PassPoint - Endocrine and Metabolic Disorders

A client with diabetes is asking the nurse about drinking alcohol. The nurse's best response would be:

"Alcohol may decrease the normal physiologic reactions in the body that produce glucose. Therefore, there is a risk for hypoglycemia."

The nurse is teaching the client how to administer insulin. Which instruction should the nurse include?

"First withdraw clear, then cloudy insulin when mixing insulins in the same syringe."

A client with diabetes is explaining to the nurse about doing foot care at home. Which statement indicates the client needs further instruction on how to care for the feet properly?

"I inspect my feet once a week for cuts and redness."

The nurse is teaching a client with type I diabetes self-administration of insulin. Which statement by the client would be an expected outcome of the teaching session? Select all that apply.

"I need to make sure that I eat my meals and snacks on time after I take my insulin." "If I monitor and control my blood glucose levels carefully, there is less likelihood of suffering long-term complications." "If I exercise more than is normal, there is a risk that I might become hypoglycemic."

The nurse is assessing a client with hepatitis A and notices that the aspartate transaminase (AST) and alanine transaminase (ALT) lab values have increased. Which statement by the client indicates the need for further instruction by the nurse

"I take acetaminophen for arthritis pain."

When educating the client with type 1 diabetes, the nurse knows that more education is needed when the client says:

"I will be able to switch to insulin pills when my sugar is under control."

A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse?

"I will increase fiber and fluids in my diet."

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 teaching a client about insulin administration. Which statement if made by a client would indicate to the nurse the client understands insulin administration teaching?

"I will use my abdominal injection site if I want to jog."

A client with hypothyroidism is afraid of needles and doesn't want to have their blood drawn. What should the nurse say to help alleviate the client's concerns?

"I'll stay here with you while the technician draws your blood."

A 24-year-old 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 nurse is teaching a client about levothyroxine. Which instruction should a nurse offer the client?

"Take the drug on an empty stomach."

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?

"Test your blood glucose every 4 hours."

An adolescent is to receive radioactive iodine for Graves disease. Which statement by the client reflects the need for more teaching?

"The advantage of radioactive iodine is that I will not need future medication for my disease."

A client with Addison disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication?

"Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage."

A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk for hypoglycemia will occur at about what time?

0100, while sleeping

A nurse administered neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitus at 7 a.m. (0700). At what time should the nurse expect the client to be most at risk for hypoglycemia?

4 p.m. (1600)

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.

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On a medical-surgical floor, a nurse is caring for a cluster of clients with diabetes mellitus. Which client should the nurse assess first?

A 55-year-old complaining of chest pressure

A nurse has just received a report on four clients. Which client should the nurse see first?

A client who underwent a thyroidectomy and has new onset hoarseness

The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100 mg intravenously at a rate of 10 mL/hour 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 client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What should the nurse anticipate in this client's plan of care?

An increased need for insulin and blood glucose monitoring

A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by the diagnosis and not sure about injecting insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because the space is needed for clients being admitted. How should the nurse handle the situation? Select all that apply.

Ask the physician for a referral for a diabetes nurse-educator to see the client before discharge. Ask the physician to delay the discharge because the client requires further teaching.

On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 0600 glucose level is 300 mg/dL (16.7 mmol/L). What should the nurse do?

Call the health care provider (HCP) for specific prescriptions based on the glucose level.

During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should:

Check with the physician for his complete order.

The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply.

Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.

The nurse is reviewing the postoperative prescriptions (see chart) just written by a health care provider (HCP) for a client with type 1 diabetes who has returned to the surgery floor from the recovery room following surgery for a left hip replacement. The client has a pain rating of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. After obtaining the client'sclient's glucose level, the nurse should do what first?

Contact the health care provider (HCP) to rewrite the insulin prescription.

A client is informed by his healthcare provider that a tumor has been found. When the nurse sees the client later, the client states that no one knows what is wrong with him. The nurse determines that the client is experiencing which of the following?

Could be in denial

A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate?

Encircle the client's neck with both hands, have the client slightly extend their neck, and ask them to swallow.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?

Have regular follow-up care.

Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. What should the nurse do next?

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

A client with a history of Addison's disease is experiencing weakness and headache. The vital signs are blood pressure of 100/60 and heart rate of 80. Laboratory values are Na 130, potassium 4.8, and blood glucose 70. Which solution would the nurse expect to administer?

I.V. normal saline and glucocorticoids

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.

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.

Bone resorption is a possible complication of Cushingterm-6 disease. To help the client prevent this complication, the nurse should make which recommendation to the client?

Maintain a regular program of weight-bearing exercise.

The nurse is caring for a client following a motor vehicle incident with head trauma. Diabetes insipidus is suspected. Which nursing intervention is appropriate?

Measure and record urinary output.

A client is ordered prednisone daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning?

Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern.

A client with type 1 diabetes mellitus is scheduled to have surgery. The client has been nothing-by-mouth since midnight. In the morning, the nurse notices that the client's daily insulin has not been prescribed. Which should the nurse do first?

Obtain the client's blood glucose level at the bedside.

The nurse is caring for a client with type 1 diabetes. The nurse finds the client unconscious and administers glucagon, 1 mg intramuscularly. What is the next action by the nurse when the client regains consciousness?

Offer orange juice and crackers.

The nurse notes grapefruit juice on the breakfast tray of a client with type 2 diabetes mellitus who is taking repaglinide. What should the nurse do next?

Remove the grapefruit juice from the client's tray, and bring another juice of the client's preference.

While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that the nurse forgot to administer insulin to client with diabetes mellitus. The nurse has made numerous errors in the past few weeks and is now afraid this job is in jeopardy. What is the best course of action?

Report the error, complete the proper paperwork, and meet with the unit manager.

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

Restrict sodium.

A client is recovering from transsphenoidal hypophysectomy. What should the nurse instruct the client to do to ensure oral hygiene?

Rinse the mouth with saline.

Which information should the nurse include about hypoglycemia when teaching a client newly diagnosed with type 2 diabetes mellitus? Select all that apply.

Symptoms of hypoglycemia can include irritability, hunger, shaking, and sweating. A carbohydrate food source should be available during strenuous exercise. Alcohol consumption can increase the incidence of hypoglycemia. Regular meals and a bedtime snack will decrease the incidence of hypoglycemia.

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. What should the nurse teach the client about these changes?

The body and mood will gradually return to normal.

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.

A client receives 12 units of intermediate- or long-acting insulin and 6 units of fast-acting insulin each morning. Place the following actions in chronological order of how the nurse would demonstrate how to mix insulins. Use all options.

Wipe off the vials with an alcohol swab. Inject 12 units of air into the intermediate- or long-acting insulin vial. Inject 6 units of air into the fast-acting insulin vial. Withdraw 6 units of fast-acting insulin. Withdraw 12 units of intermediate- or long-acting insulin .

The nurse is assigned to care for the following clients. Which client should the nurse see first?

a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute

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

a thyroid hormone antagonist.

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

What is the most common cause of hyperaldosteronism?

an adrenal adenoma

During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?

assess vital signs.

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 hours before breakfast

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the health care provider will order diuretic therapy, restrict fluid intake, and provide sodium replacement to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise?

cerebral edema

Which condition may contribute to hyperparathyroidism?

chronic renal failure

A nurse should expect to administer which medication to a client with gout?

colchicine

A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms?

coma, anxiety, confusion, headache, and cool, moist skin

The nurse is teaching a client scheduled for thyroid lobectomy. What information will the nurse include?

daily neck exercises

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client?

delayed wound healing

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

dietary fiber

Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. Which symptoms are screened for as an adverse reaction to the surgical procedure? Select all that apply.

dry skin cold intolerance fatigue hair loss

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, a problem that was accompanied by a random blood glucose reading of 31.9 mmol/L (575 mg/dL), vomiting, and shortness of breath. This client has experienced which of the following phenomena?

exacerbation

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 thirst excessive hunger frequent, high-volume urination

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

glucagon

The adrenal cortex is responsible for producing which substances?

glucocorticoids and androgens

A client with a progressively enlarging neck comes into the clinic. The client mentions that they have been in a foreign country for the previous 3 months and that they didn't eat much while there because they didn't like the food. The client also mentions that they become dizzy when lifting their arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose?

goiter

A client with cirrhosis begins to develop ascites. The health care provider prescribes spironolactone to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect?

hyperkalemia

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

hypopituitarism

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

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

The nurse is caring for a client in a diabetic coma. The nurse is aware that this is caused by an excess of which substance in the blood?

ketones from rapid fat breakdown, causing acidosis

A client with hypothyroidism has started to take thyroid hormone replacement therapy and asks the nurse about the reason for feeling sad and depressed. What should the nurse tell the client? "The feelings of sadness and depression are caused by:

low thyroid hormone levels and will improve with replacement therapy."

The nurse is caring for a client with multiple organ failure who is in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation?

lungs and kidneys

Which action hould the nurse take assessing the client being diagnosed with diabetes insipidus?

measuring urine output hourly

During surgery, a patient develops hypothermia. The circulating nurse would monitor the patient closely for which finding?

metabolic acidosis

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.

A nurse is caring for an older adult client who is admitted with an electrolyte imbalance. Which laboratory values should be a priority concern for the nurse? Select all that apply.

pH 7.32 potassium 5.8 mEq/L

Which of the following arterial blood gas (ABG) results would the nurse anticipate for a client with a 3-day history of vomiting?

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28

A client is 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.

The nurse might expect to see which manifestations in the client who is hypocalcemic? Select all that apply.

prolonged Q-T interval irritability tetany

The nurse is assigned a client newly diagnosed with type 2 diabetes. Which tasks should the nurse delegate to a unlicensed assistive personnel (UAP)?

reminding the client to check the glucose level before each meal

A client with type 1 diabetes takes 15 units of insulin isophane before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when the nurse discovers the client takes which over-the-counter preparations?

salicylate-containing preparations

A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see?

serum potassium level of 6.8 mEq/L (6.8 mmol/L)

Parathyroid hormone (PTH) has which effects on the kidney?

stimulation of calcium reabsorption and phosphate excretion

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to

suggest referral to a sex counselor or other appropriate professional.

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

tachycardia

Which client will the community health nurse visit first?

the client with type 1 diabetes mellitus with acute visual changes

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 medications 4 hours later.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply.

tingling muscle twitching and spasms numbness

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

using sterile technique during the dressing change

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

vasopressin

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering

vasopressin.

A client is diagnosed with hypothyroidism. What additional information should the nurse obtain when conducting a focused assessment?

weight gain

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis?

weight gain, decreased appetite, and constipation