Nursing V: Unit 2

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin" 2. "I need to increase my fluid intake" 3. "I need to monitor my blood sugar every 3-4 hours" 4. I need to call the HCP because of these symptoms"

1. "I need to stop my insulin"

The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? 1. Administer 50% dextrose (IVP). 2. Notify the health-care provider. 3. Move the client to the ICU. 4. Check the serum glucose level.

1. The nurse should assume the client is hypoglycemic and administer IVP dextrose, which will rouse the client immediately. If the collapse is the result of hyperglycemia, this additional dextrose will not further injure the client.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1. Tremors 3. Irritability 4. Nervousness

The nurse is discussing the endocrine system with the client. Which endocrine gland secretes epinephrine and norepinephrine? 1. The pancreas. 2. The adrenal cortex. 3. The adrenal medulla. 4. The anterior pituitary gland.

3. The adrenal medulla secretes the catecholamines epinephrine and norepinephrine.

The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply. 1. Take diabetic medication even if unable to eat the client's normal diabetic diet. 2. If unable to eat, drink liquids equal to the client's normal caloric intake. 3. It is not necessary to notify the health-care provider (HCP) if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the health-care provider if glucose levels are higher than 180 mg/dL.

1, 2, 5 1. The most important issue to teach clients is to take insulin even if they are unable to eat. Glucose levels are increased with illness and stress. 2. The client should drink liquids such as regular cola or orange juice, or eat regular gelatin, which provide enough glucose to prevent hypoglycemia when receiving insulin. 5. The HCP should be notified if the blood glucose level is this high. Regular insulin may need to be prescribed to keep the blood glucose level within acceptable range.

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicated the need for additional teaching? 1. "I should limit my fluids to 1L per day" 2. "I should use my treadmill or go on walks daily" 3. "I should follow a moderate-calcium high-fiber diet" 4. "My alendronate helps to keep calcium from coming out of my bones"

1. "I should limit my fluids to 1L per day"

Which laboratory data make the nurse suspect the client with primary hyperparathyroidism is experiencing a complication? 1. A serum creatinine level of 2.8 mg/dL. 2. A calcium level of 9.2 mg/dL. 3. A serum triglyceride level of 130 mg/dL. 4. A sodium level of 135 mEq/L.

1. A serum creatinine level of 2.8 mg/dL indicates the client is in renal failure, which is a complication of hyperparathyroidism. The formation of stones in the kidneys related to the increased urinary excretion of calcium and phosphorus occurs in about 55% of clients with primary hyperparathyroidism and can lead to renal failure.

The nurse is performing discharge teaching for a client diagnosed with Cushing's disease. Which statement by the client demonstrates an understanding of the instructions? 1. "I will be sure to notify my health-care provider if I start to run a fever." 2. "Before I stop taking the prednisone, I will be taught how to taper it off." 3. "If I get weak and shaky, I need to eat some hard candy or drink some juice." 4. "It is fine if I continue to participate in weekend games of tackle football."

1. Cushing's syndrome/disease predisposes the client to develop infections as a result of the immunosuppressive nature of the disease.

The nurse is planning the care of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should be implemented? Select all that apply. 1. Restrict fluids per health-care provider order. 2. Assess level of consciousness every two (2) hours. 3. Provide an atmosphere of stimulation. 4. Monitor urine and serum osmolality. 5. Weigh the client every three (3) days.

1. Fluids are restricted to 500 to 600 mL per 24 hours. 2. Orientation to person, place, and time should be assessed every two (2) hours or more often. 4. Urine and serum osmolality are monitored to determine fluid volume status.

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.

1. Humulin N peaks in six (6) to eight (8) hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia.

The nurse is admitting a client who is diagnosed with SIADH and has serum sodium of 118 mEq/L. Which health care provider prescription should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl 2. Administer IV furosemide 3. Restrict fluids to 800 mL over 24 hours 4. Elevate the head of the bed to High Fowlers 5. Administer a vasopressin antagonist as prescribed

1. Initiate an infusion of 3% NaCl 3. Restrict fluids to 800 mL over 24 hours 5. Administer a vasopressin antagonist as prescribed

The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client? 1. Explain it will take up to a month for symptoms of hyperthyroidism to subside. 2. Teach the iodine therapy will have to be tapered slowly over one (1) week. 3. Discuss the client will have to be hospitalized during the radioactive therapy. 4. Inform the client after therapy the client will not have to take any medication.

1. Radioactive iodine therapy is used to destroy the overactive thyroid cells. After treatment, the client is followed closely for three (3) to four (4) weeks until the euthyroid state is reached.

The client diagnosed with Addison's disease is admitted to the emergency department after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement? 1. Start an IV with an 18-gauge needle and infuse NS rapidly. 2. Have the client wait in the waiting room until a bed is available. 3. Obtain a permit for the client to receive a blood transfusion. 4. Collect urinalysis and blood samples for a CBC and calcium level.

1. The client was exposed to wind and sun at the lake during the hours prior to being admitted to the emergency department. This predisposes the client to dehydration and an addisonian crisis. Rapid IV fluid replacement is necessary.

Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? 1. Serum sodium. 2. Serum calcium 3. Urine glucose. 4. Urine white blood cells.

1. The client will have an elevated sodium level as a result of low circulating blood volume. The fluid is being lost through the urine. Diabetes means "to pass through" in Greek, indicating polyuria, a symptom shared with diabetes mellitus. Diabetes insipidus is a totally separate disease process.

The nurse identified a concept of metabolism for a client diagnosed with diabetes mellitus type 1. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Teach the client to perform self glucose monitoring. 2. Instruct the client about complications of high-glucose levels. 3. Instruct the client to inspect the feet daily. 4. Explain the need to carry a source of quick-acting proteins. 5. Encourage the client to have regular eye exams.

1. The client with diabetes should be taught to perform self glucose monitoring. 2. In order to maintain a healthy lifestyle the client should be aware of the consequences of not controlling the blood glucose. 3. Diabetes affects all tissues in the body. The feet are particularly at risk for the development of foot sores. 5. Diabetes can cause retinal changes and detachment.

The client is diagnosed with hypothyroidism. Which assessment data support this diagnosis? 1. The client's vital signs are: T 99.0, P 110, R 26, and BP 145.80. 2. The client complains of constipation and being constantly cold. 3. The client has an intake of 780 mL and output of 256 mL. 4. The client complains of a headache and has projectile vomiting.

1. The client with hypothyroidism has slowed body processes so the temperature, pulse, and BP would be brady or lower.

The elderly client is admitted to the intensive care department diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care? 1. Infuse 0.9% normal saline intravenously. 2. Administer intermediate-acting insulin. 3. Perform blood glucometer checks daily. 4. Monitor arterial blood gas (ABG) results.

1. The initial fluid replacement is 0.9% normal saline (an isotonic solution) intravenously, followed by 0.45% saline. The rate depends on the client's fluid volume status and physical health, especially of the heart.

The client is admitted to the ICU diagnosed with DKA. Which interventions should the nurse implement? Select all that apply. 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.

1. The nurse should always address the airway when a client is seriously ill. 2. The client must be assessed for fluid volume deficit and then for fluid volume excess after fluid replacement is started. 3. The electrolyte imbalance of primary concern is depletion of potassium. 4. Ketones are excreted in the urine; levels are documented from negative to large amount. Ketones should be monitored frequently. 5. The nurse must ensure the client's fluid intake and output are equal.

The client diagnosed with hyperthyroidism is complaining of being hot and cannot sit still. Which should the nurse do based on the assessment? 1. Continue to monitor the client. 2. Have the UAP take the client's vital signs. 3. Request an order for a sedative. 4. Insist the client lie down and rest.

1. The nurse should continue to monitor the client. The behavior is expected for a client with hyperthyroidism.

The nurse is developing a care plan for the client diagnosed with type 1 diabetes. The nurse identifies the problem "high risk for hyperglycemia related to noncompliance with the medication regimen." Which statement is an appropriate short-term goal for the client? 1. The client will have a blood glucose level between 90 and 140 mg/dL. 2. The client will demonstrate appropriate insulin injection technique. 3. The nurse will monitor the client's blood glucose levels four (4) times a day. 4. The client will maintain normal kidney function with 30-mL/hr urine output.

1. The short-term goal must address the response part of the nursing diagnosis, which is "high risk for hyperglycemia," and this blood glucose level is within acceptable ranges for a client who is noncompliant.

The nurse is teaching the client diagnosed with diabetes. Which should the nurse teach to limit the complications of diabetes? 1. Teach the client to keep the blood glucose under 140 mg/dL. 2. Demonstrate how to test the urine for ketones. 3. Instruct the client to apply petroleum jelly between the toes. 4. Allow the client to eat meals as desired and then take insulin.

1. To limit the complications of diabetes the client should keep the blood glucose levels under 140 mg/dL. This can be done with medications, diet, and exercise. Self glucose monitoring allows the client to monitor the glucose levels.

The nurse is teaching the client diagnosed with hyperthyroidism. Which information should be taught to the client? Select all that apply. 1. Notify the HCP if a three (3)-pound weight loss occurs in two (2) days. 2. Discuss ways to cope with the emotional lability. 3. Notify the HCP if taking over-the-counter medication. 4. Carry a medical identification card or bracelet. 5. Teach how to take thyroid medications correctly.

1. Weight loss indicates the medication may not be effective and will probably need to be increased. 2. The client needs to know emotional highs and lows are secondary to hyperthyroidism. With treatment, this emotional lability will subside. 3. Any over-the-counter medications (for example, alcohol-based medications) may negatively affect the client's hyperthyroidism or medications being used for treatment. 4. This will help any HCP immediately know of the client's condition, especially if the client is unable to tell the HCP.

The client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? 1. Provide a high-fat diet 24 hours prior to test. 2. Hold the biguanide medication for 48 hours prior to test. 3. Obtain an informed consent form for the test. 4. Administer pancreatic enzymes prior to the test.

2. Biguanide medication must be held for a test with contrast medium because it increases the risk of lactic acidosis, which leads to renal problems.

The nurse at a freestanding health-care clinic is caring for a 56-year-old male client who is homeless and is a type 2 diabetic controlled with insulin. Which action is an example of client advocacy? 1. Ask the client if he has somewhere he can go and live. 2. Arrange for someone to give him insulin at a local homeless shelter. 3. Notify Adult Protective Services about the client's situation. 4. Ask the HCP to take the client off insulin because he is homeless.

2. Client advocacy focuses support on the client's autonomy. Even if the nurse disagrees with his living on the street, it is the client's right. Arranging for someone to give him his insulin provides for his needs and allows his choices.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urinary output 5. Elevated blood glucose level

2. Comatose state 3. Deep, rapid breathing 5. Elevated blood glucose level

Which nursing instruction should the nurse discuss with the client who is receiving glucocorticoids for Addison's disease? 1. Discuss the importance of tapering medications when discontinuing medication. 2. Explain the dose may need to be increased during times of stress or infection. 3. Instruct the client to take medication on an empty stomach with a glass of water. 4. Encourage the client to wear clean white socks when wearing tennis shoes.

2. During times of stress, the medication may need to be increased to prevent adrenal insufficiency.

The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement? 1. Assess for dehydration and monitor blood glucose levels. 2. Assess for nausea and vomiting and weigh daily. 3. Monitor potassium levels and encourage fluid intake. 4. Administer vasopressin IV and conduct a fluid deprivation test.

2. Early signs and symptoms are nausea and vomiting. The client has the syndrome of inappropriate secretion of antidiuretic (against allowing the body to urinate) hormone. In other words, the client is producing a hormone that will not allow the client to urinate.

Which signs/symptoms should make the nurse suspect the client is experiencing a thyroid storm? 1. Obstipation and hypoactive bowel sounds. 2. Hyperpyrexia and extreme tachycardia. 3. Hypotension and bradycardia. 4. Decreased respirations and hypoxia.

2. Hyperpyrexia (high fever) and heart rate above 130 beats per minute are signs of thyroid storm, a severely exaggerated hyperthyroidism.

Which electrolyte replacement should the nurse anticipate being ordered by the health-care provider in the client diagnosed with diabetic ketoacidosis (DKA) who has just been admitted to the ICU? 1. Glucose. 2. Potassium. 3. Calcium. 4. Sodium.

2. The client in DKA loses potassium from increased urinary output, acidosis, catabolic state, and vomiting. Replacement is essential for preventing cardiac dysrhythmias secondary to hypokalemia.

The UAP on the medical floor tells the nurse the client diagnosed with DKA wants something else to eat for lunch. Which intervention should the nurse implement? 1. Instruct the UAP to get the client additional food. 2. Notify the dietitian about the client's request. 3. Request the HCP increase the client's caloric intake. 4. Tell the UAP the client cannot have anything else.

2. The client will not be compliant with the diet if he or she is still hungry. Therefore, the nurse should request the dietitian talk to the client to try to adjust the meals so the client will adhere to the diet.

Which assessment data indicate the client diagnosed with diabetic ketoacidosis is responding to the medical treatment? 1. The client has tented skin turgor and dry mucous membranes. 2. The client is alert and oriented to date, time, and place. 3. The client's ABG results are pH 7.29, Paco2 44, HCO3 15. 4. The client's serum potassium level is 3.3 mEq/L.

2. The client's level of consciousness can be altered because of dehydration and acidosis. If the client's sensorium is intact, the client is getting better and responding to the medical treatment.

The nurse is administering morning medications. Which medications should the nurse administer question? 1. The oral carafate to a client who has not eaten breakfast. 2. The subcutaneous insulin to a client refusing blood glucose checks. 3. The levothyroxine PO to a client diagnosed with hypothyroidism. 4. The sliding scale insulin to a client whose blood glucose level is 320 mg/dL.

2. The nurse cannot administer sliding-scale insulin without knowing the current blood glucose. The nurse should talk with the client to try and obtain the client's cooperation and, if not, then notify the HCP that the medication cannot be administered.

An 18-year-old female client, 5'4" tall, weighing 113 kg, comes to the clinic for a nonhealing wound on her lower leg, which she has had for two (2) weeks. Which disease process should the nurse suspect the client has developed? 1. Type 1 diabetes. 2. Type 2 diabetes. 3. Gestational diabetes. 4. Acanthosis nigricans.

2. Type 2 diabetes is a disorder usually occurring around the age of 40, but it is now being detected in children and young adults as a result of obesity and sedentary lifestyles. Nonhealing wounds are a hallmark sign of type 2 diabetes. This client weighs 248.6 pounds and is short.

Which question should the nurse ask when assessing the client for an endocrine dysfunction? 1. "Have you noticed any pain in your legs when walking?" 2. "Have you had any unexplained weight loss?" 3. "Have you noticed any change in your bowel movements?" 4. "Have you experienced any joint pain or discomfort?"

2. Weight loss with normal appetite may indicate hyperthyroidism.

Which sign/symptom indicates to the nurse the client is experiencing hypoparathyroidism? 1. A negative Trousseau's sign. 2. A positive Chvostek's sign. 3. Nocturnal muscle cramps. 4. Tented skin turgor.

2. When a sharp tapping over the facial nerve elicits a spasm or twitching of the mouth, nose, or eyes, the client is hypocalcemic, which occurs in clients with hypoparathyroidism. This is known as a positive Chvostek's sign.

The charge nurse is making client assignments in the intensive care unit. Which client should be assigned to the most experienced nurse? 1. The client with type 2 diabetes who has a blood glucose level of 348 mg/dL. 2. The client diagnosed with type 1 diabetes who is experiencing hypoglycemia. 3. The client with DKA who has multifocal premature ventricular contractions. 4. The client with HHNS who has a plasma osmolarity of 290 mOsm/L.

3. Multifocal PVCs, which are secondary to hypokalemia and can occur in clients with DKA, are a potentially life-threatening emergency. This client needs an experienced nurse.

The nurse is caring for clients on a medical floor. Which client should be assessed first? 1. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday. 2. The client diagnosed with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1,500 mL and an output of 1,600 mL in the last 8 hours. 3. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching. 4. The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night.

3. Muscle twitching is a sign of early sodium imbalance. If an immediate intervention is not made, the client could begin to seize.

The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client? 1. Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed. 2. Teach the client regarding sexual functioning and androgen replacement therapy. 3. Explain the signs and symptoms of infection and when to call the health-care provider. 4. Demonstrate turn, cough, and deep-breathing exercises the client should perform every two (2) hours.

3. Notifying the HCP if signs/symptoms of infection develop is an instruction given to all surgical clients on discharge.

The client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the unlicensed assistive personnel (UAP) tells the nurse the client has a headache and is really acting "funny." Which intervention should the nurse implement first? 1. Instruct the UAP to obtain the blood glucose level. 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one (1) ampule 50% dextrose intravenously.

3. Regular insulin peaks in two (2) to four (4) hours. Therefore, the nurse should think about the possibility the client is having a hypoglycemic reaction and should assess the client. The nurse should not delegate nursing tasks to a UAP if the client is unstable.

The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test? 1. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours. 2. The client will be administered an injection of antidiuretic hormone (ADH), and urine output will be measured for four (4) to six (6) hours. 3. The client will have nothing by mouth (NPO), and vital signs and weights will be done hourly until the end of the test. 4. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done.

3. The client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and weights are taken every hour to determine circulatory status. If a marked decrease in weight or vital signs occurs, the test is immediately terminated.

The client diagnosed with hypothyroidism is prescribed the thyroid hormone levothyroxine (Synthroid). Which assessment data indicate the medication has been effective? 1. The client has a three (3)-pound weight gain. 2. The client has a decreased pulse rate. 3. The client's temperature is WNL. 4. The client denies any diaphoresis.

3. The client with hypothyroidism frequently has a subnormal temperature, so a temperature WNL indicates the medication is effective.

The unlicensed assistive personnel (UAP) complains to the nurse she has filled the water pitcher four (4) times during the shift for a client diagnosed with a closed head injury and the client has asked for the pitcher to be filled again. Which intervention should the nurse implement first? 1. Tell the UAP to fill the pitcher with ice cold water. 2. Instruct the UAP to start measuring the client's I&O. 3. Assess the client for polyuria and polydipsia. 4. Check the client's BUN and creatinine levels.

3. The first action should be to determine if the client is experiencing polyuria and polydipsia as a result of developing diabetes insipidus, a complication of the head trauma.

The emergency department nurse is caring for a client diagnosed with HHNS who has a blood glucose of 680 mg/dL. Which question should the nurse ask the client to determine the cause of this acute complication? 1. "When is the last time you took your insulin?" 2. "When did you have your last meal?" 3. "Have you had some type of infection lately?" 4. "How long have you had diabetes?"

3. The most common precipitating factor is infection. The manifestations may be slow to appear, with onset ranging from 24 hours to two (2) weeks.

The nurse is assessing a client in an outpatient clinic. Which assessment data are a risk factor for developing pheochromocytoma? 1. A history of skin cancer. 2. A history of high blood pressure. 3. A family history of adrenal tumors. 4. A family history of migraine headaches.

3. There is a high incidence of pheochromocytomas in family members with adrenal tumors, and the von Hippel-Lindau gene is thought to be a primary cause.

The charge nurse of an intensive care unit is making assignments for the night shift. Which client should be assigned to the most experienced intensive care nurse? 1. The client diagnosed with respiratory failure who is on a ventilator and requires frequent sedation. 2. The client diagnosed with lung cancer and iatrogenic Cushing's disease with ABGs of pH 7.35, Pao2 88, Paco2 44, and HCO3 22. 3. The client diagnosed with Addison's disease who is lethargic and has a BP of 80/45, P 124, and R 28. 4. The client diagnosed with hyperthyroidism who has undergone a thyroidectomy two (2) days ago and has a negative Trousseau's sign.

3. This client has a low blood pressure and tachycardia. This client may be experiencing an addisonian crisis, a potentially life-threatening condition. The most experienced nurse should care for this client.

The male client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to cancer of the lung tells the nurse he wants to discontinue the fluid restriction and does not care if he dies. Which action by the nurse is an example of the ethical principle of autonomy? 1. Discuss the information the client told the nurse with the health-care provider and significant other. 2. Explain it is possible the client could have a seizure if he drank fluid beyond the restrictions. 3. Notify the health-care provider of the client's wishes and give the client fluids as desired. 4. Allow the client an extra drink of water and explain the nurse could get into trouble if the client tells the health-care provider.

3. This is an example of autonomy (the client has the right to decide for himself).

The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. The thyroid hormone to the client who does not have a T3, T4 level. 2. The regular insulin to the client with a blood glucose level of 210 mg/dL. 3. The loop diuretic to the client with a potassium level of 3.3 mEq/L. 4. The cardiac glycoside to the client who has a digoxin level of 1.4 mg/dL.

3. This potassium level is below normal, which is 3.5 to 5.5 mEq/L. Therefore, the nurse should question administering this medication because loop diuretics cause potassium loss in the urine.

The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result? 1. This result is below normal levels. 2. This result is within acceptable levels. 3. This result is above recommended levels. 4. This result is dangerously high.

3. This result parallels a serum blood glucose level of approximately 180 to 200 mg/dL. An A1c is a blood test reflecting average blood glucose levels over a period of three (3) months; clients with elevated blood glucose levels are at risk for developing long-term complications.

The nurse is teaching the client diagnosed with type 2 diabetes mellitus about diet. Which diet selection indicates the client understands the teaching? 1. A submarine sandwich, potato chips, and diet cola. 2. Four (4) slices of a supreme thin-crust pizza and milk. 3. Smoked turkey sandwich, celery sticks, and unsweetened tea. 4. A roast beef sandwich, fried onion rings, and a cola.

3. Turkey is a low-fat meat. A sandwich usually means normal slices of bread, and the client needs at least 50% carbohydrates in each meal. Celery sticks are not counted as carbohydrates.

Which medication order should the nurse question in the client diagnosed with untreated hypothyroidism? 1. Thyroid hormones. 2. Oxygen. 3. Sedatives. 4. Laxatives.

3. Untreated hypothyroidism is characterized by an increased susceptibility to the effects of most hypnotic and sedative agents; therefore, the nurse should question this medication.

Which client would the nurse identify as being at risk for developing diabetes? 1. The client who eats mostly candy and potatoes. 2. The 22-year-old client who has been taking birth control pills. 3. The client who has a cousin who has had diabetes for two (2) years. 4. The 38-year-old female who delivered a 10-pound infant.

4. Research shows that women who delivered a large infant have a greater risk for developing diabetes.

The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented? 1. Administer sliding-scale insulin as ordered. 2. Restrict caffeinated beverages. 3. Check urine ketones if blood glucose is >250. 4. Assess tissue turgor every four (4) hours.

4. The client is excreting large amounts of dilute urine. If the client is unable to drink enough fluids, the client will quickly become dehydrated, so tissue turgor should be assessed frequently.

Which nursing intervention should be included in the plan of care for the client diagnosed with hyperthyroidism? 1. Increase the amount of fiber in the diet. 2. Encourage a low-calorie, low-protein diet. 3. Decrease the client's fluid intake to 1,000 mL/day. 4. Provide six (6) small, well-balanced meals a day.

4. The client with hyperthyroidism has an increased appetite; therefore, well-balanced meals served several times throughout the day will help with the client's constant hunger.

Which statement made by the client makes the nurse suspect the client is experiencing hyperthyroidism? 1. "I just don't seem to have any appetite anymore." 2. "I have a bowel movement about every three (3) to four (4) days." 3. "My skin is really becoming dry and coarse." 4. "I have noticed all my collars are getting tighter."

4. The thyroid gland (in the neck) enlarges as a result of the increased need for thyroid hormone production; an enlarged gland is called a goiter.

Which arterial blood gas results should the nurse expect in the client diagnosed with diabetic ketoacidosis? 1. pH 7.34, Pao2 99, Paco2 48, HCO3 24. 2. pH 7.38, Pao2 95, Paco2 40, HCO3 22. 3. pH 7.46, Pao2 85, Paco2 30, HCO3 26. 4. pH 7.30, Pao2 90, Paco2 30, HCO3 18.

4. This ABG indicates metabolic acidosis, which is expected in a client diagnosed with diabetic ketoacidosis.

The client diagnosed with HHNS was admitted yesterday with a blood glucose level of 780 mg/dL. The client's blood glucose level is now 300 mg/dL. Which intervention should the nurse implement? 1. Increase the regular insulin IV drip. 2. Check the client's urine for ketones. 3. Provide the client with a therapeutic diabetic meal. 4. Notify the HCP to obtain an order to decrease insulin.

4. When the glucose level is decreased to around 300 mg/dL, the regular insulin infusion therapy is decreased. Subcutaneous insulin will be administered per sliding scale.

The client diagnosed with type 1 diabetes mellitus received regular insulin two (2) hours ago. The client is complaining of being jittery and nervous. Which interventions should the nurse implement? List in order of priority. 1. Call the laboratory to confirm blood glucose level. 2. Administer a quick-acting carbohydrate. 3. Have the client eat a bologna sandwich. 4. Check the client's blood glucose level at the bedside. 5. Determine if the client has had anything to eat.

5. Regular insulin peaks in two (2) to four (4) hours; therefore, the nurse should suspect a hypoglycemic reaction if the client has not eaten anything. 2. The antidote for insulin is glucose; therefore, the nurse should give the client some type of quick-acting food source. 4. The nurse should obtain the client's blood glucose level as soon as possible; this can be done with a glucometer at the bedside. 1. Most hospitals require a confirmatory serum blood glucose level. Do not wait for results to give food. 3. A source of long-acting carbohydrate and protein should be given to prevent a reoccurrence of hypoglycemia.

The nursing management of a patient who underwent transsphenoidal removal of a pituitary tumor yesterday includes which of the following actions? Select all that apply. A. Maintaining oral care B. Removing nasal pack to check for bleeding and CSF leak C. Giving fluid after nausea, and then slowly progressing to normal diet D. Raising the head of the bed to promote drainage E. Brush teeth to prevent bacterial overgrowth with hard toothbrush

Answer A, C, D. Nasal packs are not removed until the third or fourth postoperative day. Removing the nasal pack the day after surgery may exacerbate bleeding. If a sublabial approach is used, the patient is advised not to brush his or her teeth until the incision above the teeth has been healed.

A patient presented to the unit with an ADH-secreting tumor. Upon diagnostic and physical evaluation, the nurse suspects the patient is experiencing SIADH. Which of the following is a clinical manifestation of SIADH? Select all that apply. A. Hyponatremia B. Hypernatremia C. Increased serum osmolality D. Reduced serum osmolality E. Dry mucous membranes F. Low urine output

Answer A, D, F. The patient with SIADH has hyponatremia (plasma sodium concentration of less than 135 mEq/L) and is not hypernatremia. Unlike healthy people, patients with SIADH cannot excrete diluted urine. As a result, they retain water (thus the serum osmolality decreases) and hyponatremia is seen.

The nurse would expect that insulin may be substituted for other antidiabetic agents in which of the following patients? A. In a patient with a history of DM hospitalized for an acute infection B. In a patient having difficulty with weight management C. In a patient experiencing hypoglycemia D. In a patient who is newly diagnosed with borderline hyperglycemia

Answer A. Illness and infection increase blood sugar levels, making diabetes difficult to control with oral antidiabetic agents alone.

A 55-year-old female presents to the clinic with complaints of fatigue and tiredness. The nurse notices that the patient's skin is thin, fragile, and easily traumatized. Ecchymosis and purple striae are noted over the thighs and abdomen. She presents with a slight kyphosis and a protruding abdomen. Which of the following methods of management might be appropriate for her? A. Increase dose of corticosteroids B. Unilateral or bilateral adrenalectomy C. Increase dose of Spironolactone D. Diet that is high in carbohydrates and low in protein

Answer B, C. Adrenalectomy is the treatment of choice for patients with primary adrenal hypertrophy. Spironolactone might be prescribed if high BP and hypokalemia. It is a drug that treats fluid retention and maintains potassium levels in the body. Corticosteroids should be reduced or tapered rather than increased. Diet high in carbohydrate and high in protein should be encouraged.

A 70-year-old female patient is admitted to the unit with enlargement of thyroid gland, hypertension, high TSH levels, and bulging eyes. What nursing intervention is most appropriate for this patient? A. Providing a blanket B. Instilling eye ointment C. Providing a warm bath D. Keep room temperature comfortable at 85°F

Answer B. A patient with Graves' disease is likely to show signs of exophthalmos (protrusion of eyeball that exposes the cornea). Instillation of eye ointment is necessary to minimize corneal damage. Patients with Graves' disease perspire easily and we should keep room temperature cool rather than warm.

Which should be included when teaching a newly diagnosed patient about the dietary management of diabetes? A. Food intake should be decreased before exercise. B. Consistency between food intake and activity is important. C. Carbohydrates are strictly limited. D. Insulin and other antidiabetic agents decrease the need for dietary management.

Answer B. Activity lowers the blood glucose; more food is needed with increased activity.

A morning dose of NPH insulin is given at 7:30 AM. What is the timeframe in which the nurse can expect it to peak? A. 11:30 AM and 1:30 PM B. 1:30 PM and 3:30 PM C. 3:30 PM and 9:30 PM D. 5:30 PM and 11:30 PM

Answer B. NPH insulin peaks in 6 to 8 hours.

Which does the nurse recognize as an early indicator of nephropathy? A. Hematuria B. Glycosuria C. Albuminuria D. Polyuria

Answer C. Damaged kidneys start "leaking" protein in the form of microalbumin. Normally, protein is not found in urine.

The nurse anticipates that during the initial treatment of diabetic ketoacidosis, the provider will order which solution? A. D5W B. D5.45% saline C. Lactated Ringer solution D. 0.9% saline

Answer D. Normal saline replaces fluids without adding glucose or electrolytes. A and B contain 5% dextrose and C contains potassium as well as other electrolytes.

The health-care provider has ordered 40 g/24 hr of intranasal vasopressin for a client diagnosed with diabetes insipidus. Each metered spray delivers 10 g. The client takes the medication every 12 hours. How many sprays are delivered at each dosing time? _________

Two (2) sprays per dose.

The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit? 1. Complaints of extreme fatigue and hair loss. 2. Exophthalmos and complaints of nervousness. 3. Complaints of profuse sweating and flushed skin. 4. Tetany and complaints of stiffness of the hands.

1. A decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss.

The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the health-care provider? 1. Serum sodium of 112 mEq/L and a headache. 2. Serum potassium of 5.0 mEq/L and a heightened awareness. 3. Serum calcium of 10 mg/dL and tented tissue turgor. 4. Serum magnesium of 1.2 mg/dL and large urinary output.

1. A serum sodium level of 112 mEq/L is dangerously low, and the client is at risk for seizures. A headache is a symptom of a low-sodium level.

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care? 1. Assess the client's ability to read small print. 2. Monitor the client's serum prothrombin time (PT) level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly.

1. Age-related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosage accurately.

The nurse is planning the care of a client diagnosed with Addison's disease. Which intervention should be included? 1. Administer steroid medications. 2. Place the client on fluid restriction. 3. Provide frequent stimulation. 4. Consult physical therapy for gait training.

1. Clients diagnosed with Addison's disease have adrenal gland hypofunction. The hormones normally produced by the gland must be replaced. Steroids and androgens are produced by the adrenal gland.

The nurse identifies the client problem "risk for imbalanced body temperature" for the client diagnosed with hypothyroidism. Which intervention should be included in the plan of care? 1. Discourage the use of an electric blanket. 2. Assess the client's temperature every two (2) hours. 3. Keep the room temperature cool. 4. Space activities to promote rest.

1. External heat sources (heating pads, electric or warming blankets) should be discouraged because they increase the risk of peripheral vasodilation and vascular collapse.

A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

1. Hypotension 3. Hyperkalemia

Which interrelated concepts could be identified as actual or potential for a 56-year-old male client diagnosed with diabetes mellitus type 2? Select all that apply. 1. Nutrition. 2. Metabolism. 3. Infection. 4. Male reproduction. 5. Skin integrity.

1. Obesity is included in the concept of nutrition. Obesity is an antecedent of diabetes mellitus type 2. 2. Diabetes is a problem of glucose metabolism. 3. The client is at greater risk for developing infections resulting from the high circulating glucose levels. Bacteria utilize glucose for energy, as do mammals. 4. Diabetes affects the ability of the blood vessels to respond to circulatory need. For a middle-aged male this can result in erectile dysfunction. 5. Skin integrity is an issue if a pressure sore or a blister occurs on the feet. If not noted and treated early then an infection can result in amputation.

The nurse is completing an assessment on a client who is being admitted for a diagnostic work up for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply.. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

1. Polyuria 3. Bone pain

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2. Inadequate fluid volume

The client has developed iatrogenic Cushing's disease. Which statement is the scientific rationale for the development of this diagnosis? 1. The client has an autoimmune problem causing the destruction of the adrenal cortex. 2. The client has been taking steroid medications for an extended period for another disease process. 3. The client has a pituitary gland tumor causing the adrenal glands to produce too much cortisol. 4. The client has developed an adrenal gland problem for which the health-care provider does not have an explanation.

2. "Iatrogenic" means a problem has been caused by a medical treatment or procedure—in this case, treatment with steroids for another problem. Clients taking steroids over a period of time develop the clinical manifestations of Cushing's disease. Disease processes for which long-term steroids are prescribed include chronic obstructive pulmonary disease, cancer, and arthritis.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I should not exercise since I am taking insulin" 2. "The best time for me to exercise is after breakfast" 3. "The best time for me to exercise is mid- to late afternoon" 4. "NPH is a basal insulin, so I should exercise in the evening"

2. "The best time for me to exercise is after breakfast"

The client is admitted to the intensive care department diagnosed with myxedema coma. Which assessment data warrant immediate intervention by the nurse? 1. Serum blood glucose level of 74 mg/dL. 2. Pulse oximeter reading of 90%. 3. Telemetry reading showing sinus bradycardia. 4. The client is lethargic and sleeps all the time.

2. A pulse oximeter reading of less than 93% is significant. A 90% pulse oximeter reading indicates a Pao2 of approximately 60 on an arterial blood gas test; this is severe hypoxemia and requires immediate intervention.

The nurse is preparing to administer sliding-scale insulin to a client with type 2 diabetes. The medication administration record is as follows: At 1130, the client has a blood glucometer level of 322. Which intervention should the nurse implement? 1. Notify the health-care provider. 2. Administer 10 units of regular insulin. 3. Administer five (5) units of Humalog insulin. 4. Administer 10 units of intermediate-acting insulin.

2. According to the sliding scale, any blood glucose reading between 301 and 450 requires 10 units of regular insulin, which is fast-acting insulin.

The nurse is discharging a client diagnosed with diabetes insipidus. Which statement made by the client warrants further intervention? 1. "I will keep a list of my medications in my wallet and wear a Medic Alert bracelet." 2. "I should take my medication in the morning and leave it refrigerated at home." 3. "I should weigh myself every morning and record any weight gain." 4. "If I develop a tightness in my chest, I will call my health-care provider."

2. Medication for DI is usually taken every eight (8) to 12 hours, depending on the client. The client should keep the medication close at hand.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Select all that apply 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2. Shakiness 3. Palpitations 5. Lightheadedness

The client is admitted to rule out Cushing's syndrome. Which laboratory tests should the nurse anticipate being ordered? 1. Plasma drug levels of quinidine, digoxin, and hydralazine. 2. Plasma levels of ACTH and cortisol. 3. A 24-hour urine for metanephrine and catecholamine. 4. Spot urine for creatinine and white blood cells (WBCs).

2. The adrenal gland secretes cortisol and the pituitary gland secretes adrenocorticotropic hormone (ACTH), a hormone used by the body to stimulate the production of cortisol.

Which psychosocial problem should be included in the plan of care for a female client diagnosed with Cushing's syndrome? 1. Altered glucose metabolism. 2. Body image disturbance. 3. Risk for suicide. 4. Impaired wound healing.

2. The client with Cushing's syndrome has body changes, including moon face, buffalo hump, truncal obesity, hirsutism, and striae and bruising, all of which affect the client's body image.

The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse? 1. The client has crumbling toenails. 2. The client has athlete's foot. 3. The client has a necrotic big toe. 4. The client has thickened toenails.

3. A necrotic big toe indicates "dead" tissue. The client does not feel pain, does not realize the injury, and does not seek treatment. Increased blood glucose levels decrease the oxygen supply needed to heal the wound and increase the risk for developing an infection.

The nurse writes a problem of "altered body image" for a 34-year-old client diagnosed with Cushing's disease. Which intervention should be implemented? 1. Monitor blood glucose levels prior to meals and at bedtime. 2. Perform a head-to-toe assessment on the client every shift. 3. Use therapeutic communication to allow the client to discuss feelings. 4. Assess bowel sounds and temperature every four (4) hours.

3. Allowing the client to ventilate feelings about the altered body image is the most appropriate intervention. The nurse cannot do anything to help the client's buffalo hump or moon face.

The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess? 1. Moon face, buffalo hump, and hyperglycemia. 2. Hirsutism, fever, and irritability. 3. Bronze pigmentation, hypotension, and anorexia. 4. Tachycardia, bulging eyes, and goiter.

3. Bronze pigmentation of the skin, particularly of the knuckles and other areas of skin creases, occurs in Addison's disease. Hypotension and anorexia also occur with Addison's disease.

The client diagnosed with type 2 diabetes is admitted to the intensive care unit (ICU) with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit? 1. Kussmaul's respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor.

3. Dry mucous membranes are a result of the hyperglycemia and occur with both HHNS and DKA.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL. A continuous IV infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose is now decreased to 240 mg/dL. The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin SQ 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

3. IV fluids containing dextrose

Which signs/symptoms indicate the client with hypothyroidism is not taking enough thyroid hormone? 1. Complaints of weight loss and fine tremors. 2. Complaints of excessive thirst and urination. 3. Complaints of constipation and being cold. 4. Complaints of delayed wound healing and belching.

3. If the client were not taking enough thyroid hormone, the client would exhibit symptoms of hypothyroidism such as constipation and being cold.

The nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnosed with type 1 diabetes. Which instruction is most important to discuss with the client? 1. Refer the client to the American Diabetes Association. 2. Do not take any over-the-counter (OTC) medications. 3. Take the prescribed insulin even when unable to eat because of illness. 4. Explain the need to get the annual flu and pneumonia vaccines.

3. Illness increases blood glucose levels; therefore, the client must take insulin and consume high-carbohydrate foods such as regular Jell-O, regular popsicles, and orange juice.

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measure to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat" 2. "I will decrease my insulin dose during times of illness" 3. "I will adjust my insulin dose according to the level of glucose in my urine" 4. "I will notify my HCP if my blood sugar level is higher than 250 mg/dL"

4. "I will notify my HCP if my blood sugar level is higher than 250 mg/dL"

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority action? 1. Correct the acidosis 2. Administer 5% dextrose IV 3. Apply a monitor for an electrocardiogram 4. Administer short-duration insulin IV

4. Administer short-duration insulin IV

The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes? 1. Eat a simple carbohydrate snack before exercising. 2. Carry peanut butter crackers when exercising. 3. Encourage the client to walk 20 minutes three (3) times a week. 4. Perform warm-up and cool-down exercises.

4. All clients who exercise should perform warm-up and cool-down exercises to help prevent muscle strain and injury.

The nurse is providing an in-service on thyroid disorders. One of the attendees asks the nurse, "Why don't the people in the United States get goiters as often?" Which statement by the nurse is the best response? 1. "It is because of the screening techniques used in the United States." 2. "It is a genetic predisposition rare in North Americans." 3. "The medications available in the United States decrease goiters." 4. "Iodized salt helps prevent the development of goiters in the United States."

4. Almost all of the iodine entering the body is retained in the thyroid gland. A deficiency in iodine will cause the thyroid gland to work hard and enlarge, which is called a goiter. Goiters are commonly seen in geographical regions having an iodine deficiency. Most table salt in the United States has iodine added.

Which sign/symptom should the nurse expect in the client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? 1. Excessive thirst. 2. Orthopnea. 3. Ascites. 4. Concentrated urine output.

4. Excess antidiuretic hormone (ADH) causes SIADH, which causes increased water reabsorption and leads to increased fluid volume and scant, concentrated urine.

The nurse is teaching a community class to people with type 2 diabetes mellitus. Which explanation explains the development of type 2 diabetes? 1. The islet cells in the pancreas stop producing insulin. 2. The client eats too many foods high in sugar. 3. The pituitary gland does not produce vasopressin. 4. The cells become resistant to the circulating insulin.

4. Normally insulin binds to special receptors sites on the cell and initiates a series of reactions involved in metabolism. In type 2 diabetes, these reactions are diminished primarily as a result of obesity and aging.

Upon evaluation of the patient's laboratory data and clinical signs and symptoms, the nurse suspects that the patient may have pheochromocytoma. Which of the following is directly related with pheochromocytoma? Select all that apply. A. Severe headache; pain score of 9 out of 10 B. Perspiration C. Blood pressure 80/90 mm Hg D. Pallor E. Lethargy

Answer A and B. Severe headache, perspiration, are indicative of pheochromocytoma. High, not low, blood pressure is strongly associated with pheochromocytoma. The massive release of catecholamines is associated with tremor, and nervousness, not lethargy. Palpitations may also be seen.

The client diagnosed with Cushing's disease has developed 1++ peripheral edema. The client has received intravenous fluids at 100 mL/hr via IV pump for the past 79 hours. The client received intravenous piggyback (IVPB) medication in 50 mL of fluid every six (6) hours for 15 doses. How many mL of fluid did the client receive? _________

The client has received 8,650 mL of intravenous fluid.

The client diagnosed with type 1 diabetes is receiving Humalog, a rapid-acting insulin, by sliding scale. The order reads blood glucose level: < 150, zero (0) units; 151 to 200, three (3) units; 201 to 250, six (6) units; >251, contact health-care provider. The unlicensed assistive personnel (UAP) reports to the nurse the client's glucometer reading is 189. How much insulin should the nurse administer to the client? ______

Three (3) units.