Ch 51 & 52 NUR212

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function?

"Do you experience fatigue even if you have slept a long time?"

A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to effective based on which statement by the client?

"For dinner 1 ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client?

"I will take this medication in the morning, with my first bite of breakfast"

A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response?

"If treated successfully, the major physical changes will disappear with time"

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's bet response?

"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy"

A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask?

"has your shoe size increased recently?"

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "you look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition

"your body is using protein and fat for energy instead of glucose"

Once digested, what percentage of carbohydrates is converted to glucose?

100% of carbohydrates -50% of protein foods are also converted to glucose but has minimal effect on blood glucose concentration

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?

3 months

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11 pm to 7 am, and normally sleeps from 8 am to 4 pm. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time?

5 pm

Which statement is true regarding gestational diabetes?

A glucose challenge test should be performed between 24 to 28 weeks -It occurs 2-5% of all pregnancies. Onset usually occurs in 2nd or 3rd trimester. Above-normal risk for perinatal complicatioins

Which disorder results from excessive secretion of somatotropin (growth hormone)?

Acromegaly -demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet.

Addisonian crisis is a complication of

Addison disease

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate?

Administer IV calcium gluconate as ordered

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen?

Administering a dose of intermediate-acting insulin before the evening meal

Long-term use of antithyroid medication is not generally recommended for elderly clients because of which evenets?

Agranulocytosis and hepatic injury

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the clients symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis?

Assess the client's breath odor

Which symptom of thyroid disease is seen in older adults?

Atrial fibrillation and weight loss

A nurse is caring for a client suspected of having a pituitary tumor that is causing panhypopituitarism. During assessment of the client, which clinical manifestation would the nurse expect to find?

Atrophy of the gonads

which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)?

Blood glucose can be controlled through diet and exercise -oral hypoglycemic agents may improve blood glucose concentration if dietary mods and exercise are unsuccessful. Usually obese at diagnosis and rarely demonstrate ketosis, except w stress or infection

Which diagnostic test is done to determine a suspected pituitary tumor?

Computed tomography CT

Hypophysectomy is the treatment of choice for which endocrine disorder?

Cushing syndrome

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

Cushing syndrome

Which age-related change may affect diabetes and its management?

Decreased renal function -hypertension, decreased bowel motility, and decreased thirst

A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find?

Deficient production of vasopressin

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching?

How to control blood glucose through lifestyle modification with diet and exercise

which is a complication of hyperthyroidism

Hypothyroidism

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes?

Increased hunger -three Ps (polyuria, polydipsia, polyphagia)

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first?

Infuse 0.9% normal saline solution 1 L/hr for 2 hours

Which term refers to the progressive increase in blood glucose from bedtime to morning?

Insulin waning

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine?

Ketones

which type of insulin acts most quickly?

Lispro =rapid-acting within 10 to 15 mins

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client?

Low blood glucose concentration -because the human form of insulin is used more effectively, human insulin causes fewer allergic reactions than insulin obtained from animal sources. polyuria and hypertonicity are symptoms of diabetes mellitus

A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom?

Muscle wasting and tissue loss

intermediating acting insulin is

NPH insulin its onset is 3 to 4 hrs

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood?

Pineal gland, melatonin -melatonin plays a vital role in hypothalamicpituitary interaction

A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland?

Posterior pituitary

ADH is secreted by which gland?

Posterior pituitary -ADH=vasopressin

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes?

Presence of autoantibodies against islet cells

A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies?

Reassure the client that their emotional reactions are a result of the disorder and symptoms cab be controlled with effective treatment

which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin?

Sulfonylureas

Dilutional hyponatremia occurs in which disorder?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

the thyroid gland secretes

T3 and T4

When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate?

TH may increase the effect of digitalis preparation

A client receives a daily injection of glargine insulin at 7 am. when should the nurse monitor this client for a hypoglycemic reaction?

This insulin has no peak action and does not cause a hypoglycemic reactioin

which hormone is secreted by the posterior pituitary?

Vasopressin -causes smooth muscle, particularly blood vessels, to contract

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan?

When mixing insulin, the regular insulin is drawn up into the syringe first

acromegaly symptom

a bulging forehead

adrenogenital syndrome is the result of

abnormal secretion of adrenocortical hormones, especially androgen

Thiazolidinediones enhance insulin

action at the receptor site without increasing insulin secretion from the beta cells of the pancreas

DKA is caused by

an absence or markedly inadequate amount of insulin. This insulin deficit results in disorders in the metabolism of carbohydrates, proteins, and fats. the primary clinical features of DKA are hyperglycemia, ketosis, dehydration, electrolyte loss, and acidosis.

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high?

blurred vision

trousseau sign is elicited

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff -suggestive of latent tetany

Alpha-glucosidase inhibitors

delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

if the client has eaten and has not taken or received insulin,

diabetic ketoacidosis is more likely to develop

Glargine is "peakless" which means

do not mix with other insulins -it is absorbed very slowly over 24-hr period and can be given once a day. it is important to read the label carefully and avoid mistaking Lantus insulin for Lente insulin and vice versa

while the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. what is the nurse's most appropriate response?

document the allergy and inform the physician

which is a clinical manifestation of diabetes insipidus?

excessive thirst

A client with diabetes mellitus is receiving an oral antidiabetic agent. the nurse observes for which symptom when caring for this client?

hypoglycemia -can occur anywhere from 30 to 60 mins and up to several hrs after ingested.

Myxedema coma is a complication of

hypothyroidism

Dwarfism is caused by

insufficient secretion of growth hormone during childhood.

Corticosteroids are

secreted by the adrenal cortex

calcitonin is

secreted by the parafollicular cells of the thyroid gland

several types of food contain

sugar, including cereals, sauces, salad dressings, fruits, and fruit juices. It is not feasible, nor advisable, to remove all sources of sugar from the diet.

Biguanides facilitate

the action of insulin on peripheral receptor sites

which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus?

the client has not eaten but continues to take insulin or oral antidiabetic medications

Symptoms of Type 2 Diabetes Mellitus

three P's polyuria, polydipsia, and blurred vision

the thymus gland secretes

thymosin and thymopoietin, which aid in developing T lymphocytes

Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines?

Hypoglycemia -hypotension may occur as well

Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism?

Propylthiouracil (PTU)

A client with symptoms of Cushing syndrome is admitted to the hospital for evaluation and treatment. The nurse is creating a plan of care for the client. Which is an appropriate nursing diagnosis?

Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns

which assessment is done by the nurse when conducting a physical examination?

examine the shape and color of the nails

long-acting insulin is

glargine its onset is ~6 hrs

Acromegaly occurs

with excess growth hormone

the parathyroid glands secrete

parathormone, which increases the levels of calcium and phosphorus in the blood

The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to

monitor for symptoms of hypothyroidism

Cushing syndrome symptoms

moon face and buffalo hump

which would be included in the teaching plan for a client diagnosed with diabetes mellitus?

An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision -diabetic retinopathy is the leading cause of blindness among ppl between 20 n 74 in the U.S.

Antithyroid Medications are not generally recommended for elderly patients because of which side effect?

Granulocytopenia

the anterior pituitary secretes

growth hormone

what feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism?

hand flexing inward

Which manifestations comprise the typical triad seen in a client diagnosed with pheochromocytoma? Select all that apply.

headache, diaphoresis, and palpitations

a positive Chvostek sign is demonstrated when

a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch

Somogyi effect

occurs when blood glucose is normal or elevated at bedtime, decreases at 2 to 3 am to hypoglycemia levels, and subsequently increases as a result of the production of counter-regulatory hormones.

Dawn phenomenon

occurs when blood glucose is relatively normal until about 3 am, when the level begins to rise.

Symptom of hyperparathyroidism

cardiac dysrhythmia

A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 t o140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Bases on these symptoms, the nurse plans to instruct the client to

check blood glucose at 3 am

Cretinism occurs as a result of

congenital hypothyroidism

the adrenal cortex secretes

corticosteroids hormones, which influence many organs and structures of the body

type 2 diabetes and relationship w insulin is

if the diabetes had been well controlled without insulin before the period of acute stress causing a need for insulin, the client may be able to resume previous methods for control of diabetes when the stress is resolved.

Cardiac effects of hyperthyroidism include

palpitations -sinus tachycardia, increased pulse pressure, and systolic BP elevated

the adrenal gland secretes

glucocorticoids and mineralocorticoids

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?

presence of islet cell antibodies -usually thin or demonstrate recent weight loss at the time of diagnosis. Prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life

short-acting insulin is

regular insulin its onset is 30 to 1 hr

somatostatin is

released by the anterior lobe of the pituitary

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching?

use all available injection sites within one area

a client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition?

wear clothing that covers the neck

which factor is the focus of nutrition intervention for clients with type 2 diabetes?

weight loss