to 2 hours when unable to tolerate food because of illness. Each of the beverages listed in options 1, 2, and 3 provides approximately 13 to 15 g of carbohydrate in a half-cup serving. Mineral water is incorrect for two reasons. First, it contains sodium and should not be used by the client with hypertension. Second, it is not a source of carbohydrates.

A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 9%. On the basis of this test result, the nurse plans to reinforce teaching the client about the need for which measure? 1)Avoiding infection 2)Taking in adequate fluids 3)Preventing and recognizing hypoglycemia 4)Preventing and recognizing hyperglycemia

4)Preventing and recognizing hyperglycemia' Rationale:The normal reference range for the glycosylated hemoglobin A1c (HgbA1c) is 4.0% to 6.0%. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. Thus the test is useful in identifying clients who have periods of hyperglycemia that are undetected in other ways. Therefore, an HgbA1c of 9% is elevated. Elevations indicate continued need for teaching related to the prevention of hyperglycemic episodes.

The nurse is caring for a client with hypothyroidism who is overweight. Which food items would the nurse suggest to include in the plan? 1)Organ meat, carrots, and skim milk 2)Seafood, spinach, and cream cheese 3)Peanut butter, avocado, and red meat 4)Skim milk, apples, whole-grain bread, and cereal

4)Skim milk, apples, whole-grain bread, and cereal Rationale:Clients with hypothyroidism may have a problem with being overweight because of their decreased metabolic need. They should consume foods from all food groups, which will provide them with the necessary nutrients; however, the foods should be low in calories. Skim milk, apples, whole-grain bread, and cereal is the only option containing food items that are low in calories.

living will

A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.

Lipodystrophy

Abnormality in the metabolism or deposition of fats. Insulin lipodystrophy is the loss of local fat deposits in diabetic patients as a complication of repeated insulin injections.

palliative care

Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.

oliguria

Decreased urine output

DNR order

Do not resuscitate order: gives you permission not to attempt resuscitation.

polydispia

Excessive thirst that persists for long periods of time, despite reasonable fluid intake. Often the result of excessive urination.

artificial feeding

Feeding via a tube into the stomach or intestine when a person is unable to take oral nutrition.

Agranulocytosis

a deficiency of granulocytes in the blood, causing increased vulnerability to infection.

Hospice

a home providing care for the sick, especially the terminally ill.

durable power of attorney

a legal agreement that allows an agent or representative of the patient to act on behalf of the patient

polyphagia

excessive hunger

profuse diaphoresis

excessive sweating

polyuria

excessive urination

Osmotic Diuresis

greatly increased urination and dehydration that results when high levels of glucose cannot be reabsorbed into the blood from the kidney tubules and the osmotic pressure of the glucose in the tubules also prevents water reabsorption.

thyroiditis

inflammation of the thyroid gland; may lead to chronic hypothyroidism or may resolve spontaneously

Thrombocytopenia

low platelet count

Greif

mental and emotional distress and suffering that one experiences with death and loss, and it is expressed in various ways by each individual

The nurse is instructing a client with Addison's disease about a newly prescribed medication, fludrocortisone acetate. Which statement by the client indicates a need for further teaching? 1)"I will be glad to gain weight." 2)"I will take it with milk or food." 3)"I will wear a Medic-Alert bracelet." 4)"I will taper down the dosage of the medication."

1)"I will be glad to gain weight." Rationale:The client should notify the primary health care provider of weight gain. The client should take oral drugs with food or milk. The client should wear a Medic-Alert bracelet. Fludrocortisone acetate should not be stopped abruptly but should be tapered down.

A client with a pituitary tumor will undergo transsphenoidal hypophysectomy. The nurse reinforces which information in the preoperative teaching plan for the client? 1)Blowing the nose following surgery is prohibited. 2)A small area will be shaved at the base of the neck. 3)It will be necessary to cough and deep breathe following the surgery. 4)Brushing the teeth vigorously and frequently is important to minimize bacteria in the mouth.

1)Blowing the nose following surgery is prohibited. Rationale:The approach used for this surgery is the oronasal route, specifically where the upper lip meets the gum. The surgeon then uses a route through the sphenoid sinus to get to the pituitary gland. The client is not allowed to blow the nose, sneeze, or cough vigorously because these activities could raise intracranial pressure. The client also is not allowed to brush the teeth to avoid disrupting the surgical site. Alternate methods for performing mouth care are used.

A client with diabetes mellitus decides to exercise an extra 30 minutes. The client is now experiencing hypoglycemia. Hypoglycemia is supported by which noted data? Select all that apply. 1)Hunger 2)Shakiness 3)Cool, clammy skin 4)Fruity breath odor 5)Rapid, deep breathing

1)Hunger 2)Shakiness 3)Cool, clammy skin Rationale:Hypoglycemia is identified by cool, clammy skin; shakiness; and hunger. Diabetic ketoacidotic coma is usually identified with a fruity breath odor; dry, cracked mucous membranes; hypotension; and rapid, deep breathing.

A client with diabetes mellitus has a blood glucose level of 596 mg/dL on admission. The nurse anticipates that this client is at risk for which type of acid-base imbalance? 1)Metabolic acidosis 2)Metabolic alkalosis 3)Respiratory acidosis 4)Respiratory alkalosis

1)Metabolic acidosis Rationale:Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises while the cells of the body use all available glucose and then break down glycogen and fat for fuel, which leads to the formation of ketones. The by-products of fat metabolism are acidotic, leading to the complication called diabetic ketoacidosis.

The nurse notes in the medical record that a client with Cushing's syndrome is experiencing fluid overload. Which interventions would be included in the plan of care? Select all that apply. 1)Monitoring daily weight 2)Monitoring intake and output 3)Maintaining a low-sodium diet 4)Maintaining a low-potassium diet 5)Monitoring extremities for edema

1)Monitoring daily weight 2)Monitoring intake and output 3)Maintaining a low-sodium diet 5)Monitoring extremities for edema Rationale:The client with Cushing's syndrome experiencing fluid overload should be maintained on a high-potassium and low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water. Monitoring weight, intake, output, and extremities for edema are all appropriate interventions for such a nursing diagnosis.

A client diagnosed with hyperthyroidism will be taking propylthiouracil. The nurse reinforces medication instructions and determines that the client understands the information if the client states that it is most important to report which symptoms to the primary health care provider? 1)Sore throat 2)Excitability 3)Weight loss 4)Muscle aches

1)Sore throat Rationale:An adverse effect of propylthiouracil is agranulocytosis. The client should be alert for this effect by noting the presence of fever or sore throat, which should be reported immediately. Muscle aches, weight loss, and excitability are neither side effects nor adverse effects of this medication.

The nurse is preparing to discharge a client who has had a parathyroidectomy. When reinforcing instructions to the client about the prescribed oral calcium supplement, which information would the nurse include? 1)Take the calcium 30 to 60 minutes following a meal. 2)Avoid sunlight because it can cause skin color change. 3)Store the calcium in the refrigerator to maintain potency. 4)Check the pulse daily and hold the dosage if it is below 60 beats per minute.

1)Take the calcium 30 to 60 minutes following a meal. Rationale:Oral calcium supplements can be taken 30 to 60 minutes after meals to enhance their absorption and decrease gastrointestinal irritation. All the other options are unrelated to oral calcium therapy.

The nurse is discussing foot care with a diabetic client and the spouse. The nurse includes which instruction during this informational session? 1)The toenails should be cut straight across. 2)Strong soap should be used to decrease skin bacteria. 3)There is decreased risk of infection when feet are soaked in hot water. 4)Lanolin should be applied to dry feet, especially the heels and between the toes.

1)The toenails should be cut straight across. Rationale:The client should be instructed to cut the toenails straight across. The client should not soak the feet in hot water to prevent burns. The client should be instructed to wash the feet daily using a mild soap. Moisturizing lotion can be applied to the feet but should not be placed between the toes.

Iron dextran is prescribed to be administered intramuscularly to a client. The nurse prepares the medication and determines that the appropriate method of administration is which? 1)Using the Z-track technique 2)Injecting into the deltoid muscle 3)Using a ⅝-inch needle on a large syringe 4)Applying heat to the injection site before administration

1)Using the Z-track technique Rationale:A disadvantage of administering iron dextran intramuscularly is that it causes pain and discoloration at the injection site. When intramuscular administration is prescribed, the medication should be injected deep into the buttock with the Z-track technique. Z-track injection keeps the iron dextran deep in the muscle, thereby minimizing leakage and surface discoloration. The Z-track technique is used for injection of medications that can stain or irritate the skin. A ⅝-inch needle is used for subcutaneous injections. Applying heat to an injection site before administration is an incorrect action.

Which instruction would the nurse reinforce to the client with diabetes mellitus receiving acarbose? Select all that apply. 1"Take the medication at bedtime." 2"Take the medication with each meal." 3"Take the medication on an empty stomach." 4"Side effects include abdominal bloating and flatus." 5"Take some form of glucose if hypoglycemia occurs." 6"Report symptoms such as shortness of breath or tiredness.

2"Take the medication with each meal." 4"Side effects include abdominal bloating and flatus." 5"Take some form of glucose if hypoglycemia occurs." 6"Report symptoms such as shortness of breath or tiredness. Rationale:The mechanism of action of acarbose is a delay in absorption of dietary carbohydrates, thereby reducing the rise in blood glucose after a meal. To accomplish this, the medication must be taken with each meal. Because of its bacterial fermentation of unabsorbed carbohydrates in the colon, side effects such as borborygmus, cramps, abdominal distention, and flatulence can occur. The medication also can affect absorption of iron, leading to symptoms (shortness of breath,

Which client is at risk for developing thyrotoxicosis? 1)A client with hypothyroidism 2)A client with Graves' disease who is having surgery 3)A client with diabetes mellitus scheduled for debridement of a foot ulcer 4)A client with diabetes insipidus scheduled for an invasive diagnostic test

2)A client with Graves' disease who is having surgery Rationale:Thyrotoxicosis is usually seen in clients with Graves' disease with the symptoms precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, the birth process, or major surgery. It also must be recognized as a potential complication following a thyroidectomy.

A client has just been admitted with a diagnosis of myxedema coma. If all of the following interventions were prescribed, the nurse would place highest priority on completing which action first? 1)Warming the client 2)Administering oxygen 3)Giving fluid replacement 4)Administering thyroid hormone

2)Administering oxygen Rationale:As part of maintaining a patent airway, oxygen would be administered first. This would be quickly followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones.

The nurse is assisting in performing an arterial blood gas (ABG) analysis on a client. The nurse initially implements which intervention after the blood gas is drawn to minimize the risk for uncontrolled bleeding? 1)Applying cold packs to the site 2)Applying direct pressure to the site 3)Covering the site with 4 x 4 gauze 4)Performing range of motion to the fingers

2)Applying direct pressure to the site Rationale:Pressure should be applied to the site following an ABG draw. The pressure in the artery is higher than in the veins. It is therefore necessary to apply pressure to the punctured artery to control bleeding usually for 5 minutes. Cold causes vasoconstriction and so decreases bleeding, but it is not as effective in this case as applying pressure. Placing gauze may protect the site but will not control bleeding. Exercise will increase circulation to the area.

Which nursing measure would be effective in preventing complications in a client with Addison's disease? 1)Restricting fluid intake 2)Monitoring the blood glucose 3)Offering foods high in potassium 4)Checking family support systems

2)Monitoring the blood glucose Rationale:The decrease in cortisol secretion that characterizes Addison's disease can result in hypoglycemia. Therefore, monitoring the blood glucose would detect the presence of hypoglycemia so that it can be treated early to prevent complications. Fluid intake should be encouraged to compensate for dehydration. Potassium intake should be restricted because of hyperkalemia. Option 4 would not prevent complications for this client.

The nurse is monitoring a client following a thyroidectomy for signs/symptoms of hypocalcemia. Which signs/symptoms noted in the client indicates the presence of hypocalcemia? Select all that apply. 1)Bradycardia 2)Muscle spasms 3)Positive Trousseau's sign 4)Negative Chvostek's sign 5)Tingling around the mouth

2)Muscle spasms 3)Positive Trousseau's sign 5)Tingling around the mouth Rationale:Following a thyroidectomy, the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and fingertips, muscle twitching or spasms, palpitations or dysrhythmias, and positive Chvostek's and Trousseau's signs.

The nurse is caring for a client newly diagnosed with type 1 diabetes mellitus. In reviewing the medical record the nurse would note which signs and symptoms? Select all that apply. 1)Oliguria 2)Polyphagia 3)Poor healing 4)Blurred vision 5)Extreme thirst 6)Rapid weight loss

2)Polyphagia 5)Extreme thirst 6)Rapid weight loss Rationale:Signs and symptoms of type 1 diabetes mellitus include extreme thirst (polydipsia), extreme hunger (polyphagia), frequent urination (polyuria), and rapid weight loss. Signs and symptoms of type 2 diabetes mellitus include weight gain, poor healing, blurred vision, and itching.

The nurse is collecting data from a client who is being admitted to the hospital for a diagnostic workup for primary hyperparathyroidism. The nurse understands that which client complaint would be characteristic of this disorder? 1)Diarrhea 2)Polyuria 3)Polyphagia 4)Weight gain

2)Polyuria Rationale:Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis (polyuria). This diuresis leads to dehydration and the client would lose weight. Options 1, 3, and 4 are gastrointestinal (GI) symptoms but are not associated with the common GI symptoms typical of hyperparathyroidism (nausea, vomiting, anorexia, constipation).

What is included in the treatment of Addison's disease? Select all that apply. 1)Radiation 2)Prednisone 3)Spironolactone 4)Adrenalectomy 5)Fludrocortisone

2)Prednisone 5)Fludrocortisone Rationale:Addison's disease is treated with replacement therapy to provide the missing hormones, but the patient must continue taking the hormones as lifelong therapy. Prednisone is given to replace glucocorticoids; fludrocortisone is a synthetic adrenocortical steroid to replace the mineralocorticoid aldosterone. Cushing's syndrome treatment includes drug therapy, radiation, and surgery. Bilateral benign tumors more often are treated with an aldosterone antagonist agent (i.e., a drug that reduces aldosterone secretion or blocks its effects such as potassium-sparing diuretic spironolactone.

The nurse is asked to assist in preparing a heparin sodium infusion for a client with a diagnosis of thrombophlebitis. Which items would the nurse have available for this procedure? Select all that apply. 1)Phytonadione 2)Protamine sulfate 3)Intravenous tubing 4)Intravenous infusion controller 5)Intravenous insertion equipment

2)Protamine sulfate 3)Intravenous tubing 4)Intravenous infusion controller 5)Intravenous insertion equipment Rationale:Phytonadione is the antidote for warfarin sodium, so this is an unnecessary item. Protamine sulfate is the antidote for heparin and should be available if heparin overdose occurs. Heparin is administered by the intravenous (IV) route, so IV insertion equipment is needed. IV tubing will be necessary for connection of the IV solution with the prescribed heparin dosage to the client's IV catheter. Heparin is always infused via an IV pump or controller.

When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is essential? 1)Lower the head of the bed. 2)Test the drainage for glucose. 3)Obtain a culture of the drainage. 4)Continue to observe the drainage.

2)Test the drainage for glucose. Rationale:After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the drainage should be collected and tested for glucose indicating the presence of CSF. The head of the bed should not be lowered to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.

A client has been prescribed acarbose for treatment of diabetes mellitus. Client teaching regarding this medication would include which instructions? Select all that apply. 1)Fatty stools are common. 2)Dizziness should be expected. 3)Abdominal cramping is common. 4)Side effects include excessive flatulence. 5)The medication should be taken with each meal. 6)The medication should be taken with a full glass of water only.

3)Abdominal cramping is common. 4)Side effects include excessive flatulence. 5)The medication should be taken with each meal. Rationale:Acarbose (an alpha-glucosidase inhibitor) inhibits digestion and absorption of carbohydrates, and thereby reduces the postprandial rise in blood glucose. To be effective, the medication must be taken with each meal; a full glass of water alone is not enough sustenance. The major adverse effects of acarbose are gastrointestinal disturbances including flatulence, cramps, and abdominal distention. Fatty stools are seen in the client with cystic fibrosis; this is not a side effect of acarbose. Dizziness is an adverse effect and may be a sign of hypoglycemia; it is not an expected side effect of acarbose.

A client is admitted with a diagnosis of pheochromocytoma. The nurse would monitor which parameter to detect the most common sign of pheochromocytoma? 1)Weight gain 2)Positive urine ketones 3)Blood pressure elevation 4)Decreased skin temperature

3)Blood pressure elevation Rationale:Hypertension is the major symptom associated with pheochromocytoma and is monitored by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are other clinical manifestations of pheochromocytoma; however, hypertension is the most common sign.

The nurse is assisting in preparing a plan of care for a client with diabetes mellitus and plans to reinforce the client's understanding regarding the signs/symptoms of hypoglycemia. Which signs/symptoms would the nurse review? 1)Slow pulse; lethargy; and warm, dry skin 2)Elevated pulse; lethargy; and warm, dry skin 3)Elevated pulse; shakiness; and cool, clammy skin 4)Slow pulse, confusion, and increased urine output

3)Elevated pulse; shakiness; and cool, clammy skin Rationale:Symptoms of mild hypoglycemia include tachycardia; shakiness; and cool, clammy skin

When caring for a client diagnosed with pheochromocytoma, which signs and symptoms would the nurse note? Select all that apply. 1)Bradycardia 2)Flushed face 3)Severe headache 4)Profuse diaphoresis 5)Severe hypertension

3)Severe headache 4)Profuse diaphoresis 5)Severe hypertension Rationale:Pheochromocytoma is a catecholamine-producing tumor of the adrenal gland and causes secretion of excessive amounts of epinephrine and norepinephrine. Signs and symptoms of pheochromocytoma are related to excess catecholamine release. These include tachycardia and severe hypertension (as high as 250/150 mm Hg) that can be intermittent or persistent. Profuse diaphoresis, severe headache, palpitations, nausea, weakness, and pallor may also be present.

A client who will undergo thyroidectomy at a later date has been started on medication therapy with potassium iodide. As the licensed practical nurse (LPN) prepares to administer a scheduled dose, the client states that there is a burning sensation and a brassy taste in the mouth. Which action would the LPN take? 1)Stop the medication for 24 hours. 2)Continue to administer the medication. 3)Withhold the medication and notify the RN. 4)Give half the prescribed dose and notify RN.

3)Withhold the medication and notify the RN. Long-term ingestion of potassium iodide can produce iodism. Symptoms include a brassy taste, burning sensations in the mouth, soreness of gums and teeth, frontal headache, nasal congestion, salivation, and skin lesions. If these occur, the nurse should withhold the medication and notify the RN, who will then contact the primary health care provider.

The client with Cushing's syndrome had bilateral adrenalectomies and is now on corticosteroid therapy. The client also has a history of seizures. The nurse giving discharge instructions concerning corticosteroid therapy realizes there is a need for further teaching when the client makes which statement? 1)"I will take it every morning with my breakfast." 2)"I will never stop taking it abruptly. It will be tapered off." 3)"I will wear a Medic Alert bracelet marked steroid therapy." 4)"I know my doctor can now decrease my dosage of phenytoin."

4)"I know my doctor can now decrease my dosage of phenytoin." Rationale:Corticosteroid therapy should never be stopped abruptly but tapered off. It should be taken in the morning with food. A Medic Alert bracelet needs to be worn because of the many medication interactions. This therapy will decrease the effect of phenytoin, so the dosage will likely be increased.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise? 1)"I should not exercise after lunch." 2)"I should not exercise after breakfast." 3)"I should not exercise in the late evening." 4)"I should not exercise in the late afternoon."

4)"I should not exercise in the late afternoon." Rationale:A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. Humulin N insulin peaks between 6 and 14 hours; therefore, late-afternoon exercise would occur during the peak of the medication.

A hospitalized client is newly diagnosed with diabetes mellitus. The client must take both NPH and regular insulin for glucose control. The nurse develops a teaching plan to help the client meet which outcome as a first step in managing the disease? 1)Avoid all strenuous exercise. 2)Maintain health at an optimum level. 3)Lose 40 pounds to achieve ideal body weight. 4)Adjust insulin according to capillary blood glucose levels.

4)Adjust insulin according to capillary blood glucose levels. Rationale:There are many learning goals for the client who is newly diagnosed with diabetes mellitus. The client must learn dietary control, medication management, and proper exercise in order to control the disease. As a first step, the client learns to adjust medication (insulin) according to blood glucose results as prescribed by the primary health care provider. The client should then focus on long-term dietary control and weight loss, which will often lead to a decreased need for insulin. At the same time that diet is being controlled, the client should begin a regular exercise program to aid in weight loss.

The nurse is reviewing the prescriptions of a client diagnosed with diabetes mellitus who was admitted because of an infected foot ulcer. Which primary health care provider's prescription supports the treatment of this condition? 1)A decreased-calorie diet 2)An increased-calorie diet 3)A decreased amount of NPH daily insulin 4)An increased amount of NPH daily insulin

4)An increased amount of NPH daily insulin Rationale:Infection is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress such as when an infection exists, the client will require an increase in the dose of insulin to facilitate the transport of excess glucose into the cells. The client does not necessarily need an adjustment in the daily diet.

The nurse is collecting data from a client receiving pioglitazone 30 mg orally daily. Which finding indicates that the client is experiencing the expected result of the action of this medication? 1)Increased blood pressure and decreased hypoxia 2)Increased urinary output and reduced proteinuria 3)Reduced serum ammonia and improved level of consciousness 4)Decreased fasting blood glucose and reduced hemoglobin A1c (HbA1c)

4)Decreased fasting blood glucose and reduced hemoglobin A1c (HbA1c) Pioglitazone is similar to other thiazolidinediones, also known as glitazones. Like rosiglitazone, pioglitazone activates peroxisome proliferator-activated receptor PPAR-gamma, and thereby reduces insulin resistance. In clients with type 2 diabetes, monotherapy with pioglitazone can decrease fasting blood glucose by 30 to 56 mg/dL, and can lower HbA1c by about 0.9%.

The nurse is caring for a child with a diagnosis of diabetes insipidus. The nurse anticipates that the primary health care provider will prescribe which medications? 1)Methimazole 2)Furosemide 3)Propylthiouracil 4)Desmopressin acetate

4)Desmopressin acetate Rationale:Desmopressin acetate is used to treat diabetes insipidus. Propylthiouracil is used to treat hyperthyroidism. One of the uses for furosemide is to treat syndrome of inappropriate antidiuretic hormone (SIADH). Methimazole is also used to treat hyperthyroidism.

The nurse reinforces instructions to a pregnant client regarding the administration of iron. The nurse determines that the teaching is effective if the client states that she will take the iron with which food items? 1)Tea 2)Milk 3)Water 4)Tomato juice

4)Tomato juice Rationale:Foods containing ascorbic acid (vitamin C), such as tomato juice, may increase absorption of iron. Additionally, absorption of iron is affected by many substances. Calcium and phosphorus in milk and tannin in tea decrease iron absorption. Water will not act to increase the absorption of the iron.

laryngeal stridor (after thyroidectomy)

a harsh, high-pitched sound heard on inspiration and expiration that is caused by the compression of the trachea and that leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway. CALL A CODE

respite

a short period of rest or relief from something difficult or unpleasant

exopthalmosis

abnormal protrusion of the eyeball

artificial hydration

administration of fluids into the patients body by means of a catheter

Palliative measures

are designed to improve a situation without curing it

hospice care

care provided for the dying in institutions devoted to those who are terminally ill

Diabetic Neuropathies

cell damage from increased glucose levels leads to nerve degeneration & delayed conduction Sensory deficits & symptoms (more than mator involvement) EX: loss of sensation, foot/wrist drop, delayed gastric emptying, altered bladder function Nerve supply to different areas arnt working

Pica

compulsive eating of nonnutritive substances such as clay or ice

thyrotoxicosis

condition caused by the exposure of body tissue to excessive levels of thyroid hormone

role reversal

occurs when the children who are used to being cared for suddenly become the caregivers for their parents.

Toxic nodular goiter

results when one or more nodules, or adenomas, develop in the thyroid and trigger excess production of thyroid hormone,hyperthyroidism

photophobia

sensitivity to light

myxedema

swelling of the skin caused by deposits under the skin, caused by extreme deficiency of thyroid secretion

euthanasia

the act of painlessly killing a suffering person or animal; mercy killing

granulocytosis

the presence of an increased number of granulocytes (granulocytes are a type of white blood cell)

borborygmus

the rumbling noise caused by the movement of gas in the intestine

advocate

to recommend; to speak in favor of the patinet and assuring the patient and family wishes are communicated to other memberrs of the health care team

The nurse is reinforcing discharge teaching to a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? 1)"I can eat foods that contain potassium." 2"I will need to limit the amount of protein in my diet." 3"I am fortunate that I can eat all the salty foods I enjoy." 4"I am fortunate that I do not need to follow any special diet."

1)"I can eat foods that contain potassium."

A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client states to the nurse, "I will call the doctor next time I can't eat for more than a day or so." The nurse plans care understanding that which statement accurately reflects this client's level of knowledge? 1)The client needs immediate education before discharge. 2)The client requires follow-up teaching regarding the administration of insulin. 3)The client's statement is accurate, but knowledge should be evaluated further. 4)The client's statement is inaccurate, and the client should be scheduled for outpatient diabetic counseling.

1)The client needs immediate education before discharge. Rationale:If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the primary health care provider should be notified. The client's statement in this question indicates a need for immediate education to prevent HHS, a life-threatening emergency situation.

An oral hypoglycemic medication, a sulfonylurea, is prescribed for a client with type 2 diabetes mellitus. The nurse is reviewing the medical record and needs to contact the primary health care provider if there is a history of which condition? 1)Acidosis 2)Liver disease 3)Heart failure 4)Inflammatory bowel disease

2)Liver disease Rationale:Sulfonylureas are contraindicated in liver disease. Alpha-glucosidase inhibitors should not be given if there is inflammatory bowel disease. Biguanides are contraindicated in acidosis. Thiazolidinediones should not be given if there is congestive heart failure.

A client is admitted to the emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1)Warm the client. 2)Maintain a patent airway. 3)Monitor intravenous fluids. 4)Administer thyroid hormone.

2)Maintain a patent airway. Rationale:The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement. The nurse would also keep the client warm, monitor intravenous fluids, and administer thyroid hormones.

A client received a dose of regular insulin this morning at 7:00 a.m. At which time would the nurse likely anticipate the potential for a hypoglycemic reaction to occur? 1)8:00 a.m. 2)10:00 a.m. 3)12:00 noon 4)2:00 p.m.

2)10:00 a.m. Rationale:Regular insulin is a rapid-acting insulin with a peak action of 2 to 4 hours after injection. During the peak action of insulin is when hypoglycemic reactions are most likely to occur. This makes option 2 correct.

The nurse would monitor for which laboratory result as indicating an adverse reaction in the client who is receiving chemotherapy? 1)Hemoglobin 12.5 g/dL 2)Platelet count 20,000 mm3 3)Blood urea nitrogen (BUN) 20 mg/dL 4)White blood cell count (WBC) 7000 mm3

2)Platelet count 20,000 mm3 A normal platelet count ranges from 150,000 mm3 to 400,000 mm3. A platelet count of 20,000 mm3 places the client at severe risk for bleeding. All of the other values, hemoglobin, BUN, and WBC, are within normal limits.

The nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). Which is the priority nursing action for this client who is in the acute phase? 1)Correct the acidosis. 2)Administer IV 5% dextrose. 3)Administer intravenous (IV) regular insulin. 4)Apply an electrocardiogram (ECG) monitor.

3)Administer intravenous (IV) regular insulin. Rationale:Lack (absolute or relative) of insulin is the primary cause leading to DKA. Treatment consists of IV fluids (normal saline initially), regular insulin administration, and potassium replacement followed by correcting the acidosis. An ECG monitor may be applied but is not the priority in this situation.

A client who was receiving a blood transfusion has experienced a transfusion reaction. The nurse sends the blood bag that was used for the client to which area? 1)The pharmacy 2)The laboratory 3)The blood bank 4)The risk-management department

3)The blood bank Rationale:The nurse prepares to return the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow-up testing procedures that are needed after a transfusion reaction has been documented. The remaining options are incorrect.

.The nurse is caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed. The nurse determines that this medication has been prescribed for which reason? 1)Treat thyroid storm. 2)Prevent cardiac irritability. 3)Treat hypocalcemic tetany. 4)Stimulate the release of parathyroid hormone.

3)Treat hypocalcemic tetany. Rationale:Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes, or muscle spasms or twitching, the PHCP is notified immediately. Calcium gluconate should be accessible for the client who underwent thyroidectomy.

The nurse in a long-term care facility is observing a nursing student provide foot care to a client with diabetes mellitus. Which action by the nursing student would indicate a need for further teaching? 1)The nursing student tells the client to avoid soaking the feet. 2The nursing student dries the feet thoroughly, including in between the toes. 3The nursing student advises the client to consult the physician or a podiatrist regarding nail trimming. 4The nursing student applies lotion to the dorsal and plantar surfaces of the feet and in between the toes.

4)The nursing student applies lotion to the dorsal and plantar surfaces of the feet and in between the toes. -Clients with diabetes mellitus are at an increased risk for impaired skin integrity related to peripheral neuropathy or vascular insufficiency. The feet are at an increased risk for the development of wounds and some client's may not be able to thoroughly inspect the feet regularly due to impaired mobility or other impairments. Meticulous foot care is necessary to prevent complications. The client's feet would not be soaked to prevent maceration, or skin softening, as this increases the risk of infection. Regarding nail trimming, a podiatrist or a physician's order may be necessary to trim the nails, as a client with diabetes mellitus is at increased risk for infection if the skin were to be accidentally cut. The feet need to be dried thoroughly, with special attention given to the areas in between the toes, as skin breakdown or ulcers can go undetected in this area. Lotion needs to be applied to the dorsal and plantar surfaces of the foot. However, it would not be applied in between the toes as this area needs to be kept dry.

advance medical directives

Legal documentation in which an individual indicates the kinds of future medical treatments she will accept should she be incapacitated (and therefore be unable to make treatment decisions) at the time the treatment is needed

Comorbidity

the co-occurrence of two or more disorders in a single individual

Fludrocortisone is prescribed for a client with Addison's disease. The primary health care provider needs to be notified if the client experiences which conditions? Select all that apply. 1)Edema 2)Chest pain 3)Weight loss 4)Muscle cramps 5)Abnormal lung sounds

1)Edema 2)Chest pain 4)Muscle cramps Rationale:The client with Addison's disease being treated with fludrocortisone needs to notify the primary health care provider of muscle cramps, weight gain, edema, nausea, infection, trauma, stress, or chest pain.

The nurse is reviewing a plan of care for a client with Addison's disease. The nurse notes that the client is at risk for dehydration and suggests nursing interventions that will prevent this occurrence. Which nursing interventions are appropriate components of the plan of care? Select all that apply. 1)Monitoring intake and output 2)Maintaining a low-sodium diet 3)Monitoring for changes in mental status 4)Encouraging an intake of low-protein foods 5)Encouraging fluid intake of at least 3000 mL/day

1)Monitoring intake and output 3)Monitoring for changes in mental status 5)Encouraging fluid intake of at least 3000 mL/day Rationale:The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase the intake of sodium, protein, and complex carbohydrates. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required.

The nurse is collecting data on a client with hyperparathyroidism. Which question would elicit accurate information about this condition from the client? 1)"Do you have tremors in your hands?" 2)"Are you experiencing pain in your joints?" 3)"Have you had problems with diarrhea lately?" 4)"Do you notice swelling in your legs at night?"

2)"Are you experiencing pain in your joints?" Rationale:Hyperparathyroidism causes an 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 pathological fractures.

The nurse is planning to administer an oral glucose tolerance test (OGTT) to a client to rule out or confirm diabetes mellitus. The nurse knows that the client needs more information when the client makes which statements? Select all that apply. 1)"I may not eat anything during the test." 2)"I can at least drink fluids during the test." 3)"I have 30 minutes to drink the glucose load." 4)"I may not smoke for the duration of the test." 5)"I will have blood drawn every 30 minutes for the next 2 hours." 6)"I will have blood drawn every 5 minutes for the next 3 hours."

2)"I can at least drink fluids during the test." 3)"I have 30 minutes to drink the glucose load." 6)"I will have blood drawn every 5 minutes for the next 3 hours." Rationale:With an oral glucose tolerance test, the client should have fasted for 10 to 12 hours. After a fasting blood sample is obtained, the client consumes a 75-g or 100-g glucose load in 5 minutes. Blood is drawn every 30 minutes for 2 or 3 hours, depending on the glucose load. During the test, the client may not eat, drink, or smoke.

The nurse is reinforcing home care instructions to a client with a diagnosis of Cushing's syndrome. Which client statement reflects a need for further teaching? 1)"Taking my medications exactly as prescribed is essential." 2)"I need to read the labels on any over-the-counter medications I purchase." 3)"My family needs to be familiar with the signs and symptoms of hypoadrenalism." 4)"I could experience the signs and symptoms of hyperadrenalism because of Cushing's."

2)"I need to read the labels on any over-the-counter medications I purchase." Rationale:The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the primary health care provider before purchasing any over-the-counter medications, and maintaining regular follow-up care. The nurse should also instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

The client plans to give his lispro insulin injection at 0800 right before eating breakfast. The nurse knows that the client understood the education provided when the client states which time presents the greatest risk for hypoglycemia? 1)0815 2)0930 3)1045 4)1200

2)0930 Rationale:Rapid-acting insulin such as lispro peaks in 30 to 90 minutes after subcutaneous administration. Peak times of insulin correlates with the highest incidence of hypoglycemia. Option 1 correlates with the onset of action, and options 3 and 4 correlate with the duration of action.

A registered nurse has just hung a 250-mL bag of packed red blood cells (PRBCs) on a client. The licensed practical nurse assisting in caring for the client plans to remain with the client for at least how many minutes following the start of the infusion? 1)5 minutes 2)15 minutes 3)30 minutes 4)60 minutes

2)15 minutes

The nurse is caring for a client with Addison's disease. The diagnosis is supported by which noted data? Select all that apply. 1)Hirsutism 2)Weight loss 3)Buffalo hump 4)Skin hyperpigmentation 5)Orthostatic hypotension

2)Weight loss 4)Skin hyperpigmentation 5)Orthostatic hypotension Rationale:Addison's disease is a decreased secretion of the adrenal cortex. Signs and symptoms include orthostatic hypotension, decreased body hair, weight loss, skin hyperpigmentation, and progressive weakness.

The nurse is reinforcing instructions to the client about insulin glargine. The nurse determines that the client understands the action of the medication if the client makes which statement? 1)"I will add this medication to my insulin pump." 2)"I will take this medication 30 minutes before each meal." 3)"I will give myself this medication subcutaneously once each night before bed." 4)"I will only need to monitor my blood glucose every other day with this medication."

3)"I will give myself this medication subcutaneously once each night before bed. Rationale:Insulin glargine is a modified human insulin with a prolonged duration of action (at least 24 hours). The medication is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes mellitus and adults with type 2 diabetes mellitus. The daily injection should be administered at bedtime. Regular insulin is the only insulin that can be added to an insulin pump. Regardless of the type of insulin the client uses, the blood glucose should be monitored at least daily if not more often.

The nurse is taking care of a client preoperatively. The client is nothing-by-mouth (NPO) and an intermediate and short-acting insulin are scheduled for 0700 daily. The client's surgery is scheduled for 0900. Which is the best action for the nurse to take? 1)Administer both medications. 2)Obtain and document the client's finger stick glucose level. 3)Call the primary health care provider (PHCP) for clarification. 4)Withhold both medications and document surgery as a reason for withholding the medication.

3)Call the primary health care provider (PHCP) for clarification. Rationale:The diabetic client who is going to surgery will not have the usual diet and will not require the routine prescribed insulins. The primary health care provider should be notified to prescribe an adjusted insulin dosage for the day of surgery. The nurse must contact the PHCP for clarification of the prescription and should not give the medication because it might lead to hypoglycemia during surgery. The nurse should not withhold the insulin because this might lead to hyperglycemia during surgery and can cause increased risk for infection and impaired wound healing. The nurse may obtain the finger stick glucose reading, but this should be reported to the PHCP when seeking clarification.

The nurse is reinforcing instructions to a client newly diagnosed with diabetes mellitus regarding insulin administration. The primary health care provider has prescribed a mixture of NPH and regular insulin. The nurse would stress that which is the first step? 1)Draw up the correct dosage of NPH insulin into the syringe. 2)Draw up the correct dosage of regular insulin into the syringe. 3)Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4)Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

3)Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. Rationale:The initial step in preparing an injection of insulin that is a mixture of NPH and regular is to inject air into the NPH bottle equal to the amount of insulin prescribed. The client is instructed to next inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular insulin should then be withdrawn followed by the NPH insulin. Contamination of regular insulin with NPH insulin will convert part of the regular insulin into a longer-acting form.

Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma? 1)Weigh the client. 2)Test the client's urine for glucose. 3)Monitor the client's blood pressure. 4)Palpate the client's skin to determine warmth.

3)Monitor the client's blood pressure. Rationale:Hypertension is the major symptom that is associated with pheochromocytoma. The blood pressure status is monitored by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are also signs/symptoms of pheochromocytoma, but hypertension is the major symptom.

The nurse is reinforcing discharge instructions to a client who has undergone transsphenoidal surgery for a pituitary adenoma. Which statement by the client indicates understanding of the discharge instructions? 1)"I need to remove the nasal packing in 1 week." 2)"I need to cough and deep breathe every 2 hours." 3)"I can take acetaminophen (Tylenol) if I get a severe headache." 4)"I need to call the doctor if I develop frequent swallowing or postnasal drip."

4)"I need to call the doctor if I develop frequent swallowing or postnasal drip." Rationale:The client should report frequent swallowing or postnasal drip after transsphenoidal surgery because it could indicate cerebrospinal fluid (CSF) leakage. The surgeon removes the nasal packing, usually after 24 hours. The client should deep breathe, but coughing is contraindicated because it could cause increased intracranial pressure (ICP). The client should also report a severe headache because it could indicate increased ICP.

A client is diagnosed with hypothyroidism, and levothyroxine is prescribed. The nurse notes that the client is presently taking warfarin sodium and anticipates that the primary health care provider will alter which medication dosage? 1)Decrease the dosage of levothyroxine. 2)Increase the dosage of levothyroxine. 3)Increase the dosage of warfarin sodium. 4)Decrease the dosage of warfarin sodium.

4)Decrease the dosage of warfarin sodium. Rationale:Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, effects of warfarin sodium are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin sodium, the dosage of warfarin sodium should be reduced.

The nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which item in the diet? Correct Answer 1)Meat 2)Fish 3)Cereals 4)Vegetables

4)Vegetables Rationale:The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals. Vegetables are allowed in the diet.

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine

The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse would teach the client that which result is a sign of hypoglycemia? 1)Less than 50 mg/dL 2)Less than 90 mg/dL 3)Less than 100 mg/dL 4)Less than 120 mg/dL

1)Less than 50 mg/dL Rationale:The principal adverse effect of insulin therapy is hypoglycemia. The normal blood glucose level ranges from 90 to 110 mg/dL. Therefore, a blood glucose level less than 50 mg/dL is an indication of hypoglycemia.

The nurse is teaching a client, newly diagnosed with diabetes mellitus, to mix 24 units NPH and 12 units regular insulin in the same syringe. Which instructions would the nurse give to the client to take after wiping the vials with an alcohol wipe? 1)Inject 24 units of air into the NPH insulin vial. 2)Inject 12 units of air into the regular insulin vial. 3)Draw up the NPH insulin first without injecting any air. 4)Draw up the regular insulin first without injecting any air

1)Inject 24 units of air into the NPH insulin vial. Rationale:After wiping the vials with an alcohol wipe, the nurse would inject 24 units of air into the NPH insulin vial, then 12 units of air into the regular insulin vial. Air should be injected into the vials before drawing the correct dose. Cloudy to clear

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1)Insomnia 2)Weight loss 3)Bradycardia 4)Constipation 5)Mild heat intolerance

1)Insomnia 2)Weight loss 5)Mild heat intolerance Rationale:Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, but rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information would the nurse obtain from the client during data collection? 1)Plan for injection rotation 2)Consistency of aspiration 3)Preparation of the injection site 4)Angle at which the medication is administered

1)Plan for injection rotation Rationale:Lipodystrophy (i.e., the hypertrophy of subcutaneous tissue at the injection site) occurs in some diabetic clients when the same injection sites are used for prolonged periods of time. Thus clients are instructed to adhere to a rotating injection site plan to avoid tissue changes. Preparation of the site, aspiration, and the angle of insulin administration do not produce tissue damage.

The nurse has collected data on a client with diabetes mellitus. Findings include a fasting blood glucose of 130 mg/dL, temperature 101° F, pulse of 88 beats per minute, respirations of 22 breaths per minute, and a blood pressure of 118/78 mm Hg. Which finding would be of concern to the nurse? 1)Temperature 2)Blood glucose 3)Blood pressure 4)Pulse and respirations

1)Temperature Rationale:Elevated temperature may be indicative of infection, which is a leading cause of hyperglycemic hyperosmolar state (HHS) or diabetic ketoacidosis (DKA). Options 2, 3, and 4 are findings that are within a normal range.

The nursing student is presenting a clinical conference and discusses the causative factors related to beta-thalassemia. Which group is at greatest risk of developing this disorder? 1)A child of Mexican descent 2)A child of Mediterranean descent 3)A child whose intake of iron is extremely poor 4)A child breast-fed by a mother with chronic anemia

2)A child of Mediterranean descent Rationale:Beta-thalassemia is an autosomal recessive disorder. This disorder is found primarily in individuals of Mediterranean descent. The disease also has been reported in Asian and African populations. Options 1, 3, and 4 are not risk factors for this disorder.

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which disorder? 1)Myxedema 2)Graves' disease 3)Addison's disease 4)Cushing's syndrome

2)Graves' disease Rationale:Propylthiouracil inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication would be included on the list? 1)Shakiness 2)Increased thirst 3)Profuse sweating 4)Decreased urine output

2)Increased thirst Rationale:The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse sweating and shakiness would be noted in a hypoglycemic condition.

The nurse is caring for a postoperative parathyroidectomy client. Which would require the nurse's immediate attention? 1)Incisional pain 2)Laryngeal stridor 3)Difficulty voiding 4)Abdominal cramps

2)Laryngeal stridor Rationale:During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which causes swelling and the compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard during inspiration and expiration that is caused by the compression of the trachea and leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway.

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? 1)An additional dose of prednisone daily 2)A decreased amount of daily Humulin NPH insulin 3)An increased amount of daily Humulin NPH insulin 4)The addition of an oral hypoglycemic medication daily

3)An increased amount of daily Humulin NPH insulin Rationale:Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore, the other options are incorrect.

A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse that yesterday the late afternoon blood glucose was 60 mg/dL and that she "felt funny." Which statement by the client indicates an understanding of this occurrence? 1)"I forgot to take my usual mid-afternoon snack yesterday." 2)"I took less insulin this morning so I won't feel funny today." 3)"My blood glucose levels are running low because I'm tired." 4)"I don't know why I have to check my blood glucose four times a day. That seems too much."

1)"I forgot to take my usual mid-afternoon snack yesterday." Rationale:Hypoglycemia is a blood glucose level of 60 mg/dL or less. The causes are multiple, but in this case, omitting the afternoon snack is the cause. Fatigue and self-adjustment of dose are incorrect options. Recommended blood glucose testing for the client with type 1 diabetes mellitus is at least four times a day.

The nurse is assisting in caring for a client admitted to the emergency department with diabetic ketoacidosis. The nurse anticipates that the primary health care provider will prescribe which type of insulin for intravenous administration to treat this disorder? 1)Lantus 2)Regular 3)Humulin N 4)Isophane insulin NPH injection

2)Regular Rationale:Regular insulin is a short-acting insulin and can be administered by the intravenous route. Lantus is a long-acting insulin. Humulin N and isophane insulin NPH injection are intermediate-acting insulin.

The nurse is reviewing a primary health care provider's prescriptions for a client with newly diagnosed, untreated hypothyroidism. Which medication prescribed for the client would the nurse question and verify? 1)Atenolol 2)Levothyroxine 3)Morphine sulfate 4)Docusate sodium

3)Morphine sulfate Rationale:The client with hypothyroidism experiences fatigue, lethargy, and increased somnolence. The decreased metabolism and oxygen consumption is manifested by a slow heart rate, decreased cardiac output, and decreased blood pressure. Levothyroxine, a thyroid hormone, is a component of therapy. Stool softeners such as docusate sodium are prescribed to promote defecation. Morphine sulfate would further depress bodily functions. Atenolol is used with caution in clients with hyperthyroidism.

A client with diabetes mellitus calls the clinic nurse to report that the blood glucose level is 150 mg/dL. After obtaining further data from the client, the nurse determines that the client ate lunch approximately 2 hours ago. How would the nurse interpret the data? 1)The blood glucose level is normal. 2)The blood glucose level is lower than the normal value. 3)The blood glucose level is slightly higher than the normal value. 4)The blood glucose level indicates immediate primary health care provider notification.

3)The blood glucose level is slightly higher than the normal value. Rationale:Normal fasting blood glucose values range from 70 to 110 mg/dL, depending on primary health care provider preference. The 2-hour postprandial blood glucose level should be less than 140 mg/dL. In this situation, the blood glucose value was 150 mg/dL 2 hours after the client ate, which is slightly elevated above normal.

A client has been diagnosed as having syndrome of inappropriate antidiuretic hormone (SIADH) secretion following cranial surgery. The nurse interprets that this complication is not resolving if which urine specific gravity measurement is obtained? 1)1.016 2)1.018 3)1.020 4)1.030

4)1.030 Rationale:The normal range for urine specific gravity, the comparison of urine concentration to water is from 1.016 to 1.022. Elevations may occur with SIADH because the kidneys are stimulated to reabsorb water, thus causing a higher concentration of the urine. The client retains water in the circulating blood volume leading to hyponatremia and low sodium levels, which cause decreased mental alertness and functioning. Specific gravities of 1.016, 1.018, and 1.020 are all within the normal range.

The nurse is assigned to care for a pregnant client with a diagnosis of sickle cell anemia. The nurse plans care, knowing that which problem would receive highest priority? 1)Dehydration 2)Inability to perform activities 3)Verbalizing fear about delivery 4)Expressing concern about appearance

1)Dehydration Rationale:For the client with sickle cell anemia, dehydration will precipitate sickling of the red blood cells. Sickling can lead to life-threatening consequences for the pregnant woman and the fetus, such as an interruption of blood flow to the respiratory system and placenta. Although options 2, 3, and 4 may be components of the plan of care at some point, fluid volume deficit is the priority.

The nurse has just supervised a client who has newly diagnosed diabetes mellitus self-inject NPH insulin at 7:30 am. The nurse reviews the time frames for peak insulin action with the client, telling the client to be especially watchful for a hypoglycemic reaction during which time frame? 1)7:30 am and 9:30 am 2)1:30 pm and 7:30 pm 3)8:30 pm and 12:00 am 4)2:30 am and 4:30 am

2)1:30 pm and 7:30 pm Rationale:NPH is an intermediate-acting insulin. It begins to work in 1 to 2 hours (onset), peaks in 6 to 12 hours, and lasts for 18 to 24 hours (duration). Hypoglycemic reactions most likely occur during peak time, which in this case is option 2.

The nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which foods? Select all that apply. 1)Milk and yogurt 2)Clams and mussels 3)Apples and mangos 4)Potatoes and carrots 5)Lean beef and chicken liver

2)Clams and mussels 5)Lean beef and chicken liver Rationale:The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver and other organ meats, blackstrap molasses, clams, mussels, and oysters. Milk products are lowest in iron of all of the food sources listed. Potatoes, carrots, apples, and mangos are not rich sources of iron.

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs and symptoms noted in the client would alert the nurse to the presence of this crisis? Select all that apply. 1)Pallor 2)Fever 3)Sweating 4)Agitation 5)Bradycardia

2)Fever 3)Sweating 4)Agitation Rationale:Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical signs/symptoms include fever greater than 100°F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.

Desmopressin acetate is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1)Decreased urinary output 2)Decreased blood pressure 3)Decreased peripheral edema 4)Decreased blood glucose level

1)Decreased urinary output Rationale:Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output.

The nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse would focus on which potential problem for this client? 1)Dehydration 2)Lack of knowledge about nutrition 3)Inability of family to cope with the client's diagnosis 4)The need for knowledge about the causes of hyperglycemia

1)Dehydration Rationale:Increased blood glucose will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes causing an osmotic diuresis that leads to dehydration. This fluid loss must be replaced when it becomes severe. Lack of knowledge about nutrition, the inability of the family to cope, and the need for knowledge about the causes of hyperglycemia may be concerns at some point but are not priorities with hyperglycemia.

Insulin glargine is prescribed for a client with diabetes mellitus. The nurse tells the client that which is the best time to take the insulin? 1) 1 hour after each meal 2)Once daily at the same time each day 3)15 minutes before breakfast, lunch, and dinner 4)Before each meal on the basis of the blood glucose level

2)Once daily at the same time each day Rationale:Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has 24-hour duration of action and is administered once a day at the same time each day.

The nurse reinforces teaching to a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops? 1)Polyuria 2)Shakiness 3)Blurred vision 4)Fruity breath odor Rationale: Shakiness is a sign of hypoglycemia, and it would indicate the need for food or glucose. Fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.

2)Shakiness

A client with diabetes mellitus has a blood sample drawn for the determination of a fasting blood glucose level. When reviewing the client's results, the nurse determines that which requires a call to the primary health care provider for intervention? 1)75 mg/dL (4.2 mmol/L) 2)92 mg/dL (5.3 mmol/L) 3)120 mg/dL (6.9 mmol/L) 4)240 mg/dL (13.7 mmol/L)

4)240 mg/dL (13.7 mmol/L) Rationale:The normal fasting blood glucose level is 70 mg/dL to 100 mg/dL (4-6 mmol/L) in the adult client. Values above the normal range should be evaluated to determine whether further intervention is needed. The most critical value is 240 mg/dL (13.7 mmol/L).

A client with diabetes mellitus is receiving peritoneal dialysis. The nurse would ensure maintenance of the dwell time for the dialysis at the prescribed time because of risk for which complication? 1) Infection 2)Hypoglycemia 3)Hyperglycemia 4)Peritoneal third spacing

3)Hyperglycemia Rationale:An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. The incorrect options are not associated with dwell time.