Block 3 Final: Endocrine

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? 1. "Administer desmopressin while the suspension is cold." 2. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." 3. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." 4. "You won't need to monitor your fluid intake and output after you start taking desmopressin."

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."; Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? 1. "You must lie flat for 24 hours after surgery." 2. "You must avoid coughing, sneezing, and blowing your nose." 3. "You must restrict your fluid intake." 4. "You must report ringing in your ears immediately."

"You must avoid coughing, sneezing, and blowing your nose."; After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1. 2 to 5 g of a simple carbohydrate 2. 10 to 15 g of a simple carbohydrate 3. 18 to 20 g of a simple carbohydrate 4. 25 to 30 g of a simple carbohydrate

10 to 15 g of a simple carbohydrate; To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: 1. Increasing saturated fat intake and fasting in the afternoon 2. Increasing intake of vitamins B and D and taking iron supplements 3. Eating a candy bar if lightheadedness occurs 4. Consuming a low-carbohydrate, high-protein diet and avoiding fasting

Consuming a low-carbohydrate, high-protein diet and avoiding fasting; To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: 1. Hypotension 2. Thick, coarse skin 3. Deposits of adipose tissue in the trunk and dorsocervical area 4. Weight gain in arms and legs

Deposits of adipose tissue in the trunk and dorsocervical area; Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? 1. Fluid intake is less than 2,500 ml/day. 2. Urine output measures more than 200 ml/hour. 3. Blood pressure is 90/50 mm Hg. 4. The heart rate is 126 beats/minute.

Fluid intake is less than 2,500 ml/day; Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? 1. Muscle weakness 2. Tremors 3. Diaphoresis 4. Constipation

Muscle weakness; Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? 1. Tetanic contractions 2. Neck vein distention 3. Weight loss 4. Polyuria

Neck vein distention; SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the dose's: 1. Onset to be at 2 p.m. and its peak to be at 3 p.m. 2. Onset to be at 2:15 p.m. and its peak to be at 3 p.m. 3. Onset to be at 2:30 p.m. and its peak to be at 4 p.m. 4. Onset to be at 4 p.m. and its peak to be at 6 p.m.

Onset to be at 2:30 p.m. and its peak to be at 4 p.m.; Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? 1. Infusing I.V. fluids rapidly as ordered 2. Encouraging increased oral intake 3. Restricting fluids 4. Administering glucose-containing I.V. fluids as ordered

Restricting fluids; To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

Nurse Troy is aware that the most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia

Risk for infection; Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in: 1. Serum glucose level 2. Hair loss 3. Bone mineralization 4. Menstrual flow

Serum glucose level; Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.