Endocrine and Metabolic Disorders - ML8

The client with type 1 diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." What is the best response by the nurse? "It is correct that you do not need to count carbohydrates from fruits and vegetables." "Eliminating carbohydrates from your diet is a good first step toward getting off of insulin." "All we ask you to do is have your blood sugar in range." "A person with diabetes should monitor their eating of proteins, fats, and carbohydrates."

"A person with diabetes should monitor their eating of proteins, fats, and carbohydrates." Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client's diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins. Limiting carbohydrate intake is just part of a comprehensive diabetic diet plan. A client with type 1 diabetes will need lifelong insulin therapy. Carbohydrates from fruit and vegetable sources will still need to be factored into carbohydrate intake. Telling a client "all we ask you to do" is a value-judgement and is not therapeutic communication.

The nurse is teaching the client how to administer insulin. Which instruction should the nurse include? "Administer the rapid-acting insulin 30 minutes before a meal." "First withdraw clear, then cloudy insulin when mixing insulins in the same syringe." "Shake the vials before withdrawing the insulin." "Discard the intermediate-acting insulin if it appears cloudy."

"First withdraw clear, then cloudy insulin when mixing insulins in the same syringe." The nurse should instruct the client to withdraw clear, then cloudy insulin when mixing two insulins in the same syringe. Insulin should never be shaken, because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Rapid-acting insulin should be administered no more than 15 minutes before a meal to avoid hypoglycemia. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep-breathing exercises after surgery. What should the nurse tell the client to do? "Raise your shoulders to expand your chest." "Tighten your stomach muscles as you inhale, and breathe normally." "Hold your abdomen firmly with a pillow, and take several deep breaths." "Sit in an upright position, and take a deep breath."

"Hold your abdomen firmly with a pillow, and take several deep breaths." Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client's ability to deep-breathe effectively. Deep breathing should be done hourly by the client after surgery. Sitting upright ignores the need to splint the incision to prevent pain. Tightening the stomach muscles is not an effective strategy for promoting deep breathing. Raising the shoulders is not a feature of deep-breathing exercises.

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands the condition and how to control it? "I should be sure to limit my food and fluid intake when I'm not feeling well so my blood sugar doesn't go up." "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates."

"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." Stating the need to remain hydrated and pay attention to eating, drinking, and voiding needs indicates that the client understands HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of non-diet soda would be appropriate for hypoglycemia. Limiting fluids will exacerbate the development of HHNS; limiting food might be acceptable, but it may lead to ketosis. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.

An obese client, age 65, is diagnosed with type 2 diabetes. When educating this client about the diagnosis, the nurse knows that more education is needed when the client says which statement? Select all that apply. "If I don't keep my sugar under control, I could go into kidney failure." "My doctor says that if I keep my weight down I probably won't have to go on insulin." "I can never eat a hot fudge sundae again." "I guess I will need to stop meeting my friends at the coffee shop." "If I follow my diet and exercise, I won't have diabetes any more."

"I can never eat a hot fudge sundae again." "I guess I will need to stop meeting my friends at the coffee shop." "If I follow my diet and exercise, I won't have diabetes any more." Patients with type 2 diabetes who follow a diet and exercise program will likely be able to achieve normal blood sugar levels, but cannot consider themselves "cured" of diabetes. Renal failure is a possible complication of uncontrolled diabetes. People with well controlled diabetes can modify their diet to include occasional treats like ice cream if they select sugar free versions. Meeting friends for coffee is fine as long as the client does not include high sugar items along with the beverage. Type 2 diabetes can often be controlled with oral hypoglycemics.

A nurse working in a community clinic is discussing lifestyle modifications with a client. The client has been advised to lose weight because of a BMI greater than 25. Which statement by the nurse would be most therapeutic in helping the client? "It will be important for you to stop having between-meal snacks." "I can offer you some information outlining a variety of ways to lose weight." "There are herbal preparations for weight loss that are very effective." "Losing weight is a challenge that I can help you with."

"I can offer you some information outlining a variety of ways to lose weight." The therapeutic response would put the client in a position to make an individual choice. The nurse would offer options to allow for choice. Telling the client that losing weight is a challenge the nurse can help with puts the focus on the nurse and does not offer options. Many weight loss plans include meals plus snacks as well as limiting options. Offering herbal preparation also limits the options given to the client.

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? "I may stop taking this medication when I feel better." "I will see my ophthalmologist regularly for a check-up." "I will eat lots of chicken and dairy products." "I will avoid friends and family members who are sick."

"I may stop taking this medication when I feel better." The client requires additional teaching because they state that they may stop taking corticosteroids when they feel better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase their protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit their ophthalmologist regularly.

A nurse observes a nursing assistant bending over a bed as the nursing assistant helps an obese client sit up. The nurse discusses these observations with the nursing assistant to reinforce the need for proper body mechanics. Which response indicates that the nursing assistant understands these principles? Select all that apply. "I need to keep my back straight and lift with my thigh muscles." "I should bend at the knees, keep my back straight, then pull the client up." "I should ask the client to help as much as possible." "After letting the bed up, grasp the drawsheet, and pull the client up." "I need to keep my elbows straight and use my thigh muscles to bear the weight."

"I need to keep my back straight and lift with my thigh muscles." "I should ask the client to help as much as possible." When moving a client, a nurse is least likely to be hurt if the nurse holds the back straight and lifts with the thigh muscles. Standing at the client's side places undue stress on the nurse's back. The nurse should encourage the client to help as much as possible to minimize the risk of injury.

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. "If I lose weight and control my carbohydrate intake, I can progress to diabetic pills." "It is ok for me to skip my insulin dose if I feel that my blood sugar is not elevated." "If I exercise more than is normal, there is a risk that I might become hypoglycemic." "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."

"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 client demonstrates understanding of type 1 diabetes by stating the importance of regularly scheduled meals and snacks as well as the importance of maintaining good control of blood glucose levels via glucometer readings. There is also the understanding of the effects of exercise on blood glucose levels. Losing weight and controlling carbohydrates will not change the need for insulin in a client with type 1 diabetes, and insulin doses must never be skipped.

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 follow a low-fat, high-carbohydrate diet." "I take acetaminophen for arthritis pain." "I eat dry toast to relieve my nausea." "I require increased periods of rest."

"I take acetaminophen for arthritis pain." Acetaminophen is toxic to the liver and should be avoided in a client with liver dysfunction. Increased periods of rest allow for liver regeneration. A low-fat, high-carbohydrate diet and dry toast to relieve nausea are appropriate.

When educating the client with type 1 diabetes, the nurse knows that more education is needed when the client says: "I will need to give myself insulin every day." "I will be able to switch to insulin pills when my sugar is under control." "I will need to eliminate sugar from my diet." "I will need to go to the podiatrist to get my toenails cut so I don't get an infection."

"I will be able to switch to insulin pills when my sugar is under control." Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. The need to eliminate sugar, give insulin, and receive proper foot care are all items that indicate the client understands the teaching.

A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse? "I should stop taking the prescribed daily aspirin." "I will increase fiber and fluids in my diet." "I should stop attending group activities." "I will increase daily caloric consumption."

"I will increase fiber and fluids in my diet." Clients with hypothyroidism typically have constipation. A diet high in fiber and fluids can help prevent this. Group activities have nothing to do with the current issue. A nurse would not change medical prescriptions by telling the client to stop taking the prescribed aspirin. Increasing caloric consumption is not appropriate with hypothyroidism.

A nurse is teaching a client about how to recognize when treatment for hypothyroidism is effective. Which statement from the client would indicate that the nurse's teaching has been effective? "I will start feeling more energetic." "It will be a relief to be able to sleep more hours." "I won't feel hot and sweaty anymore." "Hopefully I won't lose any more weight."

"I will start feeling more energetic." Understanding of the treatment for hypothyroidism is shown when the client can identify what changes will signify improvement. An increase in energy will demonstrate that therapy has been effective and the thyroid levels are rising. The other choices are all examples of hyperthyroidism.

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 change the body injection site with each injection." "The lower the gauge the more comfortable the injection." "I will use my abdominal injection site if I want to jog." "I can freeze my insulin until I am ready to use it."

"I will use my abdominal injection site if I want to jog." If the client engages in an activity or exercise that focuses on one area of the body, that area may cause inconsistent absorption of insulin. A good regimen for a jogger is to inject into the abdomen. A jogger may have inconsistent absorption in the legs or arms with strenuous running. The higher the gauge the smaller the needle, and the more comfortable the injection. The gauges for insulin syringes range from 28 to 31. Sites should be rotated on one anatomical site for at least one week before changing to another body site. Insulin should not be exposed to extreme temperatures and direct sunlight. Insulin can be kept at room temperature for up to four weeks.

The nurse reviews insulin administration with a client. Which statement best indicates that the client will continue to perform the procedure correctly? "I need to be sure I use a new syringe each time." "I need to be sure no air bubbles remain." "I need to wash my hands before I give myself my injection." "I wrote down the steps in case I forget what to do."

"I wrote down the steps in case I forget what to do." The fact that the client has written down each step of insulin administration provides the best assurance that the client follows through with all the proper steps. Awareness of air bubbles, hand washing, and equipment all indicate that the client understands certain aspects of giving an injection, but awareness of any single aspect doesn't confirm that all of the steps are understood.

A client recently diagnosed with hyperparathyroidism demands to see what the healthcare provider has written in the chart. What is the nurse's best response? "The chart might be difficult to understand. I suggest you review it with your healthcare provider." "I'll have the medical records department contact you to set up a time for review of the chart." "I'll get the chart and set up a time for you to review it with your healthcare provider." "It will be necessary for you to sign a release of information before you see the chart."

"I'll get the chart and set up a time for you to review it with your healthcare provider." Every client has a right to access information that the hospital has collected about the client. However, it is in the client's best interests to have a knowledgeable professional present to explain complicated information and unfamiliar terminology that the chart might include. Having the client sign a release of medical information may be necessary, but that does not assist the client to schedule a review with the healthcare provider. Suggesting the client review the chart with the healthcare provider does not facilitate the review. Contacting medical records to set up a time for the client to review does not ensure that a knowledgeable professional is available to assist the client during the review.

A physician has referred a client newly diagnosed with diabetes mellitus to the diabetes nurse-educator. When the nurse brings up the subject, the client states, "I'd rather work with you than with a stranger." What is the nurse's best response? "You don't have to worry. Our nurse-educator is really good with clients newly diagnosed with diabetes." "Most clients feel this way at first, but you'll soon get over it." "I'll set up a meeting for today. Then you and I can meet to talk about how things went." "A diabetes nurse-educator has much more knowledge than I do."

"I'll set up a meeting for today. Then you and I can meet to talk about how things went." The client may feel overwhelmed and anxious about this diagnosis. The client's made a therapeutic connection with the nurse at a vulnerable time in their life when the client must address many new issues. Offering to follow up with the client encourages them to move forward and gives them an opportunity to meet with a safe and trusted person afterward. Telling the client that the nurse-educator is more knowledgeable about the subject doesn't help address the client's feelings. Telling the client not to worry or that they'll get over these feelings minimizes the client's feelings and may impair the nurse-client relationship.

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? "The physician has ordered this test so you can get better sooner." "When your thyroid levels are stable, we won't have to draw your blood as often." "It's only a little stick. It'll be over before you know it." "I'll stay here with you while the technician draws your blood."

"I'll stay here with you while the technician draws your blood." The nurse should tell the client that they will stay with them as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear.

A coworker asks another nurse if a client received their pathology report. The coworker is not directly involved in the care of the client. How should the nurse respond? Select all that apply. "Information can only be shared if you're involved in the client's care." "I'm sorry, but I'm not at liberty to give you that information." "You need to review the hospital policy related to client privacy." "The report came back, and the pathology was benign." "If you log into the client's chart, you will be able to read the information."

"Information can only be shared if you're involved in the client's care." "I'm sorry, but I'm not at liberty to give you that information." "You need to review the hospital policy related to client privacy." The nurse should tell the coworker that information about the client cannot be shared due to health privacy laws. In addition, client information can only be shared with those who are involved in the immediate care of the client. Hospital policies usually address such issues, and this information is covered during orientation and annually as an update.

A 24-year-old client with diabetes mellitus sustains a large laceration that requires suturing. Which statement indicates that the client understands wound healing? "My scar will fade within 4 months." "If I don't get an infection, the scar may fade in 1 to 3 years." "This procedure won't leave a scar." "It's so hard to predict when this scar will disappear."

"It's so hard to predict when this scar will disappear." In a client with diabetes, wound healing is delayed and unable to be predicted. A specific time frame for healing is unrealistic as is the statement that suturing does not produce a scar.

A client newly diagnosed with diabetes mellitus asks why they need ketone testing when the disease affects their blood glucose levels. How should the nurse respond? "The spleen releases ketones when your body can't use glucose." "Ketones will tell us if your body is using other tissues for energy." "Ketones can damage your kidneys and eyes." "Ketones help the physician determine how serious your diabetes is."

"Ketones will tell us if your body is using other tissues for energy." The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? "Rest as much as possible." "Maintain a moderate exercise program." "Lose weight." "Jog at least 2 miles (3.2 kilometers) per day."

"Maintain a moderate exercise program." The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.

The nurse teaches a client about using medroxyprogesterone as a birth control method. Which client statement indicates effective teaching? "One possible adverse effect is the absence of a menstrual period." "I should have my first injection during my menstrual cycle." "This drug will be given by subcutaneous injections." "This method of family planning requires monthly injections."

"One possible adverse effect is the absence of a menstrual period." With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common adverse effects. Other adverse effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses.

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Administer insulin into areas of scar tissue or hypertrophy whenever possible." "Inject insulin into healthy tissue with large blood vessels and nerves." "Rotate injection sites within the same anatomic region, not among different regions." "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

"Rotate injection sites within the same anatomic region, not among different regions." The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

The nurse is teaching a client about levothyroxine. Which instruction should a nurse offer the client? "Take the drug with vitamin C." "Take the drug on an empty stomach." "Take the drug in the evening." "Take the drug with meals."

"Take the drug on an empty stomach." The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release). Taking the drug in the evening may lead to sleeplessness. Although vitamin C may increase the absorption of some medications such as iron, it does not have this effect with levothyroxine.

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. What should the nurse tell the client? "Taking ginseng will increase the risk of hypoglycemia." "It's ok to take ginseng if you take it with a carbohydrate." "There are no therapeutic benefits of ginseng." "You can take the ginseng to help improve your memory."

"Taking ginseng will increase the risk of hypoglycemia." Taking ginseng when on insulin is not encouraged because ginseng increases the risk of hypoglycemia. Ginseng can be therapeutic in certain situations but is potentially harmful to clients taking insulin. Taking ginseng with a carbohydrate will not offset the long acting effect of the ginseng.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Don't take your insulin or oral antidiabetic agent if you don't eat." "Follow your regular meal plan, even if you're nauseous." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Test your blood glucose every 4 hours."

"Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check their blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when the client is sick. If the client's blood glucose level rises above 300 mg/dl, the client should call their physician immediately. If the client is unable to follow the regular meal plan because of nausea, the client should substitute soft foods, such as gelatin, soup, and custard.

An adolescent is to receive radioactive iodine for Graves' disease. Which statement by the client reflects the need for more teaching? "I plan spend more time using social media since I have to keep several feet (meters) from my friends for 3 days." "Taking radioactive iodine will not affect my ability to have children in the future." "The advantage of radioactive iodine is that I will not need future medication for my disease." "I should try to use a separate bathroom from the rest of my family for several days."

"The advantage of radioactive iodine is that I will not need future medication for my disease." Most clients will need lifelong thyroid replacement after treatments with radioactive iodine. Most clients are treated as outpatients. To reduce the risk of exposure to radioactivity to others, clients are advised to avoid public places for at least 1 day and maintain a prudent distance from others for 2 to 3 days. Additionally, clients are advised to avoid close contact with pregnant women and children for 5 to 11 days. The use of radioiodine to treat Graves' disease has not been found to affect long-term fertility. Clients are taught not to share food, utensils, and towels. Use of a private bathroom is desirable. Clients are also instructed to flush the toilet more than one time after each use.

The client who has been hospitalized with pancreatitis does not drink alcohol because of religious convictions. The client becomes upset when the health care provider (HCP) persists in asking about alcohol intake. What should the nurse tell the client about the reason for these questions? "Alcohol intake can interfere with the tests used to diagnose pancreatitis." "The health care provider must obtain the pertinent facts, regardless of religious beliefs." "Alcoholism is a major health problem, and all clients are questioned about alcohol intake." "There is a strong link between alcohol use and acute pancreatitis."

"There is a strong link between alcohol use and acute pancreatitis." Alcoholism is a major cause of acute pancreatitis in the United States and Canada. Because some clients are reluctant to discuss alcohol use, staff may inquire about it in several ways. Generally, alcohol intake does not interfere with the tests used to diagnose pancreatitis. Recent ingestion of large amounts of alcohol, however, may cause an increased serum amylase level. Large amounts of ethyl and methyl alcohol may produce an elevated urinary amylase concentration. All clients are asked about alcohol and drug use on hospital admission, but this information is especially pertinent for clients with pancreatitis. HCPs do need to seek facts, but this can be done while respecting the client's religious beliefs. Respecting religious beliefs is important in providing holistic client care.

The nurse teaches a client with type 2 diabetes mellitus about diabetic retinopathy. Which statement if made by the client would indicate to the nurse that teaching was effective? "Tight control of blood sugar and blood pressure can prevent damage to my eye." "This is less of an issue because I do not take insulin." "Retinopathy is inevitable as I age with this disease." "The fact that I have a family history of cataracts puts me at greater risk for retinopathy."

"Tight control of blood sugar and blood pressure can prevent damage to my eye." The major cause of blindness in people with diabetes mellitus is diabetic retinopathy. Corneal problems, cataracts, refractive changes, glaucoma, and extraocular muscle changes are also noted, but retinopathy is the most common problem. The risk of retinopathy is not associated with a family history of cataracts, but retinopathy risk does increase with poor glycemic, lipid, and blood pressure control. Type 1 and type 2 diabetics are at risk for retinopathy, and the risk does not increase if the client is on insulin therapy.

A nurse is caring for a client with poorly managed diabetes mellitus who has a serious foot ulcer. When the nurse informs the client that the physician has ordered a wound care nurse to examine the wound, the client asks why should anyone other than the staff nurse care for the wound. The client states, "It's no big deal. I'll keep it covered and put antibiotic ointment on it." Which responses made by the nurse would be appropriate? Select all that apply. "We're very concerned about your foot and we want to provide the best possible care for you." "You could possibly lose your foot without proper care." "Do you want me to tell the physician you refused?" "The wound nurse is specially trained to care for diabetic wounds." "This is a big deal, and you need to recognize how serious it is."

"We're very concerned about your foot and we want to provide the best possible care for you." "You could possibly lose your foot without proper care." "The wound nurse is specially trained to care for diabetic wounds." Since diabetics are at an increased risk for loss of lower extremities due to vascular problems, foot care specialists are warranted. Foot care nurses are specially trained to care for diabetic wounds.

A client diagnosed with thyroid cancer signed a living will that states the client doesn't want ventilatory support if the condition deteriorates. As the client's condition worsens, the client states, "I changed my mind. I want everything done for me." Which response by the nurse is best? "What exactly do you mean by wanting 'everything' done for you?" "Maybe you should talk with your family." "Do you understand that you'll be placed on a ventilator?" "I'll ask your physician to revoke your do-not-resuscitate order."

"What exactly do you mean by wanting 'everything' done for you?" Asking the client what they mean is the best response. The nurse should clarify the client's request and get as much information as possible before notifying the physician of the client's wishes. Asking the physician to revoke the client's do-not-resuscitate (DNR) order makes an assumption about the client's wishes without obtaining clarification of their statement. The client might want aggressive treatment without reversing the DNR order. Asking the client if they understand that they'll be placed on a ventilator places the client on the defensive. Telling the client to talk with family is an inappropriate response; the client has the right to change their treatment plan without input from their family.

A client with diabetes begins to cry and says, "I just can't stand the thought of having to give myself a shot every day." What would be the best response by the nurse? "If you don't give yourself your insulin shots, you'll be at greater risk for complications." "I can arrange to have a home care nurse give you the shots every day." "What is it about giving yourself the insulin shots that bothers you?" "We can teach a family member to give the shots so you won't have to do it."

"What is it about giving yourself the insulin shots that bothers you?" The best response is to allow the client to verbalize fears about performing self-injection. Tactics that increase fear such as threatening the client about complications are not effective in changing behavior. If possible, the client needs to be responsible for self care, including giving self-injections. A nurse for home-care visits is not justified if the client is capable of self-administration.

The health care provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. What should the nurse teach the client about this insulin? "You may increase the carbohydrates in your diet when using this insulin." "You do not need to rotate injection sites with this insulin." "You do not mix insulin detemir; the solution is clear." "You may refill the detemir insulin pen."

"You do not mix insulin detemir; the solution is clear." Insulin detemir is used only if the solution appears clear and colorless with no visible particles. Insulin detemir is not diluted or mixed with any other insulin preparations. As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Continuous rotation of the injection site within a given area may help to reduce or prevent this reaction. The client should continue to follow the prescribed diet and monitor glucose levels when taking insulin detemir. Insulin detemir is available in a prefilled insulin pen. When the insulin pen is empty, it may not be refilled; instead the pen is discarded.

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." "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." "Administer desmopressin while the suspension is cold." "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." The nurse should advise the client that 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 get adequate fluid replacement.

A 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, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? "You must avoid coughing, sneezing, and blowing your nose." "You must report ringing in your ears immediately." "You must lie flat for 24 hours after surgery." "You must restrict your fluid intake."

"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.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? "You must avoid hyperextending your neck after surgery." "The head of your bed must remain flat for 24 hours after surgery." "You should avoid deep breathing and coughing after surgery." "You won't be able to swallow for the first day or two."

"You must avoid hyperextending your neck after surgery." To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? "Our laboratory technicians use tiny needles and they're really good with children." "Your child is young and will soon forget this experience." "I'll see if the physician can reduce the number of blood draws." "Your child will need less blood work as their glucose levels stabilize."

"Your child will need less blood work as their glucose levels stabilize." Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician to reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

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 of hypoglycemia will occur at about what time? 1100, shortly before lunch. 1800, shortly after dinner. 1300, shortly after lunch. 0100, while sleeping.

0100, while sleeping. The client with diabetes mellitus who is taking NPH insulin in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. The client should eat a bedtime snack to help prevent hypoglycemia while sleeping.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, (2.3 mmol/L) and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting 2 to 5 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate. 15 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate.

15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association (Canadian Diabetes Association) guidelines recommend ingesting 15 g of a simple carbohydrate, such as 15 g of glucose tablets, 3 teaspoons (15 mL) or 3 packets of table sugar dissolved in water, 3/4 cup (175 mL) of juice or regular soft drink, 6 LifeSavers (1 = 2.5 g carbohydrate), or a 1 tablespoon (5 mL) of honey. Then the client should check their blood glucose after 15 minutes. If necessary, this treatment may 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.

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer 10 units of fast-acting insulin. I.M. or subcutaneous glucagon. I.V. bolus of dextrose 50%. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

15 to 20 g of a fast-acting carbohydrate such as orange juice. This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.

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? 10 p.m. (2200) 10 a.m. (1000) noon (1200) 4 p.m. (1600)

4 p.m. (1600) NPH is an intermediate-acting insulin that peaks 8 to 12 hours after administration. Because the nurse administered NPH insulin at 7 a.m. (0700), the client is at greatest risk for hypoglycemia from 3 p.m. (1500) to 7 p.m. (1900).

A nurse is teaching a client about metformin therapy. The nurse warns the client that metformin commonly causes hypoglycemia when combined with which other medication? acetaminophen ACE inhibitors St. John's wort multivitamins

ACE inhibitors When taken in combination with ACE inhibitors, metformin commonly causes hypoglycemia. Acetaminophen, St. John's Wort, and multivitamins may be taken with metformin without increasing the risk of hypoglycemia.

A nurse is caring for a client with type 1 diabetes who is light headed, begins sweating profusely, and loses consciousness. Which action should the nurse take? Administer an IV bolus of 50% dextrose. Raise the client's legs. Give the client 240 mL of orange juice. Administer 10 units of fast-acting insulin.

Administer an IV bolus of 50% dextrose. The client is most likely experiencing hypoglycemia and needs glucose. Giving oral fluids to an unconscious client is contraindicated. Insulin will further decrease glucose levels. Raising the client's legs will not reverse hypoglycemia.

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 hypoparathyroidism hyperthyroidism Cushing's syndrome

Addison's disease Intravenous hydrocortisone for clients in acute adrenal crisis is the proper treatment for individuals with Addison's disease. Cushing's syndrome is associated with excessive amounts of glucocorticoids. Hyperthyroidism and hypoparathyroidism are not treated with hydrocortisone.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). A family member reports the client has been skipping meals in an effort to lose weight. What is the next action by the nurse? Contact a diabetes educator to address client teaching needs. Contact the health care provider with glucose results. Offer the client 1/2 cup of orange juice and crackers. Administer 1 ampule of 50% dextrose solution IV.

Administer 1 ampule of 50% dextrose solution IV. The client with a decreased level of consciousness and a fingerstick glucose result of 39 mg/dL is experiencing dangerous hypoglycemia. The nurse would first administer 50% dextrose solution IV to restore the client's physiological integrity. Because of the decreased level of consciousness, offering the client orange juice and crackers would put the client at risk for aspiration. Referring the client to a diabetes educator is important to address the methods of weight loss, but this would be appropriate after the hypoglycemia is treated. The nurse would treat the dangerous hypoglycemia with the ordered dextrose solution before contacting a health care provider to prevent further complications of hypoglycemia.

A client is prescribed exenatide. What should the nurse instruct the client to do? Select all that apply. Inject in the thigh, abdomen, or upper arm. Understand that there is a low incidence of hypoglycemia when exenatide is taken with insulin. Take the dose of exenatide as soon as the client remembers a dose has been missed. Administer the drug within 60 minutes before morning and evening meals. Review the one-time set-up for each new pen.

Administer the drug within 60 minutes before morning and evening meals. Review the one-time set-up for each new pen. Inject in the thigh, abdomen, or upper arm. Client teaching includes reviewing proper use and storage of the exenatide dosage pen, particularly the one-time set-up for each new pen. The nurse should instruct the client to inject the drug in the thigh, abdomen, or upper arm. The drug should be administered within 60 minutes of the morning and evening meals; the client should not inject the drug after a meal. The nurse should review steps for managing hypoglycemia, especially if the client also takes a sulfonylurea or insulin. If a dose is missed, the client should resume treatment as prescribed, with the next scheduled dose.

A nurse obtained a client's fasting blood sugar (FBS) at 0700, which was 144 mg/dL (8 mmol/L). The client has an order for regular insulin 8 units every morning. What should the nurse do next? Contact the healthcare provider with the FBS result. Administer the insulin as ordered. Offer the client orange juice and a piece of toast. Hold the insulin due to the FBS result.

Administer the insulin as ordered. The nurse knows that a normal fasting blood sugar is between 72 and 108 mg/dL (4 and 6 mmol/L). The result of 144 mg/dL indicates that the client requires insulin to lower the blood glucose level. The nurse would not hold the insulin dose. Because there is already a prescription for insulin, it is not necessary to contact the healthcare provider at this time. Based on the FBS result, the nurse would administer insulin before offering the client food.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? Administering a 500-ml bolus of normal saline solution Administering 1 ampule of 50% dextrose solution, per physician's order Inserting a feeding tube and providing tube feedings Observing the client for 1 hour, then rechecking the fingerstick glucose level

Administering 1 ampule of 50% dextrose solution, per physician's order The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage.

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? Bilateral nasal and tympanic membrane cultures An increased need for insulin and blood glucose monitoring Alternation of hot and cold compresses Prepare the client for transillumination of the sinuses

An increased need for insulin and blood glucose monitoring Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications. Culture and sensitivity testing of purulent nasal drainage to show the causative bacterial organisms is rarely done with sinus infection, and tympanic membranes are never cultured by the nurse. Although a practitioner can illuminate the sinuses, it is not routine and is not necessary for diagnosis. Warm compresses can be applied for clients with sinusitis for comfort, however, hot compresses are not applied. Cold compresses are applied after sinus surgery, not in the case of acute infection.

A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching? Select all that apply. Use scissors to trim toenails. Apply foot powder after bathing. See a podiatrist regularly to have your feet checked. Wear cotton socks. Wear loose-fitting shoes. Go barefoot only when you know your home environment.

Apply foot powder after bathing. See a podiatrist regularly to have your feet checked. Wear cotton socks. Foot care for a client with diabetes mellitus includes keeping the feet dry with the application of foot powder and wearing cotton socks to absorb moisture. The client should have a podiatrist check the feet regularly to detect problems early. To prevent injury to the feet, the client should be instructed not to cut the toenails with scissors, walk barefoot, or wear loose-fitting shoes.

The nurse develops a teaching plan for the client about how to prevent the transmission of hepatitis A. Which discharge instruction is appropriate for the client? Disinfect all clothing and eating utensils. Spray the house to eliminate infected insects. Tell family members to try to stay away from the client. Ask family members to wash their hands frequently.

Ask family members to wash their hands frequently. The hepatitis A virus is transmitted via the fecal-oral route. It spreads through contaminated hands, water, and food, especially shellfish growing in contaminated water. Certain animal handlers are at risk for hepatitis A, particularly those handling primates. Frequent handwashing is probably the single most important preventive action. Insects do not transmit hepatitis A. Family members do not need to stay away from the client with hepatitis. It is not necessary to disinfect food and clothing.

A client with hypothyroidism reports feeling sad and depressed about the bodily changes experienced and states "I wonder if there is any reason to go on." What is the most appropriate response by the nurse? Inform the client this is a common side effect of therapy. Ask the client if there is a family history of depression. Ask if the client has thoughts about self-harm. Reassure the client mood will improve with treatment.

Ask if the client has thoughts about self-harm. Hypothyroidism affects many body systems, including the client's mental and emotional processes. Even though the cause of the client's depression is most likely physiological, the client is experiencing a level of hopelessness. The nurse would evaluate these feelings to determine if any suicidal risk is present. Informing the client that these feelings are temporary, expected, and due to hypothyroidism are acceptable interventions, but they are less important than determining whether there are thoughts of self-harm. Assessing for a family history of depression is appropriate, but it is not the priority at this time. Hypothyroidism is treated with levothyroxine, which does not have depression as a common side effect.

A nurse records a client's fingerstick blood glucose level and gives 2 units of regular insulin as ordered. At the next scheduled blood glucose assessment, the nurse realizes that the wrong client was tested and given insulin. What is the nurse's priority action related to this incident? Explain the error to the client, and document it in the client's chart. Recheck blood glucose levels, and then determine whether the healthcare providers need to be notified. Assess both clients, and call the appropriate healthcare providers to notify them of the errors. Notify the charge nurse of the error, and document it in the client's chart.

Assess both clients, and call the appropriate healthcare providers to notify them of the errors. The nurse must acknowledge the mistake and take all necessary actions to prevent or minimize harm arising from the incidents. This includes assessing the clients for complications of the error and notifying the healthcare providers to receive further direction in correcting the error. After performing these steps, the nurse should document the actions taken. The other options are incorrect because they are either incomplete or do not demonstrate that the nurse has taken responsibility for the mistakes.

A client is admitted to the hospital with Cushing's syndrome. Which nursing interventions are appropriate for this client? Select all that apply. Instruct the client to avoid foods high in potassium. Assess for peripheral edema. Encourage oral fluid intake. Weigh the client daily. Stress the need for a high-calorie, high-carbohydrate diet. Measure intake and output.

Assess for peripheral edema. Measure intake and output. Weigh the client daily. Because weight gain and edema are common symptoms of Cushing's syndrome, appropriate interventions include assessing for peripheral edema, measuring intake and output, and weighing the client daily. A low-calorie, low-carbohydrate, high-protein diet is ordered for a client with this disorder. Fluid restriction is often prescribed as well. Treatment of Cushing's syndrome includes the administration of potassium replacements; therefore, restricting foods high in potassium would not be appropriate.

The nurse reviewed laboratory values for a client with type 1 diabetes mellitus. The client's hemoglobin A1c (HbA1c) is 9 percent. What is the priority action for the nurse? Tell the client the test result shows that the client's blood sugars are not under control Assess the client's baseline knowledge about their treatment regimen Assess the home log of blood glucose levels Obtain a fasting serum glucose level

Assess the client's baseline knowledge about their treatment regimen A hemoglobin A1c level or glycosylated hemoglobin gives the nurse data about the average blood glucose concentration over 2 to 3 months, providing a picture of the client's overall glucose control. The nurse should determine the client's knowledge about insulin, diet, and exercise program because of the above normal result. Telling the client that their blood sugars are not under control is confrontational and is not therapeutic. A fasting serum glucose level gives a picture of the client's recent glucose level, not the overall effectiveness of the therapeutic regimen. A 1-week diet recall is not always accurate. A home log may provide some information about overall control and compliance, the log may not have all of the glucose levels recorded, and would be lacking diet and exercise information.

The nurse is caring for a client with type 2 diabetes who has been admitted with hyperglycemia. What is the most important consideration when developing a teaching plan for this client? Identify the level of motivation for learning. Inform the client about proper dietary planning and regular activity. Help the client differentiate between hypoglycemia and hyperglycemia. Assess what the client already knows to identify learning needs.

Assess what the client already knows to identify learning needs. It is most important to assess the client's learning needs. The client needs to share what is already known about diabetes and how it has been managed. After that, it is important to identify the client's level of motivation to learn. All the listed information related to diabetes is important. However, to individualize the teaching, the nurse will need to assess what the client already knows and direct the teaching to what is not understood.

A client presents to the clinic for a follow-up visit for hospitalization due to uncontrolled diabetes. Which of the following assessment findings indicates a complication of diabetes mellitus? Inflamed, painful joints Pale yellow urine Blood pressure of 160/100 mm Hg Hemoglobin of 9 g/dL (90 g/L)

Blood pressure of 160/100 mm Hg The client with diabetes mellitus is especially prone to hypertension due to atherosclerotic changes, which leads to problems of the microvascular and macrovascular systems. This can result in complications in the heart, brain, and kidneys. Heart disease and stroke are twice as common among people with diabetes mellitus as among people without the disease. Painful, inflamed joints accompany rheumatoid arthritis. Pale yellow urine is not indicative of urinary complications. Diabetic nephropathy is diagnosed by evaluating for albuminuria and measuring albumin-to-creatinine ratio. A low hemoglobin concentration accompanies anemia, especially iron deficiency anemia and anemia of chronic disease.

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? Notify the surgery department. Call the health care provider (HCP) for specific prescriptions based on the glucose level. Administer the insulin dose dictated by the sliding scale. Withhold all medications.

Call the health care provider (HCP) for specific prescriptions based on the glucose level. The nurse should notify the HCP directly for specific prescriptions based on the client's glucose level. The nurse cannot ignore the elevated glucose level. The surgical experience is stressful, and the client needs specific insulin coverage during the perioperative period. The nurse should not administer the insulin without checking with the surgeon because there are specific prescriptions to withhold all medications. It is not necessary to notify the surgery department unless the HCP cancels the surgery.

A client with type 2 insulin-requiring diabetes has the flu with nausea, body aches, and lack of appetite. The client's blood sugar is 180 mg/dL (10 mmol/L). The vital signs are temperature 101ºF (38.3ºC), pulse 88 bmp, and respirations 20 breaths/min. What should the nurse instruct the client to do? Select all that apply. Check blood sugar every 4 hours. Drink 240 mL fluids every hour. Stop taking insulin. Check urine for ketones. Take two 325 mg aspirin.

Check blood sugar every 4 hours. Drink 240 mL fluids every hour. The nurse should instruct the client with insulin-requiring diabetes who has the flu to check the blood sugar every 4 hours. The client should try to drink 240 mL of fluid every hour. If the blood sugar levels become low, the client should drink liquids with sugar in them. The client should continue to take insulin. It is not necessary to check for ketones until the blood glucose level is above 240 mg/dL. The nurse cannot prescribe aspirin for this client. If the symptoms of the flu continue, the nurse should instruct the client to contact the health care provider.

A client with diabetes mellitus asks the nurse to recommend something to remove corns from the toes. What should the nurse advise the client to do? Soak the feet in borax solution to peel off the corns. Apply iodine to the corns before peeling them off. Consult a health care provider (HCP) about removing the corns. Apply a high-quality corn plaster to the area.

Consult a health care provider (HCP) about removing the corns. A client with diabetes should be advised to consult a HCP or podiatrist for corn removal because of the danger of traumatizing the foot tissue and potential development of ulcers. The diabetic client should never self-treat foot problems but should consult a HCP or podiatrist.

A client with hyperthyroidism is to have a thyroidectomy. The health care provider (HCP) has prescribed propranolol. In reviewing the client's history, the nurse notes that the client has asthma. What should the nurse do next? Take the client's pulse and withhold the propranolol if the pulse is <100 beats per minute. Contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. Count the client's respirations and withhold the propranolol if the respirations are less than 20 breaths per minute. Instruct the client to make position changes slowly.

Contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. Propranolol hydrochloride is a nonselective beta-blocker of both cardiac and bronchial adrenoreceptors, which competes with epinephrine and norepinephrine for available beta-receptor sites. Propranolol blocks cardiac effects of beta-adrenergic stimulation; as a result, it reduces heart rate; a hypertensive effect is associated with decreased cardiac output. A contraindication of propranolol is bronchial asthma; propranolol can cause bronchiolar constriction even in normal clients. The nurse takes the apical pulse and BP before administering propranolol. The medication is withheld if the heart rate is <60 beats per minute or the systolic blood pressure is <90 mm Hg.

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? May not understand medical terminology Could be in denial Has a hearing deficit Needs teaching reinforced

Could be in denial The natural response to a new diagnosis is denial. The question does not suggest any of the other options.

A client with a serum glucose level of 618 mg/dl (34.33 mmol/L) is admitted to the facility. The client is awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? Ineffective thermoregulation related to dehydration Imbalanced nutrition: Less than body requirements related to insulin deficiency Deficient fluid volume related to osmotic diuresis Decreased cardiac output related to elevated heart rate

Deficient fluid volume related to osmotic diuresis A serum glucose level of 618 mg/dl (34.33 mmol/L) indicates hyperglycemia, which causes polyuria and fluid volume deficit, making Deficient fluid volume related to osmotic diuresis the highest priority. In this client, tachycardia is more likely to result from fluid volume deficit than from decreased cardiac output because the client's blood pressure is normal. Although the client's serum glucose is elevated, food isn't a priority because fluids and insulin should be administered to lower the serum glucose level. Therefore, a diagnosis of Imbalanced nutrition: Less than body requirements isn't appropriate. A temperature of 100.6° F (38.1° C) isn't life-threatening, eliminating Ineffective thermoregulation as the top priority.

A client with type 2 diabetes has just started to take dulaglutide. The client reports having severe nausea. What should the nurse instruct the client to do to manage the nausea? Select all that apply. Increase the fat content in the diet. Eat small meals more frequently. Stop using the drug. Drink ginger tea. Avoid fried foods.

Drink ginger tea. Avoid fried foods. Eat small meals more frequently. Nausea is a common side effect when clients first start taking dulaglutide. To manage the nausea the nurse can suggest that the client eat smaller meals more frequently, drink beverages with ginger in them, and avoid fried foods. The client should decrease the fat content in the diet. The client should not stop using the drug unless prescribed by the health care provider.

A nurse should perform which intervention for a client with Cushing's syndrome? Suggest a high-carbohydrate, low-protein diet. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather. Explain that the client's physical changes are a result of excessive corticosteroids. Offer clothing or bedding that's cool and comfortable.

Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: thyroiditis. Hashimoto's thyroiditis. Graves' disease. multinodular goiter.

Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? Have regular follow-up care. Keep an accurate record of intake and output. Use nasal desmopressin acetate (DDAVP). Exercise to improve cardiovascular fitness.

Have regular follow-up care. The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.

The nurse is preparing a client for paracentesis. What should the nurse do? Position the client supine. Have the client void before the procedure. Scrub the client's abdomen with povidone-iodine solution. Put the client on nothing-by-mouth (NPO) status 4 hours before the procedure.

Have the client void before the procedure. Before paracentesis, the client is asked to void. This is done to collapse the bladder and decrease the risk of accidental bladder perforation. The abdomen is not prepared with an antiseptic cleansing solution. The client is placed in a Fowler's position. The client does not need to be put on NPO status before the procedure.

A nurse hears a staff member giving incorrect information to the family of a client newly diagnosed with diabetes mellitus who is being discharged to home. The nurse wants to make sure the family has the proper information before the client is discharged. What should the nurse do? Have the nurse step outside of the room and tell the nurse that they are giving wrong information to the family. Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity. Go into the room and correct the nurse so the family will be safe in providing home care. Go into the room, introduce yourself to the family, and complete the discharge teaching.

Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity. The nurse should use this situation as a learning opportunity for the colleague by asking the colleague to step outside of the room to discuss the situation. Telling the nurse that they are providing incorrect information is too blunt and corrective. Going into the room to correct the teaching would undermine the nurse doing the teaching.

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. 5% dextrose and dopamine I.V. normal saline and glucocorticoids I.V. total parenteral nutrition and insulin coverage I.V. lactated Ringer's solution and packed cells

I.V. normal saline and glucocorticoids The client with Addison's is expected to have hypotension and inadequate corticosteroids. There is no evidence that the client would be anemic. Although the blood pressure may be a little below normal, there is no indication for an inotropic drug such as dopamine to increase perfusion. There is no indication that the client would be weak and hypoglycemic.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? Imbalanced nutrition: Less than body requirements related to thyroid hormone excess Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess Disturbed body image related to weight gain and edema

Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

The nurse is developing a teaching plan for the client with hepatitis A. What should the nurse tell the client to do? Avoid contact with others and sleep in a separate room. Intensify routine exercise and increase strength. Limit caloric intake and reduce weight. Increase carbohydrates and protein in the diet.

Increase carbohydrates and protein in the diet. A low-fat, high-protein, high-carbohydrate diet is encouraged for a client with hepatitis to promote liver rejuvenation. Nutrition intake is important because clients may be anorexic and experience weight loss. Activity should be modified and adequate rest obtained to promote recovery. Social isolation should be avoided, and education on preventing transmission should be provided; the client does not need to sleep in a separate room.

A client who has been diagnosed with type 1 diabetes has an insulin drip to aid in lowering the serum blood glucose level of 600 mg/dL (33.3 mmol/L). The client is also receiving ciprofloxacin IV. The health care provider (HCP) prescribes discontinuation of the insulin drip. What should the nurse do next? Add glargine to the insulin drip before discontinuing it. Hang the next IV dose of antibiotic before discontinuing the insulin drip. Inform the HCP that the client has not received any subcutaneous insulin yet. Discontinue the insulin drip, as prescribed.

Inform the HCP that the client has not received any subcutaneous insulin yet. Because subcutaneous administration of insulin has a slower rate of absorption than IV insulin, there must be an adequate level of insulin in the bloodstream before discontinuing the insulin drip; otherwise, the glucose level will rise. Adding an IV antibiotic has no influence on the insulin drip; it should not be piggy-backed into the insulin drip. Glargine cannot be administered IV and should not be mixed with other insulins or solutions.

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the healthcare team take first? Initiate fluid replacement therapy. Administer insulin. Determine the cause of diabetic ketoacidosis. Correct diabetic ketoacidosis.

Initiate fluid replacement therapy. The healthcare team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body effectively. Therefore, insulin administration follows fluid replacement therapy. Determining and correcting the cause of diabetic ketoacidosis are important steps, but the client's condition must first be stabilized to prevent life-threatening complications.

A client is diagnosed with diabetes mellitus. The physician orders 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes their hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use? Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial; withdraw 35 units NPH; withdraw 15 units regular insulin. Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. Inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; inject 35 units air into NPH vial and withdraw 35 units NPH. Inject 15 units air into regular insulin vial; inject 35 units air into NPH vial, withdraw 35 units NPH; withdraw 15 units regular insulin.

Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. To avoid creating a vacuum, the nurse must inject exactly the same amount of air into a multidose vial to replace the amount of medication to be withdrawn. The nurse should follow these steps: (1) Inject air into the vial from which the second insulin dose will be withdrawn (isophane insulin). (2) Inject air into the vial from which insulin will be withdrawn first (regular insulin). (3) With the needle inserted into the regular insulin vial, withdraw the correct amount. (4) With 15 units of regular insulin in the syringe, carefully withdraw 35 units of NPH, for a total of 50 units in the syringe. Options 2 and 4 are incorrect because regular insulin must be withdrawn first. Option 3 is incorrect because the nurse must not insert air into a multiple-dose vial with a syringe containing medication.

When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should use which technique? Draw up either insulin first. Use a high-dose insulin syringe. Inject air in the vial with the long-acting insulin first. Draw up the long-acting insulin first.

Inject air in the vial with the long-acting insulin first. The air is injected into the long-acting insulin first. Air is then injected into the short-acting insulin and the short-acting insulin is withdrawn. Then the long-acting insulin is withdrawn. It does matter which insulin is drawn up first because the nurse does not want to contaminate the short-acting insulin with the long-acting insulin. It is not necessary to use a high-dose insulin syringe to prepare 28 units of insulin.

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 unpredictably at all injection sites. Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Insulin is absorbed more slowly at abdominal injection sites than at other sites.

Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test? It determines the fasting blood glucose level. It determines the average blood glucose level in the previous 2-3 months. It determines the ratio of glucose to hemoglobin. It is used to identify a reduction in hemoglobin because of high glucose levels.

It determines the average blood glucose level in the previous 2-3 months. Blood glucose levels can be monitored with a glucometer and indicate the present state of blood glucose. Glycosylated hemoglobin gives a measure of blood glucose controls over the previous 3 months. This is a better indicator for how effectively the diabetes is being controlled. This diagnostic test is a longer-term monitor of diabetes control compared to the fasting glucose levels. It does not compare levels of glucose to hemoglobin or measure reduced hemoglobin.

The nurse is providing dietary teaching for a client with diabetes. Which statement about the diet would be accurate? It does not include processed foods because they have too many variables. It is planned around a wide variety of commonly available foods. It is rigidly controlled to avoid similar diabetic emergencies. It is based on nutritional requirements that are the same for all clients.

It is planned around a wide variety of commonly available foods. Each client should be given an individually devised diet selecting commonly used foods from the Diabetic Association exchange diet. Family members should be included in the diet teaching. Nutritional requirements are not the same for all clients. Flexibility is needed based on activity, not rigid control. Seasoning and processed food should be managed.

The nurse understands that the difference between diabetic coma and hyperosmolar hyperglycemic coma is that clients in diabetic coma can experience which finding? fluid loss increased blood glucose Kussmaul respirations glycosuria

Kussmaul respirations Kussmaul respirations occur in diabetic coma as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis). It affects clients with type 2 diabetes who still have some insulin production because insulin prevents the breakdown of fats into ketones. This type of breathing is the only difference. All the other choices can occur in both types of coma.

Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, what should the nurse recommend to the client? Limit dietary vitamin D intake. Maintain a regular program of weight-bearing exercise. Perform isometric exercises. Increase the amount of potassium in the diet.

Maintain a regular program of weight-bearing exercise. Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.

The nurse is caring for a client following a motor vehicle incident with head trauma. Diabetes insipidus is suspected. Which nursing intervention is appropriate? Assess pupils for constriction. Monitor capillary glucose twice a day. Measure and record urinary output. Obtain a daily weight to determine retention.

Measure and record urinary output. 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. Blood sugar has nothing to do with diabetes insipidus.

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? Evaluate the quality of the client's voice postoperatively, noting any drastic changes. Observe for swelling of the neck, tracheal deviation, and severe pain. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Monitor laboratory values daily for elevated thyroid-stimulating hormone.

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.

The client has chronic pancreatitis. What should the nurse teach the client to do to monitor the effectiveness of pancreatic enzyme replacement? Perform glucose fingerstick tests twice a day. Test urine for ketones. Observe stools for steatorrhea. Record daily fluid intake.

Observe stools for steatorrhea. If the dosage and administration of pancreatic enzymes are adequate, the client's stool will be relatively normal. Any increase in odor or fat content would indicate the need for dosage adjustment. Stable body weight would be another indirect indicator. Fluid intake does not affect enzyme replacement therapy. If diabetes has developed, the client will need to monitor glucose levels. However, glucose and ketone levels are not affected by pancreatic enzyme therapy and would not indicate effectiveness of the therapy.

A client with type I diabetes mellitus is scheduled to have surgery. The client has been nothing-by-mouth (NPO) since midnight. In the morning, the nurse notices the client's daily insulin has not been prescribed. Which action should the nurse do first? Inform the Post Anesthesia Care Unit staff to obtain the insulin order. Contact the health care provider for further prescriptions regarding insulin dosage. Obtain the client's blood glucose at the bedside. Give the client's usual morning dose of insulin.

Obtain the client's blood glucose at the bedside. The nurse should first obtain the blood glucose level and then contact the health care provider to clarify whether the client's usual insulin dose should be given before surgery; having the blood glucose level is objective information that the health care provider may need to know before making a final decision as to the insulin dosage. The nurse should not assume that the usual insulin dose is to be given. It is not appropriate for the nurse to defer decision-making on this issue until after the surgery.

An admitting nurse on a rehabilitation unit notices that an elderly client with a fractured hip and severe hypothyroidism is dirty and disheveled and that their personal hygiene is very poor. As the nurse gathers admission data, the nurse further notes that the client has few personal connections, is depressed, and doesn't seem to care about personal appearance. How should the nurse improve the client's performance of self-care activities? Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses. Ask the physician to refer the client to social services for a full evaluation and follow-up. Offer to take the client to the shower and help them fix their hair. Provide complete hygienic care and make an appointment for the client to see the hospital barber.

Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses. Low thyroid levels can cause depression, which can explain many of this client's symptoms. Rather than assuming the client doesn't care about their appearance, the nurse should provide supportive hygienic care and observe for mood changes as the client's thyroid levels improve. Offering to escort the client to the shower and help with their hair, providing complete hygienic care and making an appointment with the hospital barber, and asking the physician to refer the client to social services are appropriate interventions to take if the client's behavior doesn't improve as thyroid level improves.

Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? Anorexia. Poor skin turgor. Rapid weight gain. Dizziness.

Rapid weight gain. Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.

The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose? Stimulation of peristalsis of the bowel. Reduced peripheral edema and ascites. Reduced serum ammonia levels. Prevention of hemorrhage.

Reduced serum ammonia levels. Lactulose is used to treat hepatic encephalopathy by reducing serum ammonia levels. It is not used to stimulate bowel peristalsis, even though diarrhea can be a side effect of the drug. Lactulose does not have any effect on edema, ascites, or hemorrhage.

The nurse is educating a client on diabetes management. The client is asking questions that cause the nurse to be concerned about the client's ability to retain the information. Which would be the best technique for the nurse to use to enhance the retention of information by the client? Speak slowly to allow information to be absorbed. Repeat important information during the presentation. Provide the client with a thorough reference list. Conduct the education using a lecture format.

Repeat important information during the presentation. Repetition is an effective means of reinforcing critical information and enhancing content retention. The other options will not increase the client's ability to retain information and may decrease the client's concentration and ability to retain critical information.

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? Administer the medication immediately and chart it as given on time. Report the error, complete the proper paperwork, and meet with the unit manager. Contact the physician and follow their instructions. Report the error and request a private meeting with the unit manager.

Report the error, complete the proper paperwork, and meet with the unit manager. Making an error can be very stressful and a nurse may feel great pressure to hide the mistake or not follow protocol. Discussing the problem with the unit coordinator may help the nurse address some of the underlying stress that led up to making the error. Nonetheless, the nurse must still report the error and complete the proper paperwork. The nurse should contact the physician and follow their instructions, but shouldn't bypass proper protocol.

A nurse is assigned to a client who is using an insulin pump. The nurse has never cared for a client with an insulin pump and isn't sure what to do. What should the nurse do first? Request information about nursing responsibilities in caring for a client with a pump. Accept the client and do the best possible until the shift ends. Inform the charge nurse that the nurse doesn't feel comfortable with this assignment. Refuse to accept the assignment until the nurse has received training about pump management.

Request information about nursing responsibilities in caring for a client with a pump. Taking the initiative to gain new information relevant to client care as well as expressing a desire to support the unit's needs is an appropriate and professional nursing response. Refusing the assignment is inappropriate because the nurse isn't taking any initiative to learn about the pump. Refusing to care for the client until the nurse receives training is inappropriate; the nurse should gather information and evaluate the client before refusing to provide care. Accepting the assignment doesn't address the issue of lack of knowledge and may put the nurse or the client in jeopardy.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? Reduce fat to 10%. Increase calories. Restrict potassium. Restrict sodium.

Restrict sodium. A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of less than 20% of total calories is not recommended.

To provide oral hygiene for a client recovering from transsphenoidal hypophysectomy, what should the nurse instruct the client to do? Perform frequent toothbrushing. Floss the teeth thoroughly. Rinse the mouth with saline solution. Clean the teeth with an electric toothbrush.

Rinse the mouth with saline solution. After transsphenoidal surgery, the client must be careful not to disturb the suture line while healing occurs. Frequent oral care should be provided with rinses of saline, and the teeth may be gently cleaned with oral swabs. Frequent or vigorous toothbrushing or flossing is contraindicated because it may disturb or cause tension on the suture line.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces TSH, triiodothyronine (T3), and calcitonin. T3, thyroxine (T4), and calcitonin. iodine and thyroid-stimulating hormone (TSH). thyrotropin-releasing hormone (TRH) and TSH.

T3, thyroxine (T4), and calcitonin. The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.

A nurse is teaching a client with diabetes mellitus about self-management. Which statement would be correct about the administration of lispro insulin? Can be mixed with regular insulin in the same syringe for injection. Take the insulin at around the same time each day at a meal. Increase the insulin amount with the ingestion of alcohol. Take once daily in the evening.

Take the insulin at around the same time each day at a meal. The nurse should instruct the client to administer the insulin around a meal because the onset of rapid acting insulin is immediate. The use of alcohol may cause hyperglycemia or hypoglycemia. The client should be instructed to monitor glucose level closely and should be discouraged from concurrent use. Long-acting insulin is often taken in the evening once per day because the insulin mimics the basal insulin secretion for a full day. Lispro insulin can only be mixed with NPH insulin.

A client is being discharged after having a thyroidectomy. Which discharge instructions are appropriate for this client? Select all that apply. Avoid over-the-counter medications. Recognize the signs of dehydration. Carry injectable dexamethasone at all times. Take thyroid replacement medication, as ordered. Report any signs and symptoms of hypoglycemia. Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician.

Take thyroid replacement medication, as ordered. Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician. After removal of the thyroid gland, the client needs to take thyroid replacement medication. The client needs to report to the physician changes in body functioning, such as lethargy, restlessness, cold sensitivity, and dry skin. These changes may indicate the need to increase the medication dose. The thyroid gland does not regulate the serum glucose level; therefore, the client would not need to recognize the signs and symptoms of hypoglycemia. Dehydration is seen in diabetes insipidus. A client with Addison's disease should avoid over-the-counter medications and carry injectable dexamethasone.

A nurse is caring for a client with hypothyroidism. The client is extremely upset about altered physical appearance. The client doesn't want to take the medication because "it isn't doing any good." What should the nurse do? Tell the client to ask the health care provider if the medication dosage is correct. Tell the client that as the medication corrects the hormone deficiency, improvement in appearance can be expected soon. Tell the client that the client's appearance is fine and offer to help improve it. Tell the client to practice self-acceptance and be compliant with the treatment.

Tell the client that as the medication corrects the hormone deficiency, improvement in appearance can be expected soon. Stating that the client will soon experience improvement is supportive and encouraging, and the response addresses the client's concern while motivating continued medication compliance. Stating that the client should ask the health care provider about the medication dosage might influence the client to alter the dosage; it also avoids addressing the client's concern. Stating that the client looks fine discounts the client's feelings. Advising the client to practice self-acceptance and be compliant is directive at a time when the client needs support and understanding.

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 physical changes are permanent, but the mood swings will disappear. The body changes are permanent and the client will not be the same as before this condition. The body and mood will gradually return to normal. The physical changes are temporary, but the mood swings are permanent.

The body and mood will gradually return to normal. As the body readjusts to normal cortisol levels, mood and physical changes will gradually return to a normal state. The body changes are not permanent, and the mood swings should level off.

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? The client must decrease the dose of steroid medication carefully to prevent crisis. The client will require steroids only until her body can manufacture sufficient quantities. The client will need steroid replacement for the rest of her life. The client will need to take steroids whenever her life involves physical or emotional stress.

The client will need steroid replacement for the rest of her life. Bilateral adrenalectomy requires lifelong adrenal hormone replacement therapy. If unilateral surgery is performed, most clients gradually reestablish a normal secretion pattern. The client and family will require extensive teaching and support to maintain self-care management at home. Information on dosing, adverse effects, what to do if a dose is missed, and follow-up examinations is needed in the teaching plan. Although steroids are tapered when given for an intermittent or one-time problem, they are not discontinued when given to clients who have undergone bilateral adrenalectomy because the clients will not regain the ability to manufacture steroids. Steroids must be taken on a daily basis, not just during periods of physical or emotional stress

A client with Cushing's disease tells the nurse that the health care provider (HCP) said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which information? Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood. A single random blood test cannot provide reliable information about endocrine levels. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels.

The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane (NPH) insulin to be taken before breakfast. At about 4:30 p.m. (1630), the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? The regular insulin is at the end of its duration. The client's potassium level is below 3.5 mEq/L The client is experiencing hyperglycemia. The isophane (NPH) insulin is peaking.

The isophane (NPH) insulin is peaking. Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl (3.88 mmol/L). Isophane (NPH) insulin typically peaks at 4-12 hours after administration. However, hypoglycemia may occur 4 to 18 hours after administration of isophane (NPH) insulin suspension or insulin zinc suspension, both of which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl (10 mmol/L), causes such early manifestations as fatigue, malaise, and drowsiness. Intravenous insulin can cause an acute shift in potassium levels leading to hypokalemia, but these signs and symptoms would include muscle weakness and muscle cramps.

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 regulate the bicarbonate level in the intracellular fluid. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The kidneys react rapidly to compensate for imbalances in the body. The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. The kidneys cannot compensate for the metabolic acidosis created by renal failure. Renal compensation for imbalances is relatively slow (a matter of hours or days).

A client is admitted with advanced hepatic failure, including symptoms of fatigue and confusion. These symptoms are likely due to which cause? The medications usually used to treat liver failure often cause confusion. The liver is not breaking down the ammonia, and it acts as a neurotoxin on the brain. Hepatorenal syndrome is now presenting, which results in metabolic alkalosis. Portal hypertension is impairing the blood flow to the brain.

The liver is not breaking down the ammonia, and it acts as a neurotoxin on the brain. The increase in toxins because the liver has lost its capacity to detoxify will result in increased blood levels. The liver is responsible for breaking down ammonia and converting it to urea, so it can be excreted by the kidneys. High ammonia levels affect all the cells of the body, but are particularly toxic to the brain. Hepatorenal syndrome will result in metabolic acidosis--both the liver and kidneys are malfunctioning. Portal hypertension causes increased back-up pressure in the digestive organs, rather than in the brain. Medications are judiciously given in hepatic failure because the liver cannot detoxify the medications.

Which assessment in a client that has just returned from having a modified radical neck dissection with skin flap would require a nurse to take immediate action? Sutures are visible on the client's face. There is an absence of bowel sounds. The client's voice is hoarse. The skin flap appears white.

The skin flap appears white. A white skin flap indicates lack of perfusion and the healthcare provider should be notified immediately. Hoarseness may be due to trauma from the endotracheal tube that is inserted during surgery. Sutures may be visible after this surgery. An absence of bowel sounds is a normal finding immediately post surgery with general anesthesia.

A client with diabetes mellitus has a foot ulcer. The physician orders bed rest, a wet-to-damp dressing change every shift, and blood glucose monitoring before meals and at bedtime. Why are wet-to-damp dressings used for this client? They contain exudate and provide a moist wound environment. They protect the wound from mechanical trauma and promote healing. They prevent the entrance of microorganisms and minimize wound discomfort. They debride the wound and promote healing by secondary intention.

They debride the wound and promote healing by secondary intention. For this client, wet-to-damp dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Dry, sterile dressings protect the wound from mechanical trauma and promote healing. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort.

A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? Tracheostomy set Indwelling urinary catheter kit Cardiac monitor Humidifier

Tracheostomy set After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

The nurse is caring for a client following a thyroidectomy assessing for a possible low calcium level related to inadvertent removal of parathyroid glands. Identify the part of the body the nurse would assess to determine a positive or negative Chvostek's sign.

When the facial nerve is stimulated in someone with hypocalcemia, the facial muscles contract, causing twitching of the cheek, mouth, and nose (Chvostek's sign). To elicit Chvostek's sign, tap the nerve at the angle of the jaw, just below the zygomatic arch.

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 should wipe the insulin bottles with an alcohol swab before each use to eliminate contamination. Then the nurse should inject 12 units of air into the intermediate- or long-acting insulin vial, without touching the insulin. Next, the nurse should insert 6 units of air into the fast-acting insulin and draw up the insulin into the syringe. Fast-acting insulin should be drawn into the syringe first to avoid the risk of mixing the long-acting insulin into the vial and delaying the onset of action of the regular insulin in an emergency. Lastly, the nurse should draw 12 units of intermediate- or long-acting insulin into the syringe.

The nurse is receiving results of a blood glucose level from the laboratory over the telephone. What should the nurse do? Request that the laboratory send the results by e-mail to transfer to the client's medical record. Repeat the results to the caller from the laboratory, write the results on scrap paper, and then transfer the results to the medical record. Indicate to the caller that the nurse cannot receive results from lab tests over the telephone and ask the lab to bring the written results to the nurses' station. Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller.

Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. To assure client safety, the nurse first writes the results on the chart, then reads them back to the caller and waits for the caller to confirm that the nurse has understood the results. The nurse may receive results by telephone; and although electronic transfer to the client's medical record is appropriate, the nurse can also accept the telephone results if the laboratory has called the results to the nurses station.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect a blood pressure of 176/88 mm Hg. a blood glucose level of 130 mg/dl (7.2 mmol/L). bradycardia. a blood pressure of 130/70 mm Hg.

a blood pressure of 176/88 mm Hg. Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs? abdomen iliac crest legs arms

abdomen If the client engages in an activity or exercise that focuses on one area of the body, that area may cause inconsistent absorption of insulin. A good regimen for a jogger is to inject the abdomen for 1 week and then rotate to the buttock. A jogger may have inconsistent absorption in the legs or arms with strenuous running. The iliac crest is not an appropriate site due to a lack of loose skin and subcutaneous tissue in that area.

The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. What findings would be expected? absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet edema and coolness in the ankles and feet redness, inflammation, and sharp pain with calf muscle contraction capillary refill in the toes within 3 seconds

absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet This choice is the most accurate description of an interference with arterial circulation. The dorsalis pedis is one of the most peripheral pulses, its absence along with coolness indicates compromised arterial flow. Impaired blood flow will also affect the nervous status in the foot, resulting in decreased sensation. Capillary refill in 2 seconds is normal; edema and coolness is more an indication of venous impairment; and inflammation and calf pain likely indicate a thrombophlebitis.

A client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that their spouse sleeps in another room because the client's snoring keeps the spouse awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? hypothyroidism acromegaly type 1 diabetes mellitus deficient growth hormone

acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.

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? parathyroid pancreas adrenal medulla adrenal cortex

adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

A client with diabetes has been diagnosed with hypertension, and the health care provider has prescribed atenolol, a beta-blocker. When teaching the client about the drug, what should the nurse tell the client about how it may interact with the client's diabetes? Atenolol may cause: a decrease in the hypoglycemic effects of insulin. a decrease in the incidence of ketoacidosis. an increase in the hypoglycemic effects of insulin. an increase in the incidence of ketoacidosis.

an increase in the hypoglycemic effects of insulin. There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for increased hypoglycemic effects of insulin when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored. Ketoacidosis occurs in hyperglycemia. Although a decrease in the incidence of ketoacidosis could occur when a beta blocker is added, the direct result is an increase in the hypoglycemic effect of insulin.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? pitting edema of the legs frequent urination dry mucous membranes an irregular apical pulse

an irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

The nurse is teaching the client how to administer insulin. Which instruction should the nurse include? "Discard the intermediate-acting insulin if it appears cloudy." "Administer the rapid-acting insulin 30 minutes before a meal." "Shake the vials before withdrawing the insulin." "First withdraw clear, then cloudy insulin when mixing insulins in the same syringe."

an irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A client with diabetic ketoacidosis (DKA) has asked the unlicensed nursing assistant for another pitcher of water. It is the third such request over the past 4 hours. The nurse would recognize this request as which manifestation? a catabolic state induced by insulin deficiency a result of increased urination an occurrence of the excess loss of fluid associated with osmotic diuresis a result of increased activity while the blood glucose was high

an occurrence of the excess loss of fluid associated with osmotic diuresis Due to the DKA and fluid shift, the client would present with the 3 Ps: polyuria, polyphagia, and polydipsia. Fatigue and weakness may be caused by muscle wasting from the catabolic state of insulin deficiency. The other choices are part of the problem but not the main manifestation of the disease process.

After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide: 30 minutes after dinner. at bedtime. in mid-morning. at breakfast.

at breakfast. Like other oral antidiabetic agents ordered in a single daily dose, glyburide should be taken with breakfast. If the client takes glyburide later, such as in mid-morning, after dinner, or at bedtime, the drug won't provide adequate coverage for all meals consumed during the day.

An adult with type 2 diabetes mellitus has been NPO since 2200 in preparation for having a nephrectomy the next day. At 0600 on the day of surgery, the nurse reviews the client's medical record and laboratory results. Which finding should the nurse report to the health care provider (HCP)? urine output of 350 mL in 8 hours. blood glucose of 140 mg/dL (7.8 mmol/L) urine specific gravity of 1.015 potassium of 4.0 mEq (4.0 mmol/L)

blood glucose of 140 mg/dL (7.8 mmol/L) The client's blood glucose level is elevated, beyond levels accepted for fasting; normal blood glucose range is 70 to 120 mg/dL (3.9 to 6.7 mmol/L). The specific gravity is within normal range (1.001 to 1.030). Urine output should be 30 to 50 mL/h; thus, 350 mL is a normal urinary output over 8 hours. The potassium level is normal.

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? regular insulin with breakfast; NPH after breakfast in two separate syringes with breakfast both insulins 0.5 hours before breakfast NPH 1 hour before and regular 0.5 hours before breakfast

both insulins 0.5 hours before breakfast Regular and NPH insulins are scheduled together one-half hour before breakfast. They do not need to be given separately or in different syringes.

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? sodium bicarbonate calcium gluconate echothiophate iodide sodium phosphate

calcium gluconate The client with tetany is suffering from hypocalcemia, which is treated by administering an IV preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then necessary until normal parathyroid function returns. Sodium phosphate is a laxative. Echothiophate iodide is an eye preparation used as a miotic for an antiglaucoma effect. Sodium bicarbonate is a potent systemic antacid.

A client who is 12 hours post total thyroidectomy reports tingling around the mouth. Which assessment is the priority? sodium level blood pressure potassium level calcium level

calcium level Tingling around the mouth after a thyroidectomy may indicate decreased calcium levels and should be assessed. A thyroidectomy does not affect sodium or potassium levels. Assessing vital signs is important, but is not the priority.

A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor? ungloving the hands when removing the test strip smearing the drop of blood onto the reagent pad starting the timer on the machine while gathering supplies calibrating the machine after installing a new battery

calibrating the machine after installing a new battery To obtain accurate readings, the nurse should calibrate the machine whenever a new battery is installed. To adhere to standard precautions and prevent contact with blood, the nurse's hands should remain gloved throughout blood glucose testing. The nurse should drop the blood — not smear it — onto the reagent pad because smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the timer before the blood sample is collected.

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? hypovolemic shock cerebral edema tetany severe hyperkalemia

cerebral edema Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral edema. Hypovolemic shock results from severe deficient fluid volume; in contrast, SIADH causes excess fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH.

A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluids would be most appropriate? coffee and milkshakes milk and diet soda chicken broth and juice water and eggnog

chicken broth and juice Electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia, and hyperkalemia. Regular salted (not low salt) chicken or beef broth and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium.

The nurse is teaching the client to self-administer insulin. Which approach to establishing learning goals will likely be most effective? When the goals are established by the: health care provider and client, because the health care provider is the manager of care and the client is the main participant. client, because the client is best able to identify his or her own needs and how to meet those needs. nurse and client, because both need to be responsible for teaching. client, nurse, pharmacist, and health care provider, so the client can participate in planning care with the entire team.

client, nurse, pharmacist, and health care provider, so the client can participate in planning care with the entire team. Learning goals are most likely to be attained when they are established mutually by the client and members of the health care team, including the nurse, pharmacist, and health care provider. Learning is motivated by perceived problems or goals arising from unmet needs. The perception of the unmet needs must be the client's; however, the nurse, pharmacist, and health care provider help the client arrive at his or her own perception of the need or reason to learn.

A nurse should expect to administer which medication to a client with gout? colchicine calcium gluconate furosemide aspirin

colchicine A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, a diuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it doesn't treat gout.

A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms? polyuria, polydipsia, hypotension, and hypernatremia coma, anxiety, confusion, headache, and cool, moist skin polyuria, polydipsia, polyphagia, and weight loss Kussmaul respirations, dry skin, hypotension, and bradycardia

coma, anxiety, confusion, headache, and cool, moist skin Signs and symptoms of hypoglycemia [indicated by a blood glucose level of 45 mg/dl (2.5 mmol/L)] include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.

During shift report, the nurse learns the following laboratory values: pH, 7.44; PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance is the client most likely experiencing? uncompensated respiratory alkalosis compensated metabolic alkalosis compensated metabolic acidosis compensated respiratory alkalosis

compensated respiratory alkalosis The question states that the client has a history of acid-base disturbance. The nurse would first note that the pH has returned to close to normal indicating compensation. The nurse then assess the PCO2 (normal: 35 to 45 mm Hg) and HCO3 (normal: 22 to 27mEq/L) levels. In a respiratory condition, the pH and the PCO2 move in opposite direction; thus, the pH rises and the PCO2 drops (alkalosis) or vice versa (acidosis). In a metabolic condition, the pH and the bicarbonate move in the same direction; if the pH is low, the bicarbonate level will be low, also. In this client, the pH is at the high end of normal, indicating compensation and alkalosis. The PCO2 is low, indicating a respiratory condition (opposite direction of the pH).

The nurse should teach the diabetic client that which is most indicative of hypoglycemia? Kussmaul respirations nervousness anorexia bradycardia

nervousness The four most commonly reported signs and symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Other signs and symptoms include hunger, incoherent speech, tachycardia, and blurred vision. Anorexia and Kussmaul respirations are clinical manifestations of hyperglycemia or ketoacidosis. Bradycardia is not associated with hypoglycemia; tachycardia is.

A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect? lower blood pressure concentration of urine normal insulin levels improved glucose metabolism

concentration of urine The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus.

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test? cortisol levels before and after the system is challenged with a synthetic steroid changes in certain body chemicals, which are altered in depression the amount of dexamethasone in the system cortisol levels after the system is challenged

cortisol levels before and after the system is challenged with a synthetic steroid The dexamethasone suppression test measures cortisol levels before and after the system is challenged with a synthetic steroid. The dexamethasone suppression test does not measure dexamethasone or body chemicals altered in depression. Dexamethasone is used to challenge the cortisol level.

Which indicator is the best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? temperature daily weight skin turgor thirst

daily weight Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for exophthalmos and conjunctival redness. decreased body temperature and cold intolerance. systolic murmur at the left sternal border. flushed, warm, moist skin.

decreased body temperature and cold intolerance. Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.

The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel? wearing a gown and mask when providing direct care decreasing contact with blood and blood-contaminated fluids wearing gloves when emptying the bedpan administering hepatitis C vaccine to all health care personnel

decreasing contact with blood and blood-contaminated fluids Hepatitis C is usually transmitted through blood exposure or needlesticks. A hepatitis C vaccine is currently under development, but it is not available for use. The first line of defense against hepatitis B is the hepatitis B vaccine. Hepatitis C is not transmitted through feces or urine. Wearing a gown and mask will not prevent transmission of the hepatitis C virus if the caregiver comes in contact with infected blood or needles.

A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate action? short expirations and inspirations regular depth of respirations with frequent pauses shallow respirations alternating with long expirations deep, rapid respirations with long expirations

deep, rapid respirations with long expirations Deep, rapid respirations with long expirations are indicative of Kussmaul respirations, which occur in metabolic acidosis. The respirations increase in rate and depth, and the breath has a "fruity" or acetone-like odor. This breathing pattern is the body's attempt to blow off carbon dioxide and acetone, thus compensating for the acidosis. The other breathing patterns listed are not related to ketoacidosis and would not compensate for the acidosis.

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client? emboli malnutrition delayed wound healing postoperative confusion

delayed wound healing Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy. Nutritional status should be regained postoperatively.

A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with hyperthyroidism. neuropathy. depression. hypoglycemia.

depression. Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

The nurse teaches the client with type 1 diabetes mellitus about the importance of maintaining stable blood glucose levels. The nurse should suggest the client include which type of food to minimize the rise in blood glucose level after meals? vitamin-fortified foods dietary fiber dairy products meats

dietary fiber Foods high in dietary fiber tend to blunt the rise in blood glucose levels after meals. Dietary fiber is the part of food not broken down and absorbed during digestion. Most fibers come from plants; good sources include whole grains, legumes, vegetables, fruits, and nuts. The other foods do not minimize this rise in blood sugar after meals. Dairy products are poor sources of fiber. Foods fortified with vitamins are satisfactory if they also contain fiber. However, many foods fortified with vitamins contain either no dietary fiber (such as fortified milk) or little fiber (such as products fortified with vitamins but made with refined grains). Meats are poor sources of fiber.

When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of encouraging fluids. restricting potassium. restricting fluids. restricting sodium.

encouraging fluids. The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

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 hunger excessive thirst frequent, high-volume urination edema weight gain insomnia

excessive hunger excessive thirst frequent, high-volume urination Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose that the cells are using for energy, the client has weight loss, not weight gain. Clients usually do not present with insomnia; however, clients can report fatigue. Fluid retention and edema are not associated with diabetes mellitus.

The nurse is caring for a client who has returned from having a subtotal thyroidectomy. What finding would require a nurse to take immediate action? incisional pain 6/10 facial muscle twitching shortened QT interval diminished deep tendon reflexes

facial muscle twitching Facial muscle twitching is a manifestation of hypocalcemia, and the healthcare provider should be immediately notified. A shortened QT interval can be a manifestation of hypercalcemia, and diminished deep tendon reflexes can be a manifestation of hypermagnesia; both these findings should be evaluated, but they are not the priority. Incisional pain 6/10 should be addressed, but is not the priority.

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? fluid deprivation test capillary blood glucose test urine glucose test serum ketone test

fluid deprivation test The fluid deprivation test involves withholding water for 4 to 18 hours and periodically checking urine and plasma osmolarity. A client with diabetes insipidus will have an increased serum osmolarity of less than 300 mOsm/kg. Urine osmolarity won't increase. The capillary blood glucose test rapidly measures glucose level in whole blood. The serum ketone test is used to diagnose diabetic ketoacidosis. The urine glucose test monitors glucose levels in urine; however, diabetes insipidus doesn't affect urine glucose levels, so this test isn't appropriate.

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? epinephrine glucagon hydrocortisone 50% dextrose

glucagon During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled healthcare professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

A client tells the nurse that they have been working hard for the past 3 months to control the client's type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check serum fructosamine level. fasting blood glucose level. glycosylated hemoglobin level. urine glucose level.

glycosylated hemoglobin level. Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.

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? diabetes mellitus goiter diabetes insipidus Cushing's syndrome

goiter A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.

The nurse is teaching the client with Addison's disease to anticipate the need for increased glucocorticoid supplementation. When will the client likely need to increase the dose of glucocorticoids? going on vacation having a routine medical checkup returning to work after a weekend having oral surgery

having oral surgery Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, a vacation, or a routine checkup usually will not alter glucocorticoid dosage needs.

The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation? completing course work. becoming engaged gaining 4 lb (1.8 kg) having wisdom teeth extracted

having wisdom teeth extracted Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid need than physical stress.

A client comes to the clinic verbalizing a weight loss of 20 pound (9.1 kilogram) over the last month, even with a "ravenous" appetite and no change in activity level. The client is diagnosed with Graves' disease. Which other signs and symptoms of Graves' disease would the nurse assess? Select all that apply. constipation heat intolerance rapid, bounding pulse mild tremors orthopnea nervousness

heat intolerance rapid, bounding pulse mild tremors nervousness Graves' disease, or hyperthyroidism, is a hypermetabolic state that is associated with a rapid, bounding pulse, heat intolerance, tremors, and nervousness. Orthopnea is not a side effect of hyperthyroidism. Constipation is a symptom of hypothyroidism.

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's spouse reports that the client acted confused and was extremely weak upon waking that morning. The client's blood pressure is 90/58 mm Hg, pulse is 116 beats/minute, and temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? hypotonic saline insulin hydrocortisone potassium

hydrocortisone Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

The nurse is caring for a client on the urinary unit. When providing report to the next shift, it is noted that the client has osteopenia and history of renal calculi. Which disorder would the nurse suspect? hyperparathyroidism hypopituitarism hypoparathyroidism hypothyroidism

hyperparathyroidism Hyperparathyroidism is characterized by osteopenia and renal calculi secondary to overproduction of parathyroid hormone. The hallmark symptom of hypoparathyroidism is tetany from hypocalcemia. Hypopituitarism presents with extreme weight loss and atrophy of all endocrine glands. Symptoms of hypothyroidism include hair loss, weight gain, and cold intolerance.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? hypermagnesemia hypocalcemia hyponatremia hyperkalemia

hypocalcemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

The nurse should assess a client taking chlorpropamide for: dumping syndrome. oral candidiasis. hypoglycemia. extrapyramidal symptoms.

hypoglycemia. Chlorpropamide is an antidiabetic agent. Clients should be observed for signs and symptoms of hypoglycemia. Other common side effects include anorexia, nausea, vomiting, and heartburn.The drug does not cause dumping syndrome, oral candidiasis, or extrapyramidal symptoms.

The nurse should monitor the client with Cushing's disease for which finding? postprandial hypoglycemia hypokalemia decreased urine calcium level hyponatremia

hypokalemia Sodium retention is typically accompanied by potassium depletion. Hypertension, hypokalemia, edema, and heart failure may result from the hypersecretion of aldosterone. The client with Cushing's disease exhibits postprandial or persistent hyperglycemia. Clients with Cushing's disease have hypernatremia, not hyponatremia. Bone resorption of calcium increases the urine calcium level.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? hypernatremia and hypercalcemia hyperkalemia and hyperglycemia hypokalemia and hypoglycemia hypocalcemia and hyperkalemia

hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.

A client newly diagnosed with primary Addison's disease asks the nurse about the cause of the disease. What should the nurse tell the client? "The disease is caused by: dysfunction of the hypothalamic pituitary." insufficient secretion of growth hormone (GH)." idiopathic atrophy of the adrenal gland." oversecretion of the adrenal medulla."

idiopathic atrophy of the adrenal gland." Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands. The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insufficiency are autoimmune destruction (70%) and tuberculosis (20%). Insufficient secretion of GH causes dwarfism or growth delay. Hyposecretion of glucocorticoids, aldosterone, and androgens occur with Addison's disease. Pituitary dysfunction can cause Addison's disease, but this is not a primary disease process. Oversecretion of the adrenal medulla causes pheochromocytoma.

Which results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? decreased edema, stable temperature, and decreased respiratory rate improved appetite, weight gain, and sleeping fewer hours increased energy, weight loss, and a higher temperature and pulse rate elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels

increased energy, weight loss, and a higher temperature and pulse rate The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? decreased serum sodium level cool, clammy skin jugular vein distention increased urine osmolarity

increased urine osmolarity In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

A nurse is teaching a school-age child with diabetes and her parents about managing diabetes during illness. The nurse determines that the parents understand the instruction when they indicate that they will make which treatment plan modification on days when the child is ill? decreasing the sliding scale insulin monitoring morning ketone levels holding all carbohydrate-containing foods increasing the frequency of blood glucose monitoring

increasing the frequency of blood glucose monitoring During an illness, cells become more insulin resistant, increasing the risk for hyperglycemia. Clients are advised to check their blood glucose more frequently, as often as every 2 to 3 hours. Clients should continue to take their insulin and are likely to need more during illness to achieve a normal blood glucose level. Simple carbohydrates are often the nutrient source best tolerated if nausea is present, and clients must consume sufficient amounts of carbohydrates to prevent burning fat. Clients are advised that they should check blood or urine ketones every 4 hours to ensure they are not developing ketoacidosis.

What important considerations would the nurse make when teaching and caring for a client newly diagnosed with diabetes mellitus? involving the client in the development of the teaching plan and encouraging questions and active participation allowing the client to develop the teaching plan and assess readiness to learn about different aspects of the disease informing the client about complications that could occur if the client is noncompliant having the client work closely with a peer who has diabetes to learn about the condition and control

involving the client in the development of the teaching plan and encouraging questions and active participation Actively involving the client in the teaching usually results in better understanding and compliance with the plan of care.

The nurse is assessing a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). What findings does the nurse attribute to complications of this condition? weight loss and cardiac arrhythmia jugular vein distention and confusion tetany and thirst polyuria and laryngeal spasms

jugular vein distention and confusion SIADH results in antidiuretic hormone (ADH) overproduction, which leads to fluid retention and dilutional hyponatremia. Severe SIADH can cause such complications as vascular fluid overload, signaled by jugular vein distention. Hyponatremia results in osmotic fluid shifts in the brain that lead to neurological changes such as irritability and confusion. Tetany and laryngeal spasms are associated with hypocalcemia. Thirst is associated with hypernatremia. Weight gain would be expected with fluid retention. Cardiac arrhythmia would be seen with abnormal potassium levels. Polyuria would be associated with diabetes insipidus, a lack of ADH.

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? glucose from rapid carbohydrate metabolism, causing drowsiness nitrogen from protein catabolism, causing ammonia intoxication sodium bicarbonate, causing alkalosis ketones from rapid fat breakdown, causing acidosis

ketones from rapid fat breakdown, causing acidosis Ketones are released when fat is broken down for energy. In diabetic coma, the client is admitted with dehydration and ketoacidosis. The other choices do not define diabetic coma.

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 10% dextrose in water half-normal saline solution 5% dextrose and normal saline solution lactated Ringer's solution

lactated Ringer's solution Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic.

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The client is not able to make a sound. The nurse determines that the client is experiencing which complication of the surgery? upper airway obstruction internal hemorrhage laryngeal nerve damage decreasing level of consciousness

laryngeal nerve damage Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the health care provider (HCP) immediately. Internal hemorrhage is detected by changes in vital signs. The client's level of consciousness can be partially assessed by asking her to speak, but that is not the primary reason for doing so in this situation. Upper airway obstruction is detected by color and respiratory rate and pattern.

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: the side effects of thyroid hormone replacement therapy and will diminish over time." having a chronic illness and are normal." low thyroid hormone levels and will improve with replacement therapy." a condition unrelated to hypothyroidism and require follow-up."

low thyroid hormone levels and will improve with replacement therapy." Hypothyroidism may contribute to sadness and depression. This client needs to know that these feelings may be related to low thyroid hormone levels and may improve with treatment. Replacement therapy does not cause depression. Depression may accompany chronic illness, but it is not "normal."

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? heart and lungs lungs and kidneys pancreas and heart kidneys and liver

lungs and kidneys The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will: state dietary restrictions. select a diabetic diet correctly. maintain normal fluid and electrolyte balance. exhibit serum glucose level within normal range.

maintain normal fluid and electrolyte balance. Because diabetes insipidus involves excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.

Which intervention is the most critical for a client with myxedema coma? maintaining a patent airway warming the client with a warming blanket administering an oral dose of levothyroxine measuring and recording accurate intake and output

maintaining a patent airway Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.

For a client with Graves' disease, which nursing intervention promotes comfort? restricting intake of oral fluids maintaining room temperature in the low-normal range placing extra blankets on the client's bed limiting intake of high-carbohydrate foods

maintaining room temperature in the low-normal range Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

Which outcome is a priority for the client with Addison's disease? adherence to a 2-g sodium diet maintenance of medication compliance prevention of hypertensive episodes avoidance of normal activities with stress

maintenance of medication compliance Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider (HCP) to avoid an Addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease.

Which action is most effective when a nurse is assessing the client suspected of developing diabetes insipidus? assessing arterial blood gas values every other day checking blood glucose levels taking vital signs every 2 hours measuring urine output hourly

measuring urine output hourly Diabetes insipidus results from deficiency of antidiuretic hormone (ADH). The condition may occur in conjunction with head injuries as well as with other disorders. In ADH deficiency, the client is extremely thirsty and excretes large amounts of highly diluted urine. Measuring the urine output to detect excess amount and checking the specific gravity of urine samples to determine urine concentration are appropriate measures to determine the onset of diabetes insipidus.The client may be tachycardic and hypotensive from fluid deficit; however, altered vital signs in a client with a head injury may occur for other reasons as well.

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results, how would the nurse interpret the client's acid-base balance? metabolic alkalosis respiratory alkalosis respiratory acidosis metabolic acidosis

metabolic acidosis This client has metabolic acidosis, which typically manifests with a low pH, low bicarbonate level, normal to low PaCO2, and normal PaO2. The client's serum electrolyte levels also support metabolic acidosis, which include an elevated potassium level, normal to elevated chloride level, and normal calcium level. The client's anion gap of 30 mEq/L is high, also indicative of metabolic acidosis. This kind of metabolic acidosis occurs with diabetic ketoacidosis and other disorders.

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? acetaminophen-containing preparations salicylate-containing preparations vitamins with iron antacids

salicylate-containing preparations The client requires additional teaching if they take salicylates with insulin. Salicylates may interact with insulin causing hypoglycemia. Antacids, vitamins with iron, and acetaminophen aren't known to interact with insulin.

A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? respiratory alkalosis metabolic acidosis respiratory acidosis metabolic alkalosis

metabolic alkalosis A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

A 75-year-old client who complains of a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for what acid-base imbalance? metabolic acidosis metabolic alkalosis respiratory alkalosis respiratory acidosis

metabolic alkalosis Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. Regular use of baking soda (sodium bicarbonate) may place the client at risk for this condition. Metabolic acidosis refers to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary with expired air.

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery? methylprednisolone sodium succinate intravenously spironolactone intramuscularly prednisone orally fludrocortisone subcutaneously

methylprednisolone sodium succinate intravenously 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. Spironolactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisones is a mineral corticoid.

When obtaining the nursing history of a client who has type 1 diabetes mellitus, the nurse should assess the client for which early symptom of diabetic nephropathy? hematuria oliguria flank pain microalbuminuria

microalbuminuria In early diabetic nephropathy, microalbuminuria is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli in the kidneys. The kidneys begin to leak albumin into the urine through the damaged blood vessels. Clients with diabetes should be screened for nephropathy annually with a random spot urine collection. Oliguria occurs later. Flank pain and hematuria are not associated with diabetic nephropathy.

A client receiving thyroid replacement therapy develops influenza and forgets to take the prescribed thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing what life-threatening complication? thyroid storm cerebrovascular accident systolic hypertension myxedema coma

myxedema coma Myxedema coma (severe hypothyroidism) is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Although thyroid storm is life-threatening, it is caused by severe hyperthyroidism. Systolic hypertension is associated with thyroid storm. A cerebrovascular accident is not typically associated with hypothyroidism.

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. Hashimoto's thyroiditis. thyroid storm. cretinism.

myxedema coma. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

A client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases? serum bicarbonate of 28 mEq/L serum bicarbonate of 21 mEq/L pH 7.26 pH 7.30

serum bicarbonate of 28 mEq/L Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.

A nurse performs a fingerstick glucose-monitoring test for a client. The results are 49 mg/dL (2.7 mmol/L). Which clinical manifestations does the nurse assess for? polyphagia and flushed, dry skin polyuria, headache, and fatigue polydipsia, pallor, and irritability nervousness, diaphoresis, and confusion

nervousness, diaphoresis, and confusion Hypoglycemia is defined as a blood glucose level of less than 65 mg/dL. Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, lightheadedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, the condition may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.

A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client? nitroprusside lidocaine insulin dopamine

nitroprusside Excess catecholamine release occurs with pheochromocytoma and causes hypertension. The nurse should prepare to administer nitroprusside to control the hypertension until the client undergoes adrenalectomy to remove the tumor. Dopamine is used to treat hypotension, which is not associated with pheochromocytoma. Pheochromocytoma does not affect blood glucose levels, so insulin is not indicated in this client unless there is an underlying diagnosis of diabetes mellitus. Lidocaine is sometimes used to treat ventricular arrhythmias, which are not associated with pheochromocytoma.

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. polydipsia muscle twitching and spasms aphasia polyuria tingling numbness

numbness tingling muscle twitching and spasms When the parathyroid gland is removed, the body may not produce enough parathyroid hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral numbness, tingling, and muscle spasms. Aphasia is not a symptom of calcium depletion. Polyuria and polydipsia are symptoms of diabetes mellitus.

The nurse is teaching an adult recreational drug user about measures to avoid acquiring hepatitis A. What information should the nurse include in the instruction? Select all that apply. wearing a mask when in crowds obtaining a vaccination using caution with eating fresh fruits and vegetables following safe syringe disposal procedures observing proper handwashing technique

observing proper handwashing technique following safe syringe disposal procedures obtaining a vaccination using caution with eating fresh fruits and vegetables The main route of transmission for hepatitis A is the oral-fecal route. The disease can be prevented by good handwashing. The client should also use caution when eating fresh fruits and vegetables to ensure they have been washed. In addition, the client should receive a vaccine for hepatitis A; the vaccine is administered in 2 doses 6 months apart. Percutaneous transmission is more common with hepatitis B, C, and D, but the client should follow safe needle and syringe precautions. Hepatitis A is not transmitted by droplet infection; the client does not need to wear a mask.

Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza? increasing activity relieving pain obtaining adequate food intake managing own health

obtaining adequate food intake The priority goal for the client with diabetes mellitus who is experiencing vomiting with influenza is to obtain adequate nutrition. The diabetic client should eat small, frequent meals of 50 g of carbohydrate or food equal to 200 calories every 3 to 4 hours. If the client cannot eat the carbohydrates or take fluids, the health care provider (HCP) should be called, or the client should go to the emergency department. The diabetic client is in danger of complications with dehydration, electrolyte imbalance, and ketoacidosis. Increasing the client's health management skills is important to lifestyle behaviors, but it is not a priority during this acute illness of influenza. Pain relief may be a need for this client, but it is not the priority at this time; neither is increasing activity during the illness.

A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus? teaching the client dietary changes necessary with diabetes mellitus obtaining, reporting, and documenting fingerstick glucose levels assessing the client experiencing a hypoglycemic reaction treating hypoglycemia

obtaining, reporting, and documenting fingerstick glucose levels The educator should teach the nursing assistants how to obtain and document a fingerstick glucose level. The educator should also teach them normal and abnormal results and the importance of reporting them to the registered nurse caring for the client. Treating hypoglycemia, teaching clients about dietary changes, and assessing clients experiencing hypoglycemic reactions are outside the scope of practice for a nursing assistant. They are the responsibility of the registered nurse.

Several hours into a shift, a nurse on a very busy medical-surgical unit privately asks the charge nurse to change the nurse's assignment. The nurse is frustrated because so much time and energy has had to be devoted to helping a newly licensed nurse provide discharge teaching for clients with diabetes mellitus. The charge nurse should offer to assist with the discharge teaching needs. insist that the nurse follow through with the assignment. reassign the new graduate to another staff member. try to provide the staff member with a float nurse.

offer to assist with the discharge teaching needs. Staff members need to know the charge nurse is a supportive leader who respects their honesty and stands behind them. By offering to help with discharge teaching, the charge nurse is actively engaging with the staff at a time of need. Changing all the assignments on this extremely busy floor would be counterproductive. Insisting that the staff member follow through with their assignment disrespects the nurse's request and genuine need. Providing a float nurse could help, but there are no guarantees a float nurse is available.

A client with diabetes who takes insulin has a blood glucose level of 40 mg/dL (2.27 mmol/L). What should the nurse offer the client to begin to raise the blood glucose level? Select all that apply. one tablespoon (15 mL) of peanut butter one-half cup (120 mL) of orange juice one cup (240 mL) of milk one-half cup (120 mL) of regular soda one-quarter cup (60 mL) of tuna one slice of bread

one-half cup (120 mL) of orange juice one cup (240 mL) of milk one-half cup (120 mL) of regular soda one slice of bread To treat a low blood glucose level, the nurse should provide the client with approximately 15 g of carbohydrate and monitor the blood glucose level within 15 minutes. The orange juice, milk, bread, or soda would provide approximately 15 g of carbohydrate. Meat or fish, such as tuna, do not contain carbohydrate. Processed peanut butter may contain small amounts of carbohydrate, but it is also high in fat and protein. Peanut butter is not a good option to raise a blood glucose level in a timely manner.

Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m. (1400), the client has a capillary glucose level of 250 mg/dl for which the client receives 8 units of regular insulin. The nurse should expect the dose's onset to be at 4 p.m. (1600) and its peak to be at 6 p.m.(1800). onset to be at 2 p.m. (1400) and its peak to be at 3 p.m.(1500). onset to be at 2:15 p.m. (1415) and its peak to be at 3 p.m.(1500). onset to be at 2:30 p.m. (1430) and its peak to be at 4 p.m.(1600).

onset to be at 2:30 p.m. (1430) and its peak to be at 4 p.m.(1600). 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. (1400), the expected onset would be from 2:15 (1425) to 2:30 p.m. (1430) and the peak from 4 (1600) to 6 p.m. (1800).

Which of the following arterial blood gas (ABG) results would the nurse anticipate for a client with a 3-day history of vomiting? pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 The client's ABG would likely demonstrate metabolic alkalosis. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+. A common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis where only gastric fluid is lost. The other results do not represent metabolic alkalosis.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and potassium. magnesium. sodium. phosphorus.

phosphorus. PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? fludrocortisone potassium chloride hydrocortisone normal saline solution

potassium chloride Since addisonian crisis results in hyperkalemia, administering potassium chloride is contraindicated. Therefore, the nurse should question the order for potassium chloride, making this the correct choice for this question. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.

A child with type 1 diabetes is admitted to the emergency department with hot and dry skin, rapid and deep respirations, and a fruity odor to her breath. Which task, when performed by a new-graduate registered nurse (RN), requires the RN preceptor to intervene? verification of child's glucose by finger stick verification of child's prescription for IV insulin infusion assessment of child's vital signs every 15 minutes providing encouragement to the child to drink some orange juice

providing encouragement to the child to drink some orange juice The client is exhibiting symptoms that are consistent with hyperglycemia. The RN does not give any additional glucose. All of the other interventions are appropriate for this client. The new-graduate RN notifies the health care provider (HCP) about the assessment findings.

A nurse should expect a client with hypothyroidism to report thyroid gland swelling. nervousness and tremors. increased appetite and weight loss. puffiness of the face and hands.

puffiness of the face and hands. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. What should the nurse explain to the client about the expected outcome of using this drug? The drug helps: increase the body's ability to excrete thyroxine. slow progression of exophthalmos. decrease the body's ability to store thyroxine. reduce the vascularity of the thyroid gland.

reduce the vascularity of the thyroid gland. SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of exophthalmos, and it does not decrease the body's ability to store thyroxine or increase the body's ability to excrete thyroxine.

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in hair loss. serum glucose level. menstrual flow. bone mineralization.

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, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth 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.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? urine ketones fasting blood glucose test serum glycosylated hemoglobin (Hb A1c) 6-hour glucose tolerance test

serum glycosylated hemoglobin (Hb A1c) Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolbutamide. Which laboratory test is the most important for confirming this disorder? serum potassium level serum osmolarity serum sodium level arterial blood gas (ABG) values

serum osmolarity Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? serum potassium level of 5.8 mEq/L (5.8 mmol/L) serum sodium level of 134 mEq/L (134 mmol/L) blood glucose level of 90 mg/dl (4.9 mmol/L) blood urea nitrogen (BUN) level of 12 mg/dl (0.7 mmol/L)

serum potassium level of 5.8 mEq/L (5.8 mmol/L) Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see? serum sodium level of 156 mEq/L (156 mmol/L) serum glucose level of 236 mg/dl (13.1 mmol/L) blood urea nitrogen (BUN) level of 2.3 mg/dl (0.1 mmol/L) serum potassium level of 6.8 mEq/L (6.8 mmol/L)

serum potassium level of 6.8 mEq/L (6.8 mmol/L) A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion. A BUN level of 2.3 mg/dl is lower than normal. A client in addisonian crisis is likely to have an increased BUN level because the glomerular filtration rate is reduced. A serum sodium level of 156 mEq/L indicates hypernatremia. Hyponatremia is more likely in this client because of reduced aldosterone secretion. A serum glucose level of 236 mg/dl indicates hyperglycemia. This client is likely to have hypoglycemia caused by reduced cortisol secretion, which impairs gluconeogenesis.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? hematocrit of 52% serum blood urea nitrogen (BUN) level of 8.6 mg/dl serum sodium level of 124 mEq/L serum creatinine level of 0.4 mg/dl

serum sodium level of 124 mEq/L In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.

When a client demonstrates the technique for self-administering NPH insulin, which action indicates that the client needs additional teaching? holding an antiseptic sponge against the needle when removing it from subcutaneous tissue pulling back on the syringe plunger as soon as the needle is in subcutaneous tissue introducing the needle into subcutaneous tissue using a quick, dartlike action shaking the vial to properly mix the medication before drawing it up

shaking the vial to properly mix the medication before drawing it up The client should be instructed to mix the sediment that accumulates in a vial of NPH insulin by rolling the vial gently between the palms or by turning the vial upside down several times. Shaking the vial is not recommended, because it produces bubbles that make it difficult to withdraw accurate doses of insulin.Using a quick, dart-like action is a proper technique for self-administering insulin.Pulling back on the syringe plunger as soon as the needle is in subcutaneous tissue determines whether the needle is in a blood vessel and is a proper technique for self-administering insulin.Holding an antiseptic sponge against the needle when removing it from tissue to prevent the discomfort of the needle pulling on the skin is an appropriate technique.

The nurse is assessing a client with an A-V fistula. Which finding should the nurse report to the healthcare provider? pulse palpated over the fistula site skin discoloration distal to the fistula a murmur auscultated over the fistula fistula covered with long-sleeve clothing

skin discoloration distal to the fistula The nurse's priority is to ensure adequate circulation to the arm with the fistula. Discoloration may indicate poor circulation at the fistula site. A bruit (murmur) and vibration (thrill) should be assessed. Wearing long sleeves would be appropriate as long as they were not tight.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of sodium and potassium abnormalities. chloride and magnesium abnormalities. calcium and phosphorus abnormalities. sodium and chloride abnormalities.

sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. Which symptom should the nurse teach the client to report? excessive menstruation increased urine output constipation sore throat

sore throat The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider (HCP) signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and increased urine output are not associated with PTU therapy.

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes? steroids aspirin angiotensin-converting enzyme (ACE) inhibitors sulfonylureas

steroids Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.

Parathyroid hormone (PTH) has which effects on the kidney? stimulation of calcium reabsorption and phosphate excretion increased absorption of vitamin E and excretion of vitamin D stimulation of phosphate reabsorption and calcium excretion increased absorption of vitamin D and excretion of vitamin E

stimulation of calcium reabsorption and phosphate excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

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 provide support for the spouse or significant other. encourage the client to ask questions about personal sexuality. suggest referral to a sex counselor or other appropriate professional. provide time for privacy.

suggest referral to a sex counselor or other appropriate professional. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? bradycardia, thirst, and anxiety sweating, tremors, and tachycardia dry skin, bradycardia, and somnolence polyuria, polydipsia, and polyphagia

sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. When conducting a focused assessment, what should the nurse should assess the client for? cold skin weight gain tachycardia anorexia

tachycardia Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism.

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? leg cramps blurred vision tachycardia dysuria

tachycardia Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.

When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to: take glipizide 30 minutes before breakfast. take glipizide four times a day at evenly spaced intervals. take glipizide immediately after meals. take glipizide as indicated by blood glucose values.

take glipizide 30 minutes before breakfast. Glipizide is most effective when taken 30 minutes before breakfast. The duration of action is 10 to 24 hours.If the drug needs to be taken more than once a day, the dosage may be divided and taken twice a day before meals.It is not as effective to take the drug after meals.Although blood glucose levels will be monitored, the values do not dictate when the drug should be taken.

When caring for a client with diabetes insipidus, the nurse expects to administer vasopressin. 10% dextrose. furosemide. regular insulin.

vasopressin. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

When a nurse attempts to make sure the health care provider obtained informed consent for a thyroidectomy, the nurse realizes the client doesn't fully understand the surgery. The nurse approaches the health care provider, who curtly says, "I've told this client all about it. Just get the consent." The nurse should: explain the procedure more fully to the client and obtain the client's signature. ask the charge nurse to talk with the health care provider. tell the health care provider the nurse cannot obtain informed consent at this point. tell the health care provider: "You didn't give the client enough information."

tell the health care provider the nurse cannot obtain informed consent at this point. The nurse has evaluated the client's knowledge concerning the surgery and determined that the client doesn't have enough information to give informed consent. Even though the health care provider (HCP) wants to move ahead, the nurse should advocate for the client by asserting that the client isn't ready for the surgery. Stating that the HCP did not provide enough information is unlikely to gain the provider's cooperation and may be untrue: the HCP may have provided comprehensive information, but the client did not comprehend it all and requires further education. The nurse should not ask the charge nurse to talk with the HCP unless the HCP refuses to accept the nurse's professional opinion. Explaining surgery for the purpose of obtaining consent is beyond the nurse's scope of practice.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? laryngeal nerve damage tetany hemorrhage thyroid storm

tetany Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

Which client will the community health nurse visit first? the client with type 1 diabetes mellitus requiring wound care for a leg ulcer the client with a random blood glucose level of 110 mg/dL the client newly diagnosed with type 2 diabetes mellitus the client with type 1 diabetes mellitus with acute visual changes

the client with type 1 diabetes mellitus with acute visual changes The highest priority client is the one with acute vision problems. The other clients need to be seen but are not emergent.

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? the need to adjust the steroid dose based on dietary intake and exercise the importance of watching for signs of hyperglycemia how to decrease the dose of the corticosteroids when the client experiences stress To notify the health care provider (HCP) when the blood pressure is suddenly high

the importance of watching for signs of hyperglycemia Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. A serious adverse effect of corticosteroids is hyperglycemia. Clients do not adjust their steroid dose based on dietary intake and exercise; insulin is adjusted based on diet and exercise. Addisonian crisis can occur secondary to hypoadrenocorticism, resulting in a crisis situation of acute hypotension, not increased blood pressure. Addison's disease is a disease of inadequate adrenal hormone, and therefore the client will have inadequate response to stress. If the client takes more medication than prescribed, there can be a potential increase in potassium depletion, fluid retention, and hyperglycemia. Taking less medication than was prescribed can trigger Addisonian crisis state, which is a medical emergency manifested by signs of shock.

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: all medications together 1 hour after eating breakfast. the levothyroxine before breakfast and the other medications 4 hours later. all medications before going to bed. the levothyroxine with breakfast and the other medications after breakfast.

the levothyroxine before breakfast and the other medications 4 hours later. Levothyroxine) must be given at the same time each day on an empty stomach, preferably ½ to 1 hour before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? hypoglycemia tetany thyroid crisis diabetic ketoacidosis

thyroid crisis Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

A client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply. plan for a thyroidectomy high-protein, high-calorie diet use of stool softeners review of the procedure for thyroid radiation therapy high-fiber, low-calorie diet thyroid hormone replacements

use of stool softeners high-fiber, low-calorie diet thyroid hormone replacements The treatment for hypothyroidism includes a high-fiber, low-calorie diet, because weight gain and constipation are two symptoms of the disorder. Stool softeners are prescribed to prevent constipation, and thyroid hormone replacements are needed to supplement the under-functioning thyroid gland. A high-protein, high-calorie diet is commonly used for clients with hyperthyroidism, along with a thyroidectomy or irradiation of the thyroid gland.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? debriding the wound three times per day applying a heating pad using sterile technique during the dressing change cleaning the wound with a povidone-iodine solution

using sterile technique during the dressing change The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

When evaluating teaching a client how to administer insulin, which action indicates that additional teaching is necessary? The client: identifies that the syringe is U-100 rotates sites from legs to arms. draws up the regular insulin first and then the NPH. waits 30 minutes to eat breakfast after injecting rapid-acting insulin

waits 30 minutes to eat breakfast after injecting rapid-acting insulin The nurse instructs the client to not wait any longer than 5 to 15 minutes to eat after injecting rapid-acting insulin, which has an onset action of 5 minutes and duration of 1 hour. The client is using proper technique for mixing the insulins, rotating sites, and using the U-100 syringe.

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? weight loss, increased appetite, and hyperdefecation weight loss, increased urination, and increased thirst weight gain, decreased appetite, and constipation weight gain, increased urination, and purplish-red striae

weight gain, decreased appetite, and constipation Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect? in the morning and at bedtime with each meal and snack every 4 hours, at specified times three times daily between meals

with each meal and snack In chronic pancreatitis, destruction of pancreatic tissue requires pancreatic enzyme replacement. Pancreatic enzymes are prescribed to facilitate the digestion of proteins and fats and should be taken in conjunction with every meal and snack. Specified hours or limited times for administration are ineffective because the enzymes must be taken in conjunction with food ingestion.

A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat? 2 hours before the injection. 1 hour after the injection. within 10 to 15 minutes after the injection. at any time because timing of meals with lispro injections is unnecessary.

within 10 to 15 minutes after the injection. Insulin lispro begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of lispro is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.