Metabolism PrepU

The nurse is evaluating a client with hyperthyroidism who is taking propylthiouracil (PTU) 100mg/day in 3 divided doses for maintenance therapy. Which statement from the client indicates the drug is effective?

"I'm able to sleep and rest at night."

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating

"It tells us about your sugar control for the last 3 months"

When obtaining a health history from a client newly admitted to the hospital, which statement indicates the client's needs for further follow-up?

"No matter how much I drink, I'm still thirsty all the time."

The laboratory comes to draw an Hgb A1c. The client asks the nurse what this test represents. Which statement would be correct?

"This test reflects the average blood glucose over a period of approximately 2-3 months."

During a client assessment, the client shares that due to religious beliefs, she cannot have unsupervised contact with adult males. How does the nurse respond to this information?

"We will make every effort to respect your wish."

The health care provider has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. What should the nurse teach the client about this insulin?

"You do not mix insulin detemir; the solution is clear."

A client's glucose level is 365 mg/dL (365 mmol/dL). The physician orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/ml. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place

0.1

A child brought to the hospital with ketoacidosis is to receive regular insulin via an IV infusion. Which IV solution should the nurse expect the primary care provider to prescribe initially?

0.9% saline

An adolescent client is using glargine and lispro to manage type 1 diabetes. The nurse reviews the prescription for sliding scale lispro (see exhibit). The morning blood glucose is 202 mg/dL (11.2 mmol/L) and the client is going to eat 2 carbohydrate exchanges. The nurse has the client administer how many units of lispro? Record your answer using a whole number.

4

Following surgery, a client is receiving 1,000 mL normal saline (IV) with 40mEq (40 mmol/L) KCL, which has been ordered to be infused at 125mL/h. The client states, "My IV hurts." What should the nurse do first?

Access the IV site for signs of phlebitis, extravasation, or IV-related infection

During a panic attack, a client hyperventilates, becomes unable to speak, and reports symptoms that mimic those of a heart attack. Which nursing intervention would be best?

Accompanying the client to his/her room; remaining there and providing instructions in short, simple statements

A nurse is caring for a client with type 1 diabetes who is light headed, begins sweating profusely, and loses consciousness. Which action should the nurse take?

Administer an IV bolus of 50% dextrose

A client with diabetic ketoacidosis (DKA) has asked the unlicensed nursing assistant for another pitcher of water. It is the third such request over the past 4 hours. The nurse would recognize this request as which manifestation?

An occurrence of the excess loss of fluid associated with osmotic diuresis

A client with pneumonia has developed dyspnea, has a respiratory rate of 32 breaths/min, and is having difficulty expelling secretions. The nurse auscultates the lung fields and hears bronchial sounds in the lower left lobe. Which action should the nurse take first?

Apply oxygen

Which information is a priority for the nurse to teach the school-age client and parents newly diagnosed with type 1 diabetes?

Assess for hypoglycemia and hyperglycemia

The nurse gives a client 0.25mg digoxin instead of the prescribed dose of 0.125mg. What action should the nurse take after realizing the mistake?

Assess the client and notify the physician.

The nurse reviewed laboratory values for a client with type 1 diabetes mellitus. The client's hemoglobin A1c (HbA1c) is 9 percent. What is the priority action for the nurse?

Assess the client's baseline knowledge about their treatment regimen

A client presents to the clinic for a follow-up visit for hospitalization due to uncontrolled diabetes. Which of the following assessment findings indicates a complication of diabetes mellitus?

BP 160/100mmHg

The nurse is preparing to administer IM morphine sulfate to a client who is in pain. On checking the heath care provider's prescription, the nurse notes that the prescription states, "morphine sulfate 60mg IM every 4 hours as needed for pain." The usual dose of morphine is 10-15mg. What is the most appropriate action for the nurse to take?

Contact HCP to verify the prescription

When assessing an intravenous site, the nurse observes edema and a red line. The client also reports pain at the insertion site. What actions would be appropriate? You Selected:

Discontinue the infusion and apply a warm compress to the IV site

A client who is recovering from a bilateral adrenalectomy has a client-controlled analgesia (PCA) system with morphine sulfate. What should the nurse do to manage safe administration of the morphine?

Evaluate pain control at least every 2 hours

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client? Select all that apply

Excessive hunger; frequent, high-volume urination; excessive thirst

Before supper, an adult client who has type-2 diabetes and requires insulin tells the nurse about having tremors, being weak and anxious. The nurse should:

Have the client drink a glass of mile or orange juice.

Which combination of adverse effects should the nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia

A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?

I will increase my fluid and calcium intake

The nurse is providing dietary teaching for a client with diabetes. Which statement about the diet would be accurate?

It is planned around a wide variety of commonly available foods

A client newly diagnosed with hypothyroidism asks the nurse how long it will be necessary to take the prescribed levothyroxine. What should the nurse tell the client?

It will be necessary to take the medication for the rest of your life

A client newly diagnosed with diabetes mellitus asks why they need ketone testing when the disease affects their blood glucose levels. How should the nurse respond?

Ketones will tell us if your body is using other tissues for energy

The nurse understands that the difference between diabetic coma and hyperosmolar hyperglycemic coma is that clients in diabetic coma can experience which finding?

Kussmaul respirations

A nurse is teaching a new diabetic client to administer insulin. How will the nurse evaluate if the teaching interventions were appropriate?

Observe the client demonstrate an insulin injection and correctly identify the injection site

A client admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of

Profound neuromuscular irritability

A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the care plan for the neonate during the first 24 hours?

Provide frequent early feedings with formula

A child with type 1 diabetes is admitted to the emergency department with hot and dry skin, rapid and deep respirations, and a fruity odor to her breath. Which task, when performed by a new-graduate registered nurse (RN), requires the RN preceptor to intervene?

Providing encouragement to the child to drink some orange juice

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl (26.1 mmol/L). Which finding is most likely to accompany this blood glucose level?

Rapid, thready pulse

A nurse explains to a client with thyroid disease that the thyroid gland normally produces

T3, T4, and calcitonin

A nurse is caring for a client with hypothyroidism. The client is extremely upset about altered physical appearance. The client doesn't want to take the medication because "it isn't doing any good." What should the nurse do?

Tell the client that as the medication corrects the hormone

A client who expressed suicidal ideations and was admitted to a psychiatric inpatient unit tells the nurse the next day that they feel fine, are at peace, and want to go home now against medical advice. What is the best recommendation for the nurse to make to the behavior health team?

The client is possibly at more serious risk because the client may have gained sufficient energy to act on the suicidal ideation. The client requires further assessment

A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and

Vitamin D

A client reports being allergic to amoxicillin even though the medication administration record and armband do not indicate medication allergies. What should the nurse do about administering the drug to the client?

Withhold the medication

A nurse is changing a client's dressing. Which observation of the wound warrants immediate physician notification?

Yellow, purulent drainage

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect

a blood psi of 176/88 mmHg

The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is most appropriate?

a gelatin dessert

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

adrenal cortex

The nurse is reviewing a client's daily labs. Which lab report would concern the nurse related to the client's risk for skin breakdown?

albumin

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?

an irregular apical pulse

A client with pneumonia has developed dyspnea, has a respiratory rate of 32 breaths/min, and is having difficulty expelling secretions. The nurse auscultates the lung fields and hears bronchial sounds in the lower left lobe. Which action should the nurse take first?

apply oxygen

After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide:

at breakfast

The nurse is checking the laboratory results of an adult client with type 1 diabetes (see chart). What laboratory result indicates a problem that should be managed?

blood glucose

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

blood glucose level 1,100 mg/dL

An adult with type 2 diabetes mellitus has been NPO since 2200 in preparation for having a nephrectomy the next day. At 0600 on the day of surgery, the nurse reviews the client's medical record and laboratory results. Which finding should the nurse report to the health care provider (HCP)?

blood glucose of 140mg/dL

The nurse is caring for an adolescent with diabetes who admits to consuming many simple sugars and carbohydrates at a graduation party. The parents brought the client to the emergency room with unusual behavior. The serum glucose level was 375 mg/dL (20.8 mmol/L). (see schedule)

click on the 10 unit line

The nurse is beginning a shift caring for a group of postpartum clients. Which client should the nurse see first?

client who reports she has pain in the left calf

A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect?

concentration of urine

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test?

cortisol levels before and after the system is challenged with a synthetic steroid

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. The nurse knows that this may be the result of what complication of the surgery?

damage to the parathyroid glands

A client is being evaluated for hypothyroidism. Durning assessment, the nurse should stay alert for

decreased body temp and cold intolerance

The nurse teaches the client with type 1 diabetes mellitus about the importance of maintaining blood glucose levels. The nurse should suggest the client include which type of food to minimize the rise in blood glucose level after meals?

dietary fiber

A client receiving a loop diuretic should be encouraged to eat which foods to prevent potassium loss? Select all that apply.

dried fruit; banana; orange juice

The nurse assesses a child with suspected juvenile hypothyroidism. Which signs or symptoms should the nurse expect this child to manifest?

dry skin and constipation

An unconscious client with multiple injuries arrives in the emergency department. What should the nurse do first?

establish an airway

The adrenal cortex is responsible for producing which substance?

glucocorticoids and androgens

A client has had an hypophysectomy. What signs of a potential complication should the nurse teach the client to report?

hypopituitarism

A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?

levothyroxine

The nurse is caring for a client with hypothyroidism. The client notes, "The provider mentioned that I would need to take medication for this condition. What medication will I be prescribed?" What medication does the nurse anticipate the healthcare provider ordering?

levothyroxine

Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will:

maintain normal fluid and electrolyte balance

The nurse is caring for an adolescent who has been admitted several times with uncontrolled type 1 diabetes. The child is now stabilized and is preparing for discharge. What should be the priority focus for the nurse when conducting discharge teaching?

management of the therapeutic regimen

A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is:

monitoring the blood glucose level closely

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of

myxedema coma

The nurse should teach the diabetic client that which is most indicative of hypoglycemia?

nervousness

Before administering packed red blood cells, a nurse must flush a client's I.V. line. Which solution should the nurse use to flush the line?

normal saline solution

The nurse assesses the client's burned right arm and notes increasing edema, absence of a radial pulse, and decreased sensation in the fingers. The nurse should:

notify the health care provider immediately

Which action is contraindicated for a client who develops a temperature of 102° F (38.9° C)?

providing a low - calorie diet

A nurse should expect a client with hypothyroidism to report

puffiness of the face and hands

A physician writes an order for a nurse to administer an I.V. medication which, according to hospital policy, is not a nursing protocol. The nurse informs the physician that it is not a nursing protocol, and the physician states, "Give it, and I will cover you." What should the nurse do in this situation?

refuse to administer the medication

The nurse is educating a client on diabetes management. The client is asking questions that cause the nurse to be concerned about the client's ability to retain the information. Which would be the best technique for the nurse to use to enhance the retention of information by the client?

repeat important information during the presentation

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?

restrict sodium

Which nursing intervention should be done first when managing a pediatric client admitted to the emergency department with severe diabetic ketoacidosis (DKA)?

secure the client's airway to ensure adequate ventilation

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in

serum glucose level

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

serum glycosylated hemoglobin (HbA1c)

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25mcg PO daily. Which finding should the nurse recognize as an adverse reaction to the drug?

tachycardia

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. When conducting a focused assessment, what should the nurse should assess the client for?

tachycardia

A nurse is teaching a client with diabetes mellitus about self-management. Which statement would be correct about the administration of lispro insulin?

take the insulin at around the same time each day at a meal

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

tetany

A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology?

the client with diabetes insipidus

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. The nurse judges that the teaching regarding the use of these medications is effective if the client will take:

the levothyroxine before breakfast and the other meds 4 hours later

The nurse is to administer insulin to a client with diabetes mellitus. Which illustration indicates the appropriate syringe to use?

the one with units on it

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

thyroid crisis

A client who has been newly diagnosed with type 1 diabetes asks the nurse, "Why do I have to take two shots of insulin? One shot isn't enough?" What should the nurse should tell the client?

two shots will give you better control and decrease complications

A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat?

within 10-15 min after the injection

A client has received dietary instructions as part of the treatment plan for diabetes type 1. Which statement by the client would alert the nurse of needing additional instructions?

"I can eat whatever I want as long as I cover the calories with sufficient insulin"

A 24-yo client with diabetes mellitus sustains a large laceration that requires suturing. Which statement indicates that the client understands wound healing?

"It's so hard to predict when this scar will disappear."

The client is ordered oxycodone/acetaminophen 20mg tablets, one or two PRN pain. The client rates pain as a 7 on the numeric scalre of 0/10. How many tablets of oxycodone/acetaminophen should the nurse administer?

2

The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? Record your answer using a whole number.

32

A 14-YO is using glargine and lispro to manage type 1 diabetes. The prescription for sliding scale lispro reads as follows: Lispro subcut give units according to sliding scale: (lists the sliding scale). The morning blood glucose is 202mg/dL, and the client is going to eat 2 carbohydrate exchanges. The nurse has the client administer how many units of lispro?

4

A nurse is caring for a client who is prescribed 1 unit of regular insulin for every 6 g of carbohydrates consumed at mealtime and 1 unit of regular insulin for every 30 mg/dL increase of blood sugar above 130 mg/dL. For lunch, the client ate a hamburger bun (20 g carbohydrates), a 3-oz burger (10 g carbohydrates), and a 12-oz diet soda (0 g carbohydrates). The client's blood sugar is now 190 mg/dL. How much total insulin will the nurse administer? Record your answer using a whole number.

7

A young adult client comes to the clinic in an agitated state. The client's friends report that the client has been consuming beverages combining energy drinks and alcohol all day. What is the priority action by the nurse in caring for this client's immediate needs?

Hydrate the client, and monitor labwork and vital signs

The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100mg intravenously at a rate of 10mL/hr for a client in acute adrenal crisis. The nurse understands that this treatment is common in clients with which disease process?

Addison's disease

A student with type 1 diabetes tells the nurse she is feeling light-headed. The student's blood sugar is 60 mg/dL (3.3 mmol/L). Using the 15-15 rule, what should the nurse do to treat the blood glucose?

Administer 15g of carbohydrate and retest blood sugar in 15 min.

A school-age client with type 1 diabetes is sick with the flu. What is the most important information for the nurse to convey regarding diabetes management during illness?

Blood glucose needs to be checked more frequently during illness

A 62-yo client reports being tired all the time, having trouble sleeping, and having trouble thinking. What should the nurse do?

Further assess the client's mental status and health history

A client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply.

High fiber, low calorie diet; use of stool softeners; thyroid hormone replacements

A 15-year-old client is brought to the clinic by her mother, who expresses concern about her daughter's weight loss and constant dieting. A nurse conducts a health history interview. Which comment indicates that the client may be suffering from anorexia nervosa?

I just can't seem to get down to the weight i want to be. I'm so fat compared to other girls.

The nurse has completed education for a client about an antibiotic prescribed by the healthcare provider. Which statement by the client indicates an understanding of the proper use of the medication?

I will take the medication until it is all gone

An adolescent is brought to the ER in a coma and is diagnosed with diabetic ketoacidosis. What is the correct action for the nurse to take?

Infuse intravenous fluids as prescribed.

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low BP, increased Resp rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum lab results, how would the nurse interpret the client's acid-base balance?

Metabolic acidosis

A client had an appendectomy 2 days ago and is now presenting with purulent drainage, pain in the mid-incision, and a temperature of 101.3°F (38.5°C). What would be the most appropriate action by the nurse?

Notify the surgeon as soon as possible

A client visits the mental health clinic and tells the nurse that she is lethargic, experiences pain in her back, cannot concentrate, and is depressed. The nurse observes patches of hair loss on the client's scalp. Which referral should the nurse make first?

a health care provider

A client with diabetes mellitus has had declining renal function over the past several years. Which diet regimen should the nurse recommend to the client on days between dialysis?

a low protein diet with a prescribed amount of water

For a client with hyperthyroidism, treatment is most likely to include

a thyroid hormone antagonist

A client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that their spouse sleeps in another room because the client's snoring keeps the spouse awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?

acromegaly

A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications?

both insulins 0.5 hrs before breakfast

A client who is 12 hours post total thyroidectomy reports tingling around the mouth. Which assessment is the priority?

calcium level

An elderly client who is receiving steroids has secondary diabetes and chronic kidney disease (CKD) and takes insulin. The client has had episodes of hypoglycemia. The nurse should:

continue to monitor the clients blood glucose values

A client enters the crisis unit complaining of increased stress from studies as a medical student. The client reports increasing anxiety for the past month. The physician orders alprazolam, 0.25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when taken concomitantly with alprazolam?

diphenhydramine

Which nursing intervention will be most effective when caring for a client experiencing powerlessness?

include the client in decision making whenever possible

A client is asking about dietary modifications to counteract the long-term effects of prednisone. What is the most appropriate information for the nurse to give the client?

increase your intake of calcium and vitamin D

Which results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism?

increased energy, weight loss, and a higher temp and pulse rate

The nurse is caring for a 10-year-old child who is newly diagnosed with type 1 diabetes mellitus. The nurse is teaching the parents how to recognize signs and symptoms of hyperglycemia. Which of the following is most important for the nurse to include as an initial symptom of hyperglycemia?

increased thirst

A nurse explains to a client that the nurse will administer the client's first insulin dose in the client's abdomen. How does absorption at the abdominal site compare with absorption at other sites?

insulin is absorbed more rapidly at abdominal injection sites than at other sites.

What important considerations would the nurse make when teaching and caring for a client newly diagnosed with diabetes mellitus?

involving the client in the development of the teaching plan and encouraging questions and active participation

A client is admitted to the health care facility for evaluation for Addison's disease. Which lab test result best supports a diagnosis of Addison's disease?

serum potassium lvl of 5.8 mEq/L

When caring for a client with diabetes insipidus, the nurse expects to administer

vasopressin

When evaluating teaching a client how to administer insulin, which action indicates that additional teaching is necessary?

waits 30 mins to eat breakfast after injecting rapid-acting insulin

A 60-year-old female is diagnosed with hypothyroidism. What additional information should the nurse obtain when conducting a focused assessment?

weight gain

A nurse is assessing a client with hyperthyroidism. what findings should the nurse expect?

weight loss, nervousness, and tachycardia