Diabetes Practice Questions
After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage? A. Hoarseness of voice B. Difficulty in swallowing C. Tetany D. Fever
A - Laryngeal nerve damage is manifested by severe hoarseness of voice or "whispery voice."
The client has been diagnosed to have IDDM. Which order should you question? A. Propranolol B. Insulin injection C. Acetaminophen D. Diltiazem
A - Propranolol, a beta-adrenergic blocker causes hypoglycemia. It is contraindicated among diabetes clients.
When large amounts of antidiuretic hormone (ADH) are released, the patient's sodium levels will be A. Increased. B. Decreased. C. Unaffected. D. Altered inversely with potassium.
B- Because ADH causes the patient to retain free water, the patient will have a dilutional hyponatremia.
The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? SELECT ALL THAT APPLY A. Instill isotonic eye drops as necessary B. Provide several, small, well-balanced meals C. Provide rest periods D. Keep the environment warm E. Encourage frequent visitors and conversation F. Weigh the client daily
A, B, C, F - the client with hyperthyroidism may experience exopthalmos. This requires instillation of eye drops to prevent dryness and ulceration of the cornea. The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status. The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy.
A 33-years old female is admitted to the hospital with a suspected diagnosis of grave's disease. Which symptom related to the client's menstrual cycle would the client likely report? A. Amenorrhea B. Metrorrhagia C. Menorrhagia D. Dysmenorrha
A- Amenorrhea or a decreased menstrual flow is common in the client with Graves' disease. Dysmenorrhea, metrorrhagia, and menorrhagia are also disorders related to the female reproductive system; however, they do not manifest in the presence of Graves' disease.
A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification? A. Polyuria B. Diaphoresis C. Hypertension D. Increased pulse rate
A- Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options B, C, and D are not signs of hyperglycemia
A client with diabetes mellitus has a blood glucose level of 644 mg/dL. The nurse interprets that this client is most at risk of developing which type of acid-base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
A- Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises. At the same time, the cells of the body use all available glucose. The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic and can lead to the condition known as diabetic ketoacidosis. Options B, C, and D are incorrect.
A nurse is caring for a client with a diagnosis of Cushing's syndrome. The nurse plans which of these measures to prevent complications from this medical condition? A. Monitoring glucose level B. Encouraging daily jogging C. Monitoring epinephrine levels D. Encouraging visits form friends
A- In the client with Cushing's syndrome, increased levels of glucocorticoids can result in hyperglycemia and signs and symptoms of diabetes mellitus. Epinephrine levels are not affected. Clients experience activity intolerance related to muscle weakness and fatigue, therefore option B is incorrect. Visitors should be limited because of the client's impaired immune response.
A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: A. In the morning to prevent insomnia B. Only when the client complains of fatigue and cold intolerance C. At various times during the day to prevent tolerance from occurring D. Three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels
A- Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.
A client with Grave's disease has exopthalmos and is experiencing photophobia. Which of the following nursing interventions would best assist the client with this problem? A. Obtain dark glasses for the client B. Lubricate the eyes with tap water every 2 to 4 hours C. Administer methimazole (Tapazole) every 8 hours around the clock D. Instruct the client to avoid straining or heavy lifting because this can increase eye pressure
A- Medical therapy for Graves' disease does not help alleviate the clinical manifestation of exophthalmos. Because photophobia (light intolerance) accompanies this disorder, dark glasses are helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling around the eye because it could pull fluid into the interstitial space. In addition, the client is at risk for developing an eye infection because the solution is not sterile. Methimazole inhibits the synthesis of thyroid hormone and is used to treat hyperthyroidism but will not alleviate exophthalmos or photophobia. There is no need to avoid straining with exophthalmos.
As the DKA patient receives insulin and fluids, the nurse knows careful assessment must be given to which of the following electrolytes? A. Potassium B. Sodium C. Phosphorus D. Calcium
A- Potassium shifts back into the cell as the acidosis is corrected. Therefore the nurse must monitor the serum potassium frequently during the resuscitation phase. IV insulin will also push potassium into the cell.
A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen. The nurse places highest priority on which of the following nursing diagnoses developed for this client? A. Risk for infection B. Disturbed body image C. Ineffective health maintenance D. Risk for deficient fluid volume
A- The client with a stab wound has a break in the body's first line of defense against infection. The client with Cushing's disease is at great risk for infection caused by excess cortisol secretion, subsequent impaired antibody function, and decreased proliferation of lymphocytes. The client may also have an Ineffective health maintenance and Disturbed body image, but these are not the highest priority at this time. The client would be at risk for Excess fluid volume, not Deficient fluid volume, with Cushing's disease.
An older woman was found in her cold apartment. She is very lethargic. Her blood pressure (BP) is 110/95 and her heart rate is 40. The nurse would suspect: A. Hypothyroidism. B. Cushing syndrome. C. Addison disease. D. Thyrotoxic crisis.
A- These are all signs of a decrease in the metabolic rate. The systolic blood pressure is decreased and the diastolic is increased, resulting in a narrowed pulse pressure.
The patient with thyrotoxic crisis is observed for symptoms of A. Tachydysrhythmia. B. Hypotension. C. Decreased appetite. D. Hypothermia.
A- Thyrotoxic crisis is a hypermetabolic state that exhibits symptoms of tachydysrhythmia, fever, fatigue, and increased appetite
The patient weighed 62 kg on admission yesterday. Today, the patient weighs 60 kg. The nurse knows this reflects a fluid loss of A. 1 L. B. 2 L. C. 4 L. D. 10 L.
B- Daily weight changes coincide with fluid retention and fluid loss. Sudden changes in weight could result from a change in fluid balance; 1 liter of fluid lost or retained is equal to approximately 2.2 pounds, or 1 kg, of weight gained or lost.
The most common problem in the patient with type 2 diabetes is a(n) A. Lack of insulin production. B. Imbalance between insulin production and use. C. Overproduction of glucose. D. Increased uptake of glucose in the cells.
B- In type 2 diabetes the pancreatic B cells produce ineffective or insufficient insulin.
The patient has a fasting glucose level of 150 mg/dL. The nurse knows this value is A. Normal. B. Diagnostic of diabetes but it should be reevaluated for accuracy. C. Lower than what the nurse would expect in a patient receiving intravenous fluids. D. Elevated, indicating diabetic ketoacidosis.
B- A normal FPG is between 70 and 110 mg/dL. A fasting glucose between 110 and 126 mg/dL identifies a person who is prediabetic. An FPG level of greater than 126 mg/dL (7 mmol/L) is diagnostic of diabetes. In nonurgent settings the test is repeated on another day to make sure the result is accurate.
The major role of antidiuretic hormone is to regulate A. Blood pressure. B. Fluid balance. C. Potassium. D. Equilibrium.
B- Antidiuretic hormone has been identified as the single most important hormone responsible for regulating fluid balance within the body.
The nurse auscultates a bruit over the thyroid and knows that this indicates A. Normal function. B. Enlargement of the thyroid. C. Hypoplasia of the thyroid. D. Tumor of the thyroid.
B- Auscultation of the thyroid is accomplished by use of the bell portion of the stethoscope to identify a bruit or blowing noise from the circulation through the thyroid gland. The presence of a bruit indicates enlargement of the thyroid as evidenced by increased blood flow through the glandular tissue.
The client with insulin-dependent diabetes mellitus (IDDM) has been brought to the emergency room. What should the nurse watch for if blood pH is 7.28? A. Lactic acidosis B. Ketoacidosis C. Metabolic alkalosis D. Respiratory Acidosis
B - Ketoacidosis is characterized by low blood pH. Type 1 diabetic clients are prone to ketoacidosis.
The diabetic client is having ketoacidosis. Which of the following is the appropriate initial nursing action? A. Start an intravenous glucose B. Administer insulin per IV C. Give a glass of orange juice D. Give a cup of skim milk
B - Ketoacidosis is characterized by severe hyperglycemia. The emergency management of ketoacidosis is regular insulin IV
Ms. K is admitted with a diagnosis of DKA. The nurse notes a sweet-smelling odor on Ms. K's exhaled breath. This is a result of A. Compensation for metabolic alkalosis. B. The body attempting to decrease accumulated acids. C. Prior ingestion of high-calorie foods. D. Decreased serum osmolality.
B- Ketones are detected by a sweet, fruity odor on the exhaled breath. This odor occurs when the lungs release carbon dioxide in an attempt to decrease the accumulated acids.
The nurse is preparing to care for a client returning from the operating room following a subtotal thyroidectomy. The nurse anticipates the need for which of the following items to be placed at the bedside? A. Hypothermia blanket B. Emergency tracheostomy kit C. Magnesium sulfate in a ready-to-inject vial D. Ampule of saturated solution of potassium iodide (SSKI)
B- Respiratory distress can occur following thyroidectomy as a result of swelling in the tracheal area. The nurse would ensure that an emergency tracheostomy kit is available. Surgery on the thyroid does not alter the heat control mechanism of the body. Magnesium sulfate would not be indicated because the incidence of hypomagnesemia is not a common problem post-thyroidectomy. SSKI is typically administered preoperatively to block thyroid hormone synthesis and release, as well as to place the client in a euthyroid state.
A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client's anxiety is to: A. Administer a sedative B. Convey empathy, trust, and respect toward the client C. Ignore the signs and symptoms of anxiety so that they will soon disappear D. Make sure that the client knows all the correct medical terms to understand what is happening
B- The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client's anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.
Adequate thyroid function depends on A. The basal metabolic rate. B. Dietary intake of iodine. C. Colloid osmotic pressure. D. Sodium levels in the blood.
B- The function of the thyroid gland depends in part on the hypothalamus, adenohypophysis, dietary intake of iodine, and circulating protein bodies in the blood.
The major electrolyte disturbances that result from diuresis are A. Low calcium and high phosphorus levels. B. Low potassium and low sodium levels. C. High sodium and low phosphorus levels. D. Low calcium and low potassium levels.
B- The major electrolytes lost in the diuresis are sodium, potassium, and phosphorus.
Which of the following laboratory test best indicate compliance of the diabetic client and insulin therapy? A. 2-hour postprandial blood glucose B. Fasting blood glucose C. Glycosylated hemoglobin (HbA1c) D. Oral glucose tolerance test
C - Glycosylated hemoglobin (HbA1c) is the best indicator of diabetic control. If reflects blood glucose level for the past 3 to 4 months
Which of the following is the appropriate initial action by the nurse when preparing insulin administration? A. Injecting air into the regular insulin B. Withdrawing the cloudy insulin first before the clear insulin C. Injecting air into the cloudy insulin but withdrawing the clear insulin first D. Withdrawing the clear insulin and cloudy insulin in separate syringes
C - This action ensures prevention of contamination of the rapid-acting insulin. In case of emergency (DKA), rapid effect of the clear insulin is maintained. Injecting air into the cloudy insulin will promote easy aspiration of the medication, once the syringe already contains the clear insulin.
A nurse is preparing postoperative discharge instructions for a client who had one adrenal gland removed. The nurse includes which of the following in the instructions? A. the reason for maintaining a diabetic diet B. Teaching proper application of an ostomy pouch C. Instructions about early signs of a wound infection D. The need for lifelong replacement of all adrenal hormones
C- A client who had a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Also, because of the anti-inflammatory properties of corticosteroids produced by the adrenals, clients who undergo an adrenalectomy are at increased risk of developing wound infections. The client does not need to maintain a diabetic diet, and the client will not have an ostomy following this surgery.
While a client with myxedema is being admitted to the hospital, the client reports having experienced a lack of energy, cold intolerance, and puffiness around the eyes and face. The nurse knows that these symptoms are caused by a lack of production of which hormone(s) A. Luteinizing hormone (LH) B. Adrenocorticotropic hormone (ACTH) C. Triiodothyronine (T3) and thyroxine (T4) D. Prolactin (PRL) and growth hormone (GH)
C- Although all of these hormones originate from the anterior pituitary, only T3 and T4 are associated with the client's symptoms. Myxedema results from inadequate thyroid hormone levels (T3 and T4). Low levels of thyroid hormone result in an overall decrease in the basal metabolic rate, affecting virtually every body system and leading to weakness, fatigue, and a decrease in heat production. A decrease in LH results in the loss of secondary sex characteristics. A decrease in ACTH is seen in Addison's disease. PRL stimulates breast milk production by the mammary glands, and GH affects bone and soft tissue by promoting growth through protein anabolism and lipolysis
A nurse develops a plan of care for a client with hyperparathyroidism who is receiving calcitonin salmon (Calcimar). Which of the following outcome criteria has the highest priority regarding this medication? A. Relief of pain B. Absence of side effects C. Achievement of normal serum calcium levels D. Verbalization of appropriate medication knowledge
C- Calcitonin can lower plasma calcium levels in clients with hypercalcemia caused by hyperparathyroidism. The therapeutic effect in this client situation would be a reduction in serum calcium levels. Options A, B, and D are incorrect outcome criteria.
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of regular insulin is intiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which of the following? A. Ampule of 50% dextrose B. NPH insulin subcutaneously C. Intravenous fluids containing 5% dextrose D. Phenytoin (Dilantin) for the prevention of seizures
C- During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and 5% dextrose is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. NPH insulin is not used to treat DKA. Fifty percent dextrose is used to treat hypoglycemia. Phenytoin (Dilantin) is not a usual treatment measure for DKA.
The nurse is preparing a client with Graves' disease to receive radioactive iodine therapy. The nurse tells the client which of the following about the therapy? A. Following the initial dose, subsequent treatments must continue for life B. The radioactive iodine is designed to destroy the entire thyroid gland with just one dose C. It takes 6 to 8 weeks after treatment to experience relief from the symptoms of the disease D. The high levels of radioactivity prohibit contact with family for 4 weeks after initial treatment
C- Following treatment with radioactive iodine therapy, a decrease in thyroid hormone level should be noted, which would help alleviate symptoms. Relief of symptoms does not occur until 6 to 8 weeks after initial treatment. This form of therapy is not designed to destroy the entire gland; rather, some of the cells that synthesize thyroid hormone will be destroyed by the local radiation. The nurse needs to reassure the client and family that unless the dosage is extremely high, clients are not required to observe radiation precautions. The rationale for this is that the radioactivity quickly dissipates. Occasionally, a client may require a second or third dose, but treatments are not lifelong.
A nurse is preparing to care for a client following parathyroidectomy. The nurse plans care anticipating which postoperative order? A. Maintain the endotracheal tube for 36 hours B. Take a rectal temperature only until discharge C. Ensure that intravenous calcium preparations are available D. Place the client in a flat position with the head and neck immobilized
C- Hypocalcemia is a potentially life-threatening complication following parathyroidectomy, and the nurse should ensure that intravenous calcium preparations are readily available. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures are not required. Tympanic temperatures can be taken. The client will not necessarily have an endotracheal tube.
A client with Cushing's syndrome is being instructed by the nurse on follow-up care. Which statement by the client would indicate a need for further instructions? A. I should avoid contact sports B. I should check my ankles for swelling C. I need to avoid foods high in potassium D. I need to check my blood glucose regularly
C- Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients also experience activity intolerance, osteoporosis, and frequent bruising. Excess fluid volume results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.
Insulin produces hypoglycemia. What other physiologic effect may occur when insulin is given? A. Polyuria B. Hypercalcemia C. Hypokalemia D. Cellular dehydration
C- Insulin is a potent anabolic hormone that produces hypoglycemia and augments the transport of potassium into the cells. With potassium driven into the cells, serum potassium may decrease, resulting in hypokalemia
The nurse is completing a health history on a client with diabetes mellitus who has been taking insulin for many years. At present the client states that he is experiencing periods of hypoglycemia followed by periods of hyperglycemia. The most likely cause for this occurrence is which of following? A. Eating snacks between meals B. Initiating the use of the insulin pump C. Injecting insulin at a site of lipodystrophy D. Adjusting insulin according to blood glucose levels
C- Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of repeated injections. This can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been on insulin for many years, this is the most likely cause of poor control. Options A, B, and D are appropriate techniques to use in order to regulate blood glucose levels.
The home care nurse is developing a plan of care for an older client with diabetes mellitus who has gastroenteritis. In order to maintain food and fluid intake to prevent dehydration, the nurse plans to: A. Offer water only until the client is able to tolerate solid foods B. Withhold all fluids until vomiting has ceased for at least 4 hours C. Encourage the client to take 8 to 12 ounces of fluid every hour while awake D. Maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the bowel to dissipate
C- The client should be offered liquids containing both glucose and electrolytes. Small amounts of fluid may be tolerated, even when vomiting is present. The diet should be advanced as tolerated and include a minimum of 100 to 150 grams of carbohydrates daily. Offering water only and maintaining liquids for 5 days will not prevent dehydration but may promote it in this client.
Characteristics of diabetes insipidus (DI) are A. Hyperglycemia and hyperosmolarity. B. Hyperglycemia and peripheral edema. C. Intense thirst and passage of excessively large quantities of dilute urine. D. Peripheral edema and pulmonary crackles.
C- The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.
The nurse is caring for a client scheduled for a bilateral adrenalectomy for treatment of an adrenal tumor that is producing excessive aldosterone (primary hyperaldosteronism). The nurse appropriately tells the client which of the following? A. You will need to wear an abdominal binder after surgery B. You will most likely need to undergo chemotherapy after surgery C. You will need to take hormone replacements for the rest of your life D. You will not require any special long-term treatment after surgery
C- The major cause of primary hyperaldosteronism is an aldosterone-secreting tumor called an aldosteronoma. Surgery is the treatment of choice. Clients undergoing a bilateral adrenalectomy will need permanent replacement of adrenal hormones. Options A, B, and D are inaccurate
Nursing management of the patient with thyrotoxic crisis includes A. Providing diversional stimuli. B. Restricting fluids. C. Maintaining a quiet, restful environment. D. Administering thyroid supplements at the same time each day.
C- The patient in thyroid storm is agitated, anxious, and unable to rest, and benefits from an environment that is calm. Gradually, the effects of the antithyroid medications, iodides, and beta-adrenergic blocking drugs will decrease the neurologic symptoms related to the catecholamine sensitivity. Frequent reassurance and clear, simple explanations of the patient's condition help decrease the fear brought on by the onset thyroid storm.
Which of the following laboratory results is found in the patient with hyperglycemia? A. Insulin level of 125 mg /dL B. Absence of ketones in the blood C. Presence of ketones in the urine D. Serum osmolality of 270 mOsm/kg H2O
C- The presence of ketones in the blood (ketonemia) is indicative of hyperglycemia.
The patient weighs 140 kilograms and is 60 inches tall. The patient's blood sugar is being controlled by glipizide. As the nurse discusses discharge instructions, the primary treatment goal with this type 2 diabetes patient would be A. Signs of hypoglycemia. B. Proper injection technique. C. Weight loss. D. Increased caloric intake.
C- This patient weighs 308 pounds and is 5 feet tall. Diet management and exercise are interventions to facilitate weight loss in the type 2 diabetes patient.
A patient reports losing weight even though she eats "everything in sight." She also reports tremors and diarrhea. The nurse would suspect A. Hypothyroidism. B. Diabetes mellitus. C. Hyperthyroidism. D. Pancreatic tumor.
C- Weight loss, increased appetite, tremors, insomnia, and diarrhea are symptoms of hyperthyroidism.
A child with Type 1 diabetes mellitus is brought to an emergency room by the mother, who states that the child has been complaining of abdominal pain and has a fruity odor of the breath. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which intravenous infusion? A. Potassium B. NPH Insulin C. 5% dextrose D. Normal saline
D - Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level reaches an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.
The nurse is caring for a client who is scheduled for an adrenalectomy. The nurse plans to administer which medication in the preoperative period to prevent Addison's crisis? A. Prednisone (deltasone) orally B. Fludrocortisone (Florinef) subcutaneously C. Spironolactone (Aldactone) intramuscularly D. Methiprednisolone sodium succinate (Solu-Medrol) intravenously
D- A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalectomy. Aldactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisone is a mineralocorticoid.
A nurse notes on the cardiac monitor that a client with aldosteronism is experiencing a dysrhythmia. The nurse immediately assesses the client's: A. Peripheral pulses B. Intake and output C. Superficial reflexes D. Plasma potassium level
D- Aldosteronism can lead to hypokalemia, which in turn can cause life-threatening dysrhythmias. Options A, B, and C are not immediate priorities for this client.
The nurse knows that which of the following signs may indicate diabetes? A. Kidney stones B. Indigestion and diarrhea C. Loss of appetite D. Blurred vision and nausea
D- Because severe hyperglycemia affects a variety of body systems, all systems are assessed. The patient may complain of blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain.
A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: A. Relief of pain B. Signs of renal toxicity C. Signs and symptoms of hyperglycemia D. Signs and symptoms of hypothyroidism
D- Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which finding would a nurse expect to note as confirming this diagnosis? A. Comatose state B. Decreased urine output C. Increased respiration and an increase in pH D. Elevated blood glucose level and low plasma bicarbonate level
D- In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.
A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the nurse plans to teach the client about the need to: A. Avoid infection B. Take in adequate fluids C. Prevent and recognize hypoglycemia D. Prevent and recognize hyperglycemia
D- In the test result for glycosylated hemoglobin A1c, 7% or less indicates good control, 7% to 8% indicates fair control, and 8% or higher indicates poor control. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose.
The patient with thyrotoxicosis may exhibit which of the following signs or symptoms? A. Lethargy B. Bradycardia C. Constipation D. Increased appetite
D- Signs and symptoms of thyrotoxicosis include tremors, insomnia, increased appetite, diarrhea, muscle weakness/wasting, and a change in menstruation.
The patient is admitted to the unit with extreme fatigue, vomiting, and headache. This patient has IDDM but has been on an insulin pump for 6 months. He states, "I know it could not be my diabetes because my pump gives me 24-hour control." The nurse's best response would be A. "You know a lot about your pump and you are correct." B. "You're right. This is probably a virus." C. "We'll get an abdominal CT and see if your pancreas is inflamed." D. "We'll check your serum blood glucose and ketones."
D- Subcutaneous insulin pumps can malfunction. It is critical to assess glucose and ketone levels to evaluate for diabetic ketoacidosis.
A client undergoes a thyroidectomy and the nurse monitors the client for signs of damage to the parathyroid glands postoperatively. Which of the following findings would indicate damage to the parathyroid glands? A. Neck pain B. Hoarseness C. Respiratory distress D. Tingling around the mouth
D- The parathyroid glands can be damaged or their blood supply impaired during thyroid surgery. Hypocalcemia and tetany result when parathyroid hormone (PTH) levels decrease. The nurse monitors for complaints of tingling around the mouth or of the toes or fingers and muscular twitching because these are signs of calcium deficiency. Additional later signs of hypocalcemia are positive Chvostek's and Trousseau's signs. Hoarseness and neck pain are expected findings postoperatively. Respiratory distress indicates a complication but is not a sign of damage to the parathyroid glands.