Endocrine EAQ
A nurse is providing education for a patient with a new diagnosis of type I diabetes mellitus. Therapy for the patient will require subcutaneous insulin injections several times per day. When teaching the patient how to administer subcutaneous insulin, what education is the most accurate?
"Avoid injecting insulin intramuscularly, because rapid and unpredictable absorption could result in hypoglycemia.
A nurse is providing discharge teaching to a patient with a new diagnosis of type I diabetes mellitus who will need to give self-injections of insulin at home. What statement by the patient indicates to the nurse that the discharge teaching was effective?
"I need to rotate sites of injection to allow for better absorption of the insulin."
The nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective?
"I should take my levothyroxine every morning before eating my breakfast."
The nurse is caring for a patient in an outpatient diabetes clinic. Which statement by the patient indicates an understanding of the teaching?
"I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." Reasoning: When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with your basal dosing of insulin and continue to correct a finger stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row.
After a teaching session with the registered nurse, the newly diagnosed patient with type 1 diabetes mellitus is correct when he or she makes which statement?
"I will need to be medicated with insulin for the rest of my life." Reasoning: Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence. Weight loss and recovery will not affect insulin production. Exogenous insulin is not absorbed in the GI system and therefore must be given parenterally. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.
Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism?
"I will use an enema for constipation."
The nurse provides education to a patient with type 1 diabetes. Which statement made by the patient indicates a need for further instruction?
"I'll check my blood sugar level after every meal."
A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working, I don't feel any different." What is the best response by the nurse?
"It may take several weeks to see the full benefits of the treatment." Reasoning: Radioactive iodine has a delayed response, and the maximum effect may not be seen for up to three months. For this reason, it would not be necessary to contact the primary health care provider immediately, or for the patient to have the thyroid gland removed sooner. Asking the patient to sit and talk about it demonstrates that the nurse is being responsive to psychosocial/emotional needs, but is not the best nursing response at this time.
A patient prescribed metformin complains of an "upset stomach" after ingestion of the medication. The nurse asks a student nurse what suggestion he or she would make. What is the most appropriate suggestion by the student?
"Take metformin with food to decrease gastrointestinal (GI) side effects."
The patient has a prescription for levothyroxine 37.5 mcg. Available are 0.075 mg tablets. How many tablets should the nurse administer?
0.5
A patient is prescribed levothyroxine. To promote optimal absorption, the nurse should instruct the patient to take the medication at which time?
0600 In the morning, empty stomach
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action?
10:30 PM to 1:30 AM
A patient with diabetes who takes long-acting and mealtime insulin calls the ambulatory center with complaints of an upper respiratory infection. The patient has a decreased appetite, fever, and cough. Which instructions should the nurse give the patient? Select all that apply.
2.) "Any illness can cause a hormone response that can result in hyperglycemia. "5.) "If you are sick, you should check your blood sugar every four hours, even if you are not eating regularly." Rationale: Any illness or surgery can cause a regulatory hormonal response that may lead to hyperglycemia. Patients with diabetes and concurrent illnesses should check their blood sugar at least every four hours, despite current eating patterns, to monitor for hyperglycemia. Many clinics will ask a patient to report to his or her health care provider for two blood glucose readings over 300 mg/dL in a row, not just one. Common illnesses such as an upper respiratory illness or the flu can cause changes in glucose requirements. Patients should be encouraged to continue their insulin injectables as prescribed and monitor for hyperglycemia or hypoglycemia. These patients should supplement with carbohydrate-containing foods or beverages as necessary.
A nurse is caring for a patient with diabetes mellitus who is in an inpatient unit. The primary health care provider has ordered regular insulin. The nurse is preparing the medication for subcutaneous injection. What is the most effective site for subcutaneous injection of insulin?
Abdomen
Who can serve as a health care proxy?
Anyone the patient chooses
A patient who underwent thyroid surgery develops neck swelling. What is the first action that the nurse should take?
Assess the patient for signs of hemorrhage Reasoning: The patient who undergoes thyroid surgery is at risk for hemorrhage. Swelling is a clinical manifestation of hemorrhage. The first nursing action is to assess the patient. Monitoring calcium levels and evaluating difficulty in speaking helps in assessing the signs of hypoparathyroidism. Placing the patient in a semi-Fowler's position helps in avoiding flexion of the neck and tension on the suture lines.
A patient who underwent thyroid surgery develops neck swelling. What is the first action that the nurse should take?
Assess the patient for signs of hemorrhage Reasoning; The patient who undergoes thyroid surgery is at risk for hemorrhage. Swelling is a clinical manifestation of hemorrhage. The first nursing action is to assess the patient. Monitoring calcium levels and evaluating difficulty in speaking helps in assessing the signs of hypoparathyroidism. Placing the patient in a semi-Fowler's position helps in avoiding flexion of the neck and tension on the suture lines.
The nurse is caring for a patient who is postoperative following a thyroidectomy. A priority of the patient's nursing care includes which action?
Assessment of Chvostek's sign
The nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective?
Avoid using enemas. Avoid using sedatives. Take the prescribed medication before breakfast.
A nurse caring for a patient with hyperparathyroidism should monitor the patient for which complication?
Cardiac Dysrhythmias Reasoning: Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism. Seizures and cataracts are complications seen in hypoparathyroidism. Constipation is not directly associated with parathyroid disorders.
A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse should be performed initially?
Check the patient's blood sugar at 3 AM
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what?
Chooses a puncture site in the center of the finger pad The patient should select a site on the sides of the fingertips, not on the center of the finger pad, because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.
Which clinical manifestation is a classic finding in Graves' disease?
Exophthalmos Reasoning: Exophthalmos is the protrusion of eyeballs from the orbits; it results from increased fat deposits and fluid in orbital tissues. It is a classic clinical manifestation in Graves' disease. Gingivitis, cretinism, and muscular dystrophy are not classic clinical manifestations associated with Graves' disease.
Activity intolerance in a patient with hypothyroidism is related to what?
Fatigue Reasoning: Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness.
To determine how well a patient's diabetes mellitus has been controlled over the past two to three months, what assessment parameter should the nurse review?
Glycosylated hemoglobin Reasoning: When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs). This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months. Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose tests are used to measure the current blood glucose level, which is different from the glycosylated hemoglobin level.
A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent?
Goiter
The nurse assesses a patient that presents with eye protrusion. The patient states, "My eyes are dry and irritated." Based on these data, the nurse expects that what diagnosis will be made?
Graves Disease Reasoning: Eye protrusion is referred to as exophthalmos and this indicates Graves' disease. Exophthalmos results from an increase in fat and fluid in the orbital tissues. The increased pressure due to edema forces the eyeballs outwards, and the upper eye lids retract and become elevated. As a result, the corneal surface is exposed, causing eye dryness and irritation. Myxedema coma presents with generalized edema. Diabetes insipidus is characterized by the large amount of urine excretion (2 to 20 L/day). Pheochromocytoma is characterized by tachycardia, dysrhythmia, and metanephrines in urine.
The nurse has been teaching a patient newly diagnosed with diabetes mellitus to test his or her own blood glucose level. During evaluation of his or her technique, the nurse determines that the teaching has been adequate when the patient performs which task?
Hangs the arm in the dependent position for one minute before puncturing
A patient is just returning to the surgical floor from the recovery room after undergoing a thyroidectomy. What is the nurse's priority nursing intervention?
Have a tracheostomy tray at the bedside. Reasoning: Postoperative complications for a patient following a thyroidectomy include injury to the recurrent or superior laryngeal nerve, which can lead to vocal cord paralysis. If both cords are paralyzed, spastic airway obstruction will occur, requiring an immediate tracheostomy. Closely monitoring the patient's emotional status is important, especially because the appearance of the incision may be distressing to the patient. However, providing reassurance that the scar will fade in color and eventually look like a normal neck wrinkle is not the priority. Following surgery, patients are nothing by mouth status, and would not be taking small sips of water to maintain hydration. Hydration status is maintained via intravenous fluids. The nurse would not avoid touching the patient's neck and shoulders, because this would impede a thorough assessment.
The patient has a prescription for repaglinide. The nurse instructs the patient to take the medication at which time?
Immediately before meals
A patient with type 2 diabetes mellitus (DM) receives a prescription for metformin. The nurse identifies that which statement is characteristic of this medication?
It decreases hepatic glucose production The primary action of metformin is to reduce glucose production by the liver. Metformin often causes weight loss instead of weight gain. Metformin can be administered in conjunction with sulfonylureas. Metformin is preferred for the initial management of type 2 diabetes.
A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time?
Midnight before the test
The health care provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient?
Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Reasoning: Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.
One of the unlicensed assistive personnel (UAP) reports to the nurse that a patient with diabetes is slow to respond, pale, and diaphoretic. What is the nurse's priority intervention?
Obtain a bedside glucose reading
In developing a teaching plan for the patient with exophthalmos, the nurse understands that the highest priority is placed on
Preventing corneal injury Reasoning: The patient with exophthalmos may not be able to close the eyelids completely. This puts the patient at risk for dry eyes, for overexposure to environmental irritants, and for corneal injury. Lubricating eye drops can be used to combat drying, and dark glasses are encouraged to decrease exposure to environmental irritants. Preventing corneal injury is the priority for the patient with exophthalmos. Exophthalmos may create a function limitation in extraocular movements because of forward protrusion of the globe of the eye. The patient with exophthalmos is encouraged to move the eyes through the six cardinal fields of gaze several times a day to maintain ocular muscle flexibility. Avoiding eyestrain is not a priority for the patient with exophthalmos. Patients may suffer from decreased self-esteem because of the physical changes associated with exophthalmos. Good grooming is encouraged as a strategy to improve self-esteem. Improving self-esteem is of lower priority than preventing corneal injury. Exophthalmos is not associated with ocular nerve damage.
A patient presents with diabetic ketoacidosis (DKA). The nurse initiates the collaborative plan of care with the understanding that the initial goal of the treatment plan is:
Rehydration through intravenous fluid replacement Reasoning: Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish intravenous (IV) access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored, because insulin therapy, which is needed to correct the hyperglycemia, may further reduce the potassium level. Insulin therapy will be used to lower the blood glucose gradually, to prevent rapid drops in serum glucose, which could lead to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy, because excess glucose is not being transported to the cells and used as a source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen.
The nurse is educating a diabetic patient about the use of premixed insulin neutral protamine hagedorn /regular 70/30. What should the nurse inform the patient about using this insulin?
Rotate the injection within one anatomic site for a week.
A patient's blood glucose level before breakfast is 324 mg/dL. The nurse reviews the electronic medical record and notes that the patient receives a high dose of insulin each evening at bedtime. The nurse recognizes that the patient's hyperglycemia is most likely due to which problem with insulin therapy?
Somogyl Effect Reasoning: The Somogyi effect occurs when a patient receives a high dose of evening/bedtime insulin that produces a decline in blood glucose levels during the night. As a result, counter regulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia. Lipodystrophy is atrophy or hypertrophy of the subcutaneous tissue. Allergic reactions related to insulin occur as local inflammatory reactions and do not produce hyperglycemia. The dawn phenomenon also is characterized by hyperglycemia that is present on awakening; however, it is caused by growth hormone and cortisol excretion during the early morning hours and is unrelated to the amount of insulin given at nighttime.
A nurse in the outpatient setting is teaching a patient about the importance of self-monitoring of blood glucose (SMBG) using a glucometer. What should the nurse tell the patient? Select all that apply.
Test blood glucose whenever hypoglycemia is suspected. Test blood glucose before and after exercise. Take a blood sample from the side of the finger pad.
Which parameter would indicate the optimal intended effect of therapy with levothyroxine?
Thyroid-stimulating hormone (TSH) of 1.5 mIU/
A patient calls the health care provider's office at 8:00 AM and states, "I just experienced an episode of low blood sugar, which responded to oral glucose tablets." To help identify the cause of the low blood sugar, an appropriate question the nurse should ask is:
Were you more active than usual yesterday?
A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure?
When was the last time you took your metformin?
