Cha 1 endo retake
A 27-year-old client admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? a) Place the client on a cardiac monitor. b) Administer IV potassium supplements. c) Obtain urine glucose and ketone levels. d) Start an insulin infusion at 0.1 units/kg/hr.
A Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patient's care.
A child with GH deficiency is receiving GH therapy. What is the best time for the GH to be administered? a) At bedtime b) After meals c) Before meals d) On arising in the morning
A Injections are best given at bedtime to more closely approximate the physiologic release of GH.
A client receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a) 9:00 AM b) 11:30 AM c) 4:00 PM d) 8:00 PM
A The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times. Alicia Strong What is the time for onset for rapid-acting insulin?
A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8 AM. The nurse instructs the patient to fast for what period of time? a) At least eight hours b) 4 AM on the day of the test c) After dinner the evening before the test d) 7 AM on the day of the test
A Typically a patient is prescribed to be nothing by mouth (NPO) for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8 AM should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4 AM and 7 AM would not allow for sufficient time to fast for morning laboratory testing.
When assessing a patient with hypothyroidism, which finding does the nurse anticipate? a) Dehydration b) Goiter c) Cyanosis d) Dry eyes
B A goiter is a common clinical manifestation of hypothyroidism, caused by the thyroid's compensatory enlargement to try to produce and secrete more thyroid hormone. Dehydration, cyanosis, and dry eyes are not clinical manifestations of hypothyroidism.
Which action should the nurse take first when teaching a client who is newly diagnosed with type 2 diabetes about home management of the disease? a) Ask the client's family to participate in the diabetes education program. b) Assess the client's perception of what it means to have diabetes mellitus. c) Demonstrate how to check glucose using capillary blood glucose monitoring. d) Discuss the need for the client to actively participate in diabetes management.
B Before planning education, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.
The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the client's a) weight has increased. b) urinary output is increased. c) peripheral edema is decreased. d) urine specific gravity is increased.
B Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder
Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? a) Dwarfism b) Acromegaly c) Gigantism d) Cretinism
B Excess GH after closure of the epiphyseal plates results in acromegaly. When there is excess GH before the epiphyseal plates, then gigantism can result. Dwarfism is associated with a deficiency of GH, not excess, and cretinism can result as an effect of congenital hypothyroidism.
A patient who had been diagnosed with pre-diabetes six months ago is following up in the outpatient diabetes clinic. The nurse is reviewing the assessment data and understands the best reflection of good management of this condition is: a) A 20-pound weight loss b) Hemoglobin A1C of 5.5% c) Reduction of total cholesterol to 200 mg/dL d) Decrease in polyuria, polydipsia, and polyphagia
B Individuals with pre-diabetes are at increased risk for development of type-2 diabetes mellitus. Prediabetes is an intermediate stage between normal glucose homeostasis and elevated blood glucose levels (diabetes). The best indicator of control of this condition is a hemoglobin A1C within normal limits for the non-diabetic patient. Hemoglobin A1C measures the amount of glucose that binds with the component of hemoglobin (AlC), which gives an indication of average glucose levels in the blood over a 90-day period. Although a reduction of risk factors through weight reduction, dietary management, and exercise is important, weight loss and cholesterol within normal limits does not reflect prevention of diabetes. Because the patient does not have true diabetes, the patient would not be experiencing the classic symptomology of the disease: polyuria, polydipsia, and polyphagia.
Which information will the nurse include when teaching a client who has type 2 diabetes about glyburide? a) Glyburide decreases glucagon secretion from the pancreas. b) Glyburide stimulates insulin production and release from the pancreas. c) Glyburide should be taken even if the morning blood glucose level is low. d) Glyburide should not be used for 48 hours after receiving IV contrast media.
B The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide, because hypoglycemia can occur with this category of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.
The nurse is teaching care guidelines to the parent of a child with hypothyroidism. During the follow-up visit, the nurse suspects that the child may be receiving ineffective treatment. Which action of the parent supports the nurse's suspicion? a) The parent is giving the child fiber-rich food. b) The parent gives the child a thyroid supplement after meals. c) The mother gives the child a thyroid supplement each morning. d) The mother encourages the child to increase activity and exercise.
B Thyroid supplements should be given on an empty stomach in order to enhance absorption. Therefore, giving thyroid supplements after meals reduces the concentration of medication in the blood. Thyroid supplements may cause constipation, so the nurse recommends that the parent give the child fiber-rich food. Thyroid supplements should be given in the morning for effective treatment. Hypothyroidism causes low metabolic activity, so a gradual increase in activity and exercise will be beneficial for the child
A 78-year-old client in a long-term care facility has these medications prescribed. After the client is diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administration of a) docusate b) diazepam c) ibuprofen d) cefoxitin
B Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the diazepam with the health care provider before administration. The other medications may be given safely to the patient.
The nurse is caring for a patient that had the parathyroid glands removed. The nurse expects what urinalysis finding? a) High sodium level b) High calcium level c) High potassium level d) High phosphate level
B high PHos in the blood so it needs to dump ca Parathyroid glands secrete parathyroid hormones, which help in the reabsorption of calcium into the body and the excretion of phosphate in the urine. In the absence of parathyroid hormone, less calcium would be reabsorbed into the body, increasing calcium levels in the urine. Sodium and potassium levels are unrelated to the parathyroid hormone and would be unaffected by the removal of the parathyroid glands. Absence of the parathyroid hormone would increase reabsorption of phosphate into the body, decreasing its level in the urine.
The nurse concludes that a patient has Cushing syndrome. Which findings support the nurse's conclusion? Select all that apply. a) Goiter b) Moon face c) Hypertension d) Exophthalmos e) Decreased muscle mass
B, C, E Cushing syndrome is caused by an increase in serum cortisol levels. A patient with Cushing syndrome has moon face, hypertension, and decreased muscle mass due to protein wasting. A goiter is an enlargement of the thyroid gland caused by iodine deficiency. Exophthalmos is a condition in which the eyeballs protrude from the orbits. It occurs in patients with hyperthyroidism due to accumulation of fluid in the eye and retroorbital tissue.
What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? a) Providing a dark, low-stimulation environment b) Closely monitoring the patient's intake and output c) Patient teaching related to levothyroxine (Synthroid) d) Patient teaching related to radioactive iodine therapy
C A euthyroid state most often is achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.
The nurse, providing care to a patient with Cushing's syndrome, understands that the disorder is primarily related to: a) Liver dysfunction b) Chronic renal failure c) Excessive secretion of adrenocorticosteroid hormones d) Decreased secretion of adrenocorticosteroid hormones
C Cushing's syndrome results from excessive secretion of adrenocorticosteroid hormones, usually caused by pituitary gland tumors or carcinoma of the adrenal glands. It is also the result of excessive steroid intake for other medical conditions or nonmedical use (e.g., sports). Cushing's syndrome is not directly related to liver function or renal failure. It is caused by excessive, not decreased, amounts of adrenocorticosteroid hormones.
A patient presents with diabetic ketoacidosis (DKA). The nurse initiates the collaborative plan of care with the understanding that the initial goal of the treatment plan is: a) Treatment for hypokalemia b) Rapid reduction of elevated blood glucose c) Rehydration through intravenous fluid replacement d) Reduction of ketosis by encouraging oral nourishment
C Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish intravenous (IV) access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored as insulin therapy, which is needed to correct the hyperglycemia, may further reduce the pota level. Insulin therapy will be used to lower the blood glucose gradually to prevent rapid drops in serum glucose, leading to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy because excess glucose is not being transported to the cells and used as source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen
A patient who was recently diagnosed with Type 2 diabetes mellitus completed a teaching session about disease management. Which statement by the patient indicates understanding of Type 2 diabetes mellitus? a) "I will always be able to manage my diabetes with pills." b) "As I get older, I will be able to decrease my diabetes medicine." c) "If I become ill, I will need to check my blood sugar more frequently." d) "As long as I take my medication, I do not have to follow a diabetic diet "
C Illness may increase blood glucose on people with type 2 diabetes. Diabetes is a progressive disease and as time goes on, patients with diabetes type 2 may need to increase oral medications or begin insulin therapy. Nutritional therapy is an integral part of diabetes management.
A client with Cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which intervention by the nurse will be most helpful? a) Reassure the client that the physical changes are very common in patients with Cushing syndrome. b) Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c) Teach the client that most of the physical changes caused by Cushing syndrome will resolve after surgery. d) Remind the client that the metabolic impact of Cushing syndrome is of more importance than appearance.
C The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiological problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.
After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority? a) Administer insulin b) Administer oxygen c) Insert a Foley catheter d) Establish an intravenous (IV) access
D A person with DKA is severely dehydrated, which can be life- threatening. An IV access must be established first to administer fluids. Insulin is administered intravenously only after a potassium level is determined, because insulin administration may cause hypokalemia.Oxygen and a Foley catheter are not normally necessary in treating DKA.
Which information about a client who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test? a) The client reports having occasional orthostatic dizziness. b) The client has had a 10-pound weight gain in the last month. c) Theclient drank several glasses of water an hour previously. d) The client takes oral corticosteroids for rheumatoid arthritis.
D Corticosteroids can affect blood glucose results. The other information will be provided to the provider, but will not affect the test results.
The nurse creates a plan of care for a patient with Graves disease. What is an appropriate expected outcome? a) The patient will be free of infection. b) The patient will remain awake, alert, and oriented. c) The patient will be compliant with fluid restrictions. d) The patient will demonstrate maintenance of his weight.
D Graves disease, which results from hyperthyroidism, causes an increase in metabolism. Untreated, it may cause unexplained weight loss. It is important for the nurse to plan care to support an expected outcome to maintain or gain weight. Risk for infection and fluid overload are not direct issues related to hyperthyroidism. Because of the increased secretion of thyroid hormone, these patients will be hyperalert and anxious and may have difficulty sleeping. Therefore the goal of remaining awake, alert, and oriented is not a priority.
A patient is admitted with diabetic ketoacidosis. Which signs/symptoms would the nurse expect to find upon physical examination? a) Blood sugar 200 mg/dL and bradypnea b) Hypotension and blood sugar 68 mg/dL c) Diaphoresis and extreme hunger d) Dry skin and ketonurea
D In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. The patient also will present with dry, loose skin. Blood pressure will not be low and respiratory rate will be increased, not decreased.
Which information will the nurse include when teaching a client who has been newly diagnosed with Graves' disease? a) Exercise is contraindicated to avoid increasing metabolic rate. b) Restriction of iodine intake is needed to reduce thyroid activity. c) Surgery will eventually be required to remove the thyroid gland. d) Antithyroid medications may take several weeks to have an effect.
D Medications used to block the synthesis of thyroid hormones may take several weeks before an effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease, although surgery may be used.
A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition? a) Cretinism b) Early menopause c) Hyperthyroidism d) Myxedema
D Myxedema is severe hypothyroidism characterized by this woman's symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss.
A client has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for a) calcitonin levels. b) catecholamine levels. c) thyroid hormone levels. d) parathyroid hormone levels.
D Parathyroid hormone is the major controller for blood calcium levels. Although calcitonin secretion is a counter mechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.
The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse: a) "I am going to check my feet for pressure areas every morning before I take a bath." b) "I need to be careful on how I cut my toenails. I should not cut down the corners of the nail." c) "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." d) "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."
D Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye exam annually by an ophthalmologist
A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure? a) Exercise will be restricted for up to six months. b) A low- or no-sodium diet will be prescribed. c) Physical therapy will need to be continued. d) Life-long hormone replacement will be needed.
D This patient will need life-long thyroid hormone replacement with levothyroxine (Synthroid) because the entire thyroid gland will be missing after surgery. Exercise will not be restricted for six months. Lengthy exercise restriction or physical therapy generally is not indicated following a thyroidectomy. A sodium- restricted diet would not ordinarily be necessary.
A 30-year-old patient has been diagnosed with hypothyroidism. What should the nurse expect to assess in this patient's integumentary system? a) Warm, flushed skin, alopecia, and thin nails b) General hyperpigmentation and loss of body hair c) Pale skin, pale mucous membranes, hair loss, and nail dystrophy d) Cold, dry, pale skin, dry, coarse hair, and brittle, slow growing nails
D With hypothyroidism the patient will manifest with cold, dry, pale skin, dry, coarse, brittle hair, and brittle, slow growing nails. With hyperthyroidism the patient will have warm, flushed skin, alopecia with fine soft hair, and thin nails. With Addison's disease the patient will have loss of body hair and generalized hyperpigmentation, especially in folds. With anemia, the patient will display pallor, pale mucous membranes, hair loss, and nail dystrophy.
A patient's blood test reveals elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). In discussing these results with the patient, the nurse explains that both of these hormones have which feature? a) Stimulate the release of cortisol b) Are secreted by the anterior pituitary c) Stimulate the release of aldosterone d) Are secreted by the posterior pituitary
b Both GH and ACTH are secreted by the anterior pituitary, not the posterior pituitary. ACTH does stimulate the release of cortisol from the adrenal cortex, but GH does not. Release of aldosterone is stimulated by renin from the kidney.
