Endocrine Pharm

Which purpose is served by an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin? Encouragement to stay on the diet Food to counteract late insulin activity Added calories to promote weight gain High carbohydrates to provide nourishment for immediate use

Food to counteract late insulin activity The protein in milk and cheese is converted slowly to glucose (gluconeogenesis), providing the body with some glucose during sleep while the insulin is still acting. The purpose of an evening snack is to cover for insulin activity during sleep, not to encourage the client to stay on the diet. There are no data that indicate a need to gain weight. The foods chosen are rich in protein and are used slowly.

How will the nurse respond to a client with a new diagnosis of type 1 diabetes who becomes agitated and says, "I am scared of shots. If that is my only option, I'll just have to go into a coma and die!" when told that lifelong insulin will be needed? "Injections are not the only option available for insulin." "It won't be so bad; you will get used to it if you will only try." "This is one of those times when you need to act like an adult." "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision."

"Injections are not the only option available for insulin." An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available for clients who do not want insulin injections. The nurse should use therapeutic communication in interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting that the client's concerns are not significant are not therapeutic responses. The nurse's primary concern should be for the client's well-being, not protection from liability.

Which response would a nurse give to a client diagnosed with type 1 diabetes who states "I hate shots. Why can't I take the insulin in tablet form?"? "Your diabetic condition is too serious for oral insulin." "Insulin is poorly absorbed orally, so it is not available in a tablet." "Insulin by mouth causes a high incidence of allergic and adverse reactions." "Once your diabetes is controlled, your primary health care provider might consider oral insulin."

"Insulin is poorly absorbed orally, so it is not available in a tablet." The chemical structure of insulin is altered by gastric secretions, rendering it ineffective. There is no such thing as oral insulin; this comment about the seriousness of the diabetic condition may increase anxiety. There are no data to support the statement regarding allergic or adverse reactions, and insulin is given parenterally, not orally. Insulin is not absorbed but is destroyed by gastric secretions; there is no insulin that is effective if taken by mouth.

Which instruction will the nurse provide to a client with type 2 diabetes who develops gout when teaching about the administration of allopurinol? "Allopurinol masks symptoms of hypoglycemia." "Increase your oral hypoglycemic medications." "Increase attention to diabetic foot care." "Monitor blood glucose levels more frequently."

"Monitor blood glucose levels more frequently." Allopurinol can potentiate the effect of oral hypoglycemics, causing hypoglycemia; the blood glucose level should be monitored more frequently. Allopurinol does not mask symptoms of hypoglycemia. Medications should not be increased; this is a determination made by the health care provider. Allopurinol does not increase the risk for problems related to foot care.

The nurse mixes a short-acting and an intermediate-acting insulin in the same syringe. List the actions in the order the nurse will perform them. 1. Put air into the intermediate-acting insulin vial. 2. Put air into the short-acting insulin vial. 3. Withdraw the prescribed amount of short-acting insulin. 4. Withdraw the prescribed amount of intermediate-acting insulin.

1234 Air should be injected into the air space of the intermediate-acting insulin vial before short-acting insulin is drawn into the syringe; the needle should not touch the insulin. The nurse should inject the amount of air into the short-acting insulin vial equivalent to the volume to be withdrawn to prevent negative pressure that can make withdrawal difficult. The short-acting insulin should be withdrawn first to prevent possible contamination of the vial with the intermediate-acting insulin, which would cause a delay in onset time of the short-acting insulin. The intermediate-acting insulin should be drawn up after the short-acting insulin to prevent contamination of the short-acting insulin.

A client states, 'I keep my insulin in the refrigerator because that is where my parents kept it.' Which reason will the nurse include when explaining why insulin should be stored at room temperature? Its potency and effectiveness are maximized. Absorption is enhanced and local irritation is decreased. It is more convenient and drawing insulin into the syringe is facilitated. Adherence of insulin to the syringe and resistance upon injection are decreased.

Absorption is enhanced and local irritation is decreased. Insulin that is close to body temperature prevents vasoconstriction at the site and decreases irritation of tissues. Insulin can be stored at room temperature for up to 1 month but must be kept away from heat or sunlight. Inappropriate storage of insulin can decrease its stability and decrease, not increase, its therapeutic action. Although it may be more convenient to keep insulin in the refrigerator, this is not a valid rationale; temperature of the solution does not increase the viscosity of insulin. Neither adherence of insulin to the syringe nor decreased resistance upon injection occurs.

A 12-year-old child with cystic fibrosis is prescribed four pancrelipase capsules five times a day. The nurse explains to the child they would take the medication with meals and snacks to accomplish which goal? Enhance oxygenation Limit excretion of fats Facilitate nutrient utilization Prevent iron-deficiency anemia

Facilitate nutrient utilization Pancreatic enzyme replacement is needed because children with cystic fibrosis cannot manufacture pancreatic enzymes that promote the digestion of food. This results in large amounts of fat in the stool, which can cause bloating and abdominal cramping. Increased oxygenation is not the effect of pancrelipase; pancrelipase contains enzymes to break down fats, proteins, and carbohydrates. Pancrelipase promotes the body's ability to metabolize and absorb fat rather than limit its excretion. The purpose of pancrelipase is not the prevention of anemia.

A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing? Hyperosmolar hyperglycemic nonketotic state Ketoacidosis Glycogenesis Hypoglycemia

Hypoglycemia The time of the client's response corresponds to the expected peak action (4-12 hours after administration) of the intermediate-acting insulin that was administered in the morning, which can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Hyperosmolar hyperglycemic nonketotic state is a severe hyperglycemia state that occurs in clients with type 2 diabetes secondary to severe illness or stress. Warm, dry, flushed skin and lethargy are associated with hyperglycemia and ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.

A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated? Diabetic coma Hyperosmolar hyperglycemic nonketotic syndrome Diabetic ketoacidosis Hypoglycemic reaction

Hypoglycemic reaction These are sympathetic nervous system responses to hypoglycemia; the peak action of NPH insulin is 8 to 12 hours after administration, and 8.5 hours have elapsed since it was given. The signs and symptoms of diabetic coma are dry mucous membranes; hot, flushed skin; deep, rapid respirations (Kussmaul breathing); acetone odor to the breath; nausea and vomiting; and, as with hypoglycemia, weakness. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a hyperglycemic state and this client has symptoms of a hypoglycemic state. Ketoacidosis results from excess use of fats for energy when carbohydrates cannot be used. Lipids are metabolized incompletely, and dehydration, acidosis (both ketotic and lactic), and electrolyte imbalance result. It is not the result of insulin administration.

Which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with type 1 diabetes? Diabetic acidosis Hyperinsulin secretion Insulin-induced hypoglycemia Idiosyncratic reactions to insulin

Insulin-induced hypoglycemia Glucose gel delivers a measured amount of simple sugars to provide glucose to the blood for rapid action. Acidosis occurs when there is an increased serum glucose level; therefore glucose gel is not indicated. Diabetes mellitus involves a decreased insulin production. Glucose gel is not indicated in idiosyncratic reactions to insulin.

Which parameter would the nurse monitor to evaluate the effectiveness of desmopressin acetate (DDAVP) administered to a client with diabetes insipidus? Arterial blood pH Intake and output Fasting serum glucose Pulse and respiratory rates

Intake and output DDAVP replaces antidiuretic hormone, facilitating the reabsorption of water and the consequent return of balanced fluid intake and urinary output. The mechanisms that regulate pH are not affected. DDAVP does not alter serum glucose levels; diabetes mellitus, not diabetes insipidus, results in hyperglycemia. Although the correction of tachycardia is consistent with the correction of dehydration, the client is not dehydrated if the fluid intake is adequate; respirations are unaffected.

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Which action of PTU will the nurse include in teaching? Increases the uptake of iodine Causes the thyroid gland to atrophy Interferes with the synthesis of thyroid hormone Decreases the secretion of thyroid-stimulating hormone (TSH)

Interferes with the synthesis of thyroid hormone PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil.

Which rationale accurately explains why insulin is prescribed for clients in acute renal failure? It promotes transfer of potassium into cells to lower serum potassium levels. Insulin is required because the alpha cells of the pancreas cease to function with renal failure. It is necessary to manage the elevated blood glucose levels that accompany renal failure. Insulin reduces the accumulated toxins by lowering the metabolic rate.

It promotes transfer of potassium into cells to lower serum potassium levels. Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. Renal failure does not cause pancreatic alpha cells to cease functioning. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

The nurse plans to teach a fifth-grader with type 1 diabetes how to self-administer lispro and glargine insulin. Which action would the nurse include in the teaching plan? Alternate the sites until the best one to use is found. Self-administer the injections after being taught the technique. Draw up the insulin glargine and then draw up the insulin lispro. Learn to use the needle and syringe by practicing on an insulin pad first.

Learn to use the needle and syringe by practicing on an insulin pad first. Practice using a syringe builds confidence. The child's confidence, readiness, and skill for giving self-injections are essential for long-term management of diabetes. Injection sites must be rotated. Learning responsibility for injections should be a gradual process with continual support and guidance. Insulin glargine should not be mixed with other insulins; it should be prepared and administered separately.

In addition to clients who are receiving insulin for type 1 diabetes, the nurse will assess for signs and symptoms of hypoglycemia in clients who have which diagnosis? Liver failure Anemia Hyperthyroidism Stage 3 hypertension

Liver failure The client with liver disease is at risk for hypoglycemia—40% of clients with liver failure develop hypoglycemia. This client is limited in mobilizing carbohydrates because of a decreased ability to form glycogen (glycogenesis) and to form glucose from glycogen (glycogenolysis). Anemia is not related to a decreased serum glucose level. Hyperthyroidism is not related to a decreased serum glucose level. Hypertension is not related to a decreased serum glucose level.

Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? Monitoring for signs of hypoglycemia resulting from treatment Withholding glucose in any form until the situation is corrected Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally Regulating insulin dosage according to the client's urinary ketone levels

Monitoring for signs of hypoglycemia resulting from treatment During treatment for acidosis, hypoglycemia may develop; careful observation for this complication will be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

Which advice about the administration of vitamins A, D, E, and K will the nurse teach the parents of a toddler with newly diagnosed cystic fibrosis? Offer them in a water-miscible form. Give them during meals and snack times. The dosage is based on the child's height and weight. Present them to the child with fruit juice rather than milk.

Offer them in a water-miscible form. Because children with cystic fibrosis do not absorb fat-soluble vitamins effectively, they should be given in a water-miscible form. These vitamins may be given with other vitamins once a day; pancreatic enzymes are administered with meals and snacks. The nurse does not have to base the dosage of these vitamins on the child's height and weight. There is no reason to select juice over milk when administering these vitamins.

Which rationale explain why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? Potassium loss occurs rapidly from diaphoresis present during coma. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.

Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.

Which is the priority short-term goal when teaching a client with type 1 diabetes who is placed on an insulin pump to control the diabetes? "The client will adhere to the medical regimen." "The client will remain normoglycemic for 3 weeks." "The client will demonstrate correct use of the insulin pump." "The client will list three self-care activities that are necessary to control the diabetes."

"The client will demonstrate correct use of the insulin pump." Demonstrating the correct use of the administration equipment is a short-term, client-oriented goal that is necessary for the client to control the diabetes and is measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge.

A client with hyperthyroidism is being treated with propylthiouracil (PTU). Which instruction will the nurse include in the teaching plan regarding this medication? Select all that apply. One, some, or all responses may be correct. 'Avoid abrupt discontinuation of the medication.' 'Monitor your weight, pulse, and mood routinely.' 'You can expect an immediate response to this medication.' 'Also take an iodine replacement to aid metabolism of the medication.' 'Report side effects, such as sore throat, fever, joint pain, or oral lesions.'

'Avoid abrupt discontinuation of the medication.' 'Monitor your weight, pulse, and mood routinely.' 'Report side effects, such as sore throat, fever, joint pain, or oral lesions.' Abrupt discontinuation of the medication may result in thyroid crisis. PTU blocks the synthesis of T 3 (triiodothyronine) and T 4 (thyroxine). The therapeutic effect of the medication should result in increased weight, decreased pulse, and stability of mood. Sore throat, joint pain, fever, or oral lesions may indicate infection caused by medication-induced blood dyscrasias, such as leukopenia and agranulocytosis. The response to this medication may take up to 3 weeks. Over-the-counter medications and seafood containing iodine should be avoided.

A client with type 2 diabetes takes one glyburide tablet daily. The client asks whether an extra tablet should be taken before exercise. Which response will the nurse provide? 'You will need to decrease how much you are exercising.' 'An extra pill will help your body use glucose when exercising.' 'The amount of medication you need to take is not related to exercising.' 'Do not take an extra pill because you may become hypoglycemic when exercising.'

'Do not take an extra pill because you may become hypoglycemic when exercising.' Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacological therapy.

Which statement by the nurse is most appropriate regarding the greatest advantage of using an insulin pump? 'Independence is fostered.' 'Fear of daily injections is allayed.' 'Dietary restrictions are minimized.' 'Blood glucose monitoring can be eliminated.'

'Independence is fostered.' Continuous insulin therapy allows the child to become independent of parental control and anxiety regarding insulin injections. The pump can be programmed to give a bolus of insulin, which corresponds to food eaten, rather than the child needing an injection because of a sudden increase in blood glucose. The pump requires a subcutaneous needle insertion site that needs periodic changing (e.g., every third day or as necessary). The child must still adhere to the recommended diet; dietary control minimizes the amount of exogenous insulin needed. Blood glucose monitoring is required regardless of the method of insulin administration.

During a teaching session about insulin injections, a client asks the nurse, 'Why can't I take the insulin in pills instead of taking shots?' How will the nurse respond? 'Insulin cannot be manufactured in pill form.' 'Insulin is destroyed by gastric juices, rendering it ineffective.' 'Your health care provider decides the route of administration.' 'Your health care provider will prescribe pills when you are ready.'

'Insulin is destroyed by gastric juices, rendering it ineffective.' Insulin in tablet form is inactivated by gastric juices; insulin given by injection avoids exposure to digestive enzymes. Insulin is not given orally at this time because it is inactivated by digestive enzymes. The response, 'Your health care provider will prescribe pills when you are ready,' is incorrect information and provides false reassurance; the client currently is insulin dependent. The response, 'Your health care provider decides the route of administration,' does not answer the client's question; insulin is administered intravenously or subcutaneously, and the route depends on the client's needs.

A child is prescribed insulin glargine before breakfast. Which instruction is most appropriate for the nurse to give the parents regarding a bedtime snack? 'Offer a snack to prevent hypoglycemia during the night.' 'Give the child a snack if signs of hyperglycemia are present.' 'Avoid a snack because the child is being treated with long-acting insulin.' 'Keep a snack at the bedside in case the child gets hungry during the night.'

'Offer a snack to prevent hypoglycemia during the night.' Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the child should eat the snack before going to bed.

Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 'I will need to have my eyes and vision examined once a year.' 'I will need to check my blood sugar at home to evaluate my response to my treatment plan.' 'I can improve metabolic and cardiac risk factors of this disease if I follow a healthy diet and exercise routine.' 'Once I get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication.'

'Once I get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication.' Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. A person with type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate the treatment plan. Disease risk factors can be improved with a healthy diet and exercise routine.

When a female client becomes hypothyroid, levothyroxine is prescribed. The client asks whether she can become pregnant while taking levothyroxine. How will the nurse respond? 'If you become pregnant, thyroid abnormalities will develop in the fetus.' 'Yes, but you will have a high-risk pregnancy.' 'This medication causes infertility for the length of time that it is taken.' 'This medicine will not interfere with your ability to become pregnant.'

'This medicine will not interfere with your ability to become pregnant.' Hormone replacement should stabilize the metabolic rate and should not interfere with the client's becoming pregnant. If thyroid function remains controlled, there is no reason why the client should not become pregnant. Because thyroid function will be normalized, the fetus will not be negatively affected, and pregnancy risk will not be increased.

The nurse is reviewing discharge instructions with the parent of an infant with cystic fibrosis. Which statement indicates the parents know how to administer the pancreatic enzyme replacement? 'We should give the medication with feedings.' 'We should put crushed enteric-coated pills in the formula.' 'We need to give the medication every 6 hours, even during the night.' 'We should feed the granules from the capsule in applesauce every morning.'

'We should give the medication with feedings.' Pancreatic enzyme replacement is given just before or with every meal to aid digestion. Breaking up and dissolving the medication will hasten its degradation by gastric secretions and interfere with its efficiency. The medication must be given just before or with every meal, not every 6 hours or every morning, to aid digestion.

Which response by the nurse would be most appropriate to promote a sense of control in a 6-year-old child who is about to receive an injection? 'This won't hurt, so you shouldn't cry.' 'Which arm should I use to give you the medicine?' 'I know you're grown up. You won't cry, will you?' 'Close your eyes. You won't even know what's happening.'

'Which arm should I use to give you the medicine?' Offering a choice and involving the child in decision-making gives the child a sense of control over the situation. Assuring the child that the injection will not hurt is not truthful and conveys an unrealistic expectation. Stating that the child is grown up and won't cry indicates an expectation that the child might not be able to meet. Instructing the child not to look negates the child's needs.

Propylthiouracil and potassium iodide are prescribed for the client with hyperthyroidism. Which statement would the nurse include in the client's plan of care? Administer propylthiouracil and potassium iodide on an empty stomach. Assess the client for signs of infection and bleeding every shift. Stop the medications 2 weeks before thyroid surgery. Discontinue the medications if the heart rate is maintained within the expected range for 48 hours.

Assess the client for signs of infection and bleeding every shift. Propylthiouracil can cause depression of leukocytes and platelets. This creates an increased bleeding risk. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Medication therapy decreases the risk of postoperative hemorrhage because this medication regimen decreases the size and vascularity of the thyroid gland. Medication therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.

Which mineral deficiency would a nurse suspect in a client who reports tingling in the fingers and around the mouth and exhibits carpopedal spasm and tremors after a surgical thyroidectomy ? Potassium Calcium Magnesium Sodium

Calcium The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Deficits in potassium, magnesium, and sodium do not cause these classic manifestations.

Which alteration is the likely cause of thyrotoxic crisis (thyroid storm) in a client who has had treatment with propylthiouracil for hyperthyroidism followed by thyroid ablation with 131I? Deficiency of iodine Decreased serum calcium Increased sodium retention Excessive hormone replacement

Excessive hormone replacement Thyrotoxic crisis (thyroid storm) is the body's response to excessive circulating thyroid hormones. A deficiency of iodine results in a deficiency in thyroid hormone production. A decreased serum calcium causes tetany. Sodium retention is unrelated to thyrotoxic crisis; thyrotoxic crisis is caused by excessive circulating thyroid hormones.

The nurse is caring for a client with type 1 diabetes. Which signs or symptoms may indicate that the client has insulin-induced hypoglycemia? Select all that apply. One, some, or all responses may be correct. *Excessive hunger *Weakness *Diaphoresis Excessive thirst Deep respirations

Excessive hunger Weakness Diaphoresis Hypoglycemia affects the central nervous system, causing weakness. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

Which insulin would the nurse conclude has the fastest onset of action? NPH insulin Insulin lispro Regular insulin Insulin glargine

Insulin lispro Insulin lispro has an onset of 0.25 hours, a peak action of 0.5 to 1.5 hours, and a duration of 3 to 4 hours. Neutral protamine Hagedorn (NPH) or intermediate-acting insulin has an onset of 1.5 hours, a peak action of 4 to 12 hours, and a duration of 18 to 24 hours. Regular insulin has an onset of 0.5 hours, a peak action of 1 to 5 hours, and a duration of 6 to 10 hours. Insulin glargine has an onset of 1 to 1.5 hours, no peak action, and a duration of 20 to 24 hours.

The nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. One, some, or all responses may be correct. Irritability Glycosuria Dry, hot skin Heart palpitations Fruity odor of breath

Irritability Heart palpitations Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? Exercise regularly. Rotate injection sites. Use the Z-track technique. Vigorously massage the injection site.

Rotate injection sites. Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise reduces blood glucose but is unrelated to lipodystrophy. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure applied over the injection site after insulin administration promotes absorption; it should not be vigorously massaged.

An infant with congenital hypothyroidism receives levothyroxine for 3 months. Which finding would indicate to the nurse that the medication is effective? The infant is alert and interactive. The skin is cool to the touch. The baby's fine tremor has ceased. The baby's thyroid stimulating hormone level has increased.

The infant is alert and interactive. Infants with congenital hypothyroidism are lethargic, and may even need to be awakened and stimulated to nurse; therefore an infant who is alert and interacts appropriately for its age would demonstrate improvement. Cool skin is a clinical sign of hypothyroidism related to a slow basal metabolic rate. Fine hand tremor is related to hyperthyroidism and is not present in an infant with hypothyroidism, even one whose condition is being stabilized with levothyroxine. An increased thyroid stimulating hormone level would indicate inadequate treatment.

The nurse is teaching a school-age child how to use an insulin pump. Which instruction by the nurse is most important for the child to understand? The needle must be changed every day. A blood glucose check is necessary once a day. The pump is an attempt to mimic the way a healthy pancreas works. Subcutaneous pockets near the abdomen are used to implant the pump.

The pump is an attempt to mimic the way a healthy pancreas works. The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals. The subcutaneous needle and tubing may be left in place for as long as 3 days. Blood glucose monitoring is performed at least four times a day. Most insulin pumps are battery-driven syringes external to the body.

Which statement made by a client prescribed metformin extended release to control type 2 diabetes mellitus indicates the need for further education? "I will take the medication with food." "I must swallow my medication whole and not crush or chew it." "I will notify my doctor if I develop muscular or abdominal discomfort." "I will stop taking metformin for 24 hours before and after having a test involving dye."

"I will stop taking metformin for 24 hours before and after having a test involving dye." Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

Which response would a nurse give to a client taking an oral hypoglycemic tablet daily who asks if an extra tablet should be taken before exercise? "You will need to decrease your exercise." "An extra tablet will help your body use glucose correctly." "When taking medicine, your diet will not be affected by exercise." "No, but you should observe for signs of hypoglycemia while exercising."

"No, but you should observe for signs of hypoglycemia while exercising." Exercise improves glucose metabolism; with exercise, there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.

The parents of a child with cystic fibrosis tell the nurse they have switched to natural pancreatic enzymes because of financial issues. Which response by the nurse is most appropriate? 'You don't need to give the enzymes now that your child is in school.' 'Natural enzymes don't have any side effects and can be taken without regard to meals.' 'If you are using generic enzymes, you will need to give twice as many to achieve the required effect.' 'Natural enzymes are not as effective as the brand-name product. This is something you need to discuss with your health care provider.'

'Natural enzymes are not as effective as the brand-name product. This is something you need to discuss with your health care provider.' Natural pancreatic enzymes are not considered adequate in children with cystic fibrosis because of the bioavailability of the enzymes. Pancreatic enzyme supplementation is a lifelong treatment for cystic fibrosis. All medications have side effects, and pancreatic enzymes should be taken with meals. Giving twice as many natural enzymes does not constitute accurate dosing.

Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 AM? 8:30 AM to 9:30 AM 8:00 PM to 12:00 AM 1:00 PM to 8:00 PM 10:00 AM to 1:00 PM

10:00 AM to 1:00 PM Regular insulin peaks in 2 to 5 hours; therefore the greatest risk is between 10:00 AM and 1:00 PM. Although the onset of action occurs earlier, during the period from 8:30 AM to 9:30 AM, the level is not yet at its highest, so the risk of hypoglycemia is not at its greatest. NPH insulin's peak action is 4 to 12 hours; if hypoglycemia occurs, it will most likely happen between 12:00 PM and 8:00 PM.

Which medication will the nurse expect the health care provider to prescribe to a client who had a thyroidectomy and is pale with spasms of the hand when taking the blood pressure? Calcium Magnesium Bicarbonate Potassium chloride

Calcium These signs may indicate calcium depletion as a result of accidental removal of parathyroid glands during thyroidectomy. Symptoms associated with hypomagnesemia include tremors, neuromuscular irritability, and confusion. Symptoms associated with metabolic acidosis include deep, rapid breathing, weakness, and disorientation. Symptoms associated with hypokalemia include muscle weakness and dysrhythmias.

Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? Select all that apply. One, some, or all responses may be correct. Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min

Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min Signs of hypoglycemia include confusion, drowsiness, diaphoresis, nervousness, tachycardia, and headache. The nurse would recheck the blood glucose level of a diabetic client with these symptoms to avoid worsening hypoglycemia caused by the administration of additional insulin.

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. Which purpose would the nurse include when explaining why this medication is prescribed? Decreases the total basal metabolic rate Maintains the function of the parathyroids Blocks the formation of thyroxine by the thyroid gland Decreases the size and vascularity of the thyroid gland

Decreases the size and vascularity of the thyroid gland Potassium iodide aids in decreasing the size and vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed; it should be given no longer than 10 to 14 days before surgery because its effect is temporary. Thyroid hormone substitutes regulate the body's metabolism. Maintaining the function of the parathyroids is not the therapeutic action of potassium iodine. The parathyroid glands help regulate adequate levels of calcium in the blood. When hypocalcemia occurs, the parathyroid glands increase the absorption of calcium from urine and the intestine and stimulate the breakdown of bone matrix, increasing the release of calcium from bone. Antithyroid medications, not iodine, prevent the formation of thyroxine.

Which outcome would the nurse expect when caring for a child receiving adrenocorticosteroid therapy? Accelerated wound healing Development of hyperkalemia Increased antibody production Suppressed inflammatory process

Suppressed inflammatory process Because of the suppression of the inflammatory process, the nurse must be alert to the subtle symptoms of infection, such as changes in appetite, sleep patterns, and behavior. Adrenocorticosteroid therapy delays (not accelerates) wound healing. Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the accompanying retention of sodium and fluid. Adrenocorticosteroid therapy decreases (not increases) the production of antibodies.

The nurse is planning to teach an adolescent about diabetes and self-administration of insulin. Which would the nurse complete first? Establish realistic goals. Assess the adolescent's intellectual ability. Determine what the adolescent knows about diabetes. Gather the equipment that will be needed for the demonstration.

Determine what the adolescent knows about diabetes. Before developing and instituting a teaching plan, the nurse must assess the adolescent's attitudes, experience, knowledge, and understanding of the health problem. Before realistic goals can be set there must be an assessment. The adolescent's intellectual ability is only one aspect of the information the nurse must collect and can be assessed as the nurse is determining what the adolescent knows about diabetes. Performing a demonstration is premature until readiness for learning has been established.

The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL. Which medication would be administered to this client? Glucagon Kayexalate Hydrocortisone Insulin with dextrose in normal saline

Glucagon A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. The nurse should administer glucagon as per the prescription to manage the low glucose levels. Kayexalate is a potassium-binding resin that facilitates potassium excretion and is used to manage hyperkalemia. Intramuscular hydrocortisone is given concomitantly every 12 hours as part of hormone replacement in adrenal insufficiency. Insulin with dextrose in normal saline is given to manage hyperkalemia by causing an intracellular shift of potassium.

Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin aspart Insulin detemir

Insulin aspart Insulin aspart is a rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

The nurse administers a tube of glucose gel to a client who is hypoglycemic. Which explanation would the nurse share regarding the reversal of hypoglycemia? It liberates glucose from hepatic stores of glycogen. It provides a glucose source that is rapidly absorbed. Insulin action is blocked as it competes for tissue sites. Glycogen is supplied to the brain as well as other vital organs.

It provides a glucose source that is rapidly absorbed. The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon. It is a medication that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.

A client is scheduled to have a thyroidectomy. Which medication is indicated for decreasing the size and vascularity of the thyroid gland before surgery? Vasopressin Levothyroxine Propylthiouracil Potassium iodide

Potassium iodide Potassium iodide adds iodine to the body fluids, exerting negative feedback on the thyroid tissue and decreasing its metabolism and vascularity. Vasopressin is a pituitary hormone. Propylthiouracil interferes with production of thyroid hormone but causes increased vascularity and size of the thyroid. Levothyroxine is a thyroid hormone that may be administered after a thyroidectomy if the client develops hypothyroidism.

A client takes an oral hypoglycemic agent daily. For which condition is an oral hypoglycemic agent indicated? Ketosis Obesity Pancreatitis Reduced insulin production

Reduced insulin production Oral hypoglycemics may be helpful when some functioning of the beta cells exists, as in type 2 diabetes. Rapid-acting regular insulin is needed to reverse ketoacidosis. Obesity does not offer enough information to determine the status of beta cell function. Oral hypoglycemics are not routinely indicated for the treatment of pancreatitis.

Which finding in a client with hypothyroidism and hypertension who reports taking an extra dose of levothyroxine indicates the need to obtain a thyroid function panel? Select all that apply. One, some, or all responses may be correct. Tremors Diaphoresis Nervousness Temperature 101°F Heart rate 116 beats/mi

Tremors Diaphoresis Nervousness Temperature 101°F Heart rate 116 beats/mi Clients with hypothyroidism can develop thyrotoxicosis from an acute overdose of thyroid hormone. Tremors, diaphoresis, and nervousness are all signs of thyrotoxicosis. Clients may also be hyperthermic and tachycardic.

The health care provider prescribes finasteride for a client with benign prostatic hyperplasia. Which information would the nurse provide to the client? Male pattern baldness can occur. Results can be expected in 4 to 6 weeks. The medication relaxes the muscles in the bladder neck. A condom should be worn during intercourse with a pregnant female.

A condom should be worn during intercourse with a pregnant female. Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman. Finasteride helps prevent male pattern baldness. Results may take 6 to 12 months. Finasteride is used to shrink an enlarged prostate. Other medications, such as tamsulosin, relax the muscles in the prostate and bladder neck, making it easier to urinate.

A client with diabetes mellitus is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. Which type of insulin would the nurse recognize as compatible with IV solutions? NPH insulin Insulin lispro Insulin detemir Insulin glargine

Insulin lispro Insulin lispro is compatible with IV solutions; it is a rapid-acting insulin. Insulin glargine is not compatible with IV solutions; it is a long-acting insulin. NPH insulin is not compatible with IV solutions; it is an intermediate-acting insulin.

The nurse identifies a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes. The client says to the nurse, 'That is where I give myself insulin shots.' The nurse concludes that the nodule is a result of which condition? Callus An allergy An infection Lipodystrophy

Lipodystrophy Lipodystrophy is a noninflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits. Injections of insulin will not cause a horny growth such as a wart or callus. An allergic response will precipitate a localized or systemic inflammatory response. Hyperthermia and localized heat, erythema, and pain are associated with an infection.

Intravenous (IV) insulin is prescribed for a client in. Which insulin can be administered IV? Select all that apply. One, some, or all responses may be correct. Lispro insulin Aspart insulin Regular insulin Glargine insulin Glulisine insulin

Lispro insulin Aspart insulin Regular insulin Glulisine insulin Four insulins are approved for IV administration: regular, aspart, lispro, and glulisine insulin can be administered intravenously. Glargine insulin is long-acting insulin; it is not approved for IV use.

Which information would the nurse provide to a client with type 1 diabetes who requests information about the differences between penlike insulin delivery devices and syringes? "The penlike devices have a shorter injection time." "Penlike devices provide a more accurate dose delivery." "The penlike delivery system uses a smaller-gauge needle." "Penlike devices cost less by having reusable insulin cartridges."

Penlike devices provide a more accurate dose delivery." Penlike insulin delivery devices are more accurate because they are easy to use; also, they promote adherence to insulin regimens because the medication can be administered discreetly. One disadvantage of the penlike insulin delivery device is that the injection time will be longer; the device must remain in place for several seconds after the insulin is injected to ensure that no insulin leaks out. The penlike insulin delivery device has a larger-gauge needle that has a smaller diameter. The insulin cartridges of a penlike insulin delivery device are single-use and disposable.

The nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. Which purpose would this medication serve? Treats hyperpnea Prevents flaccid paralysis Prevents hypokalemia Treats cardiac dysrhythmias

Prevents hypokalemia Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with replacement fluids, is needed to prevent hypokalemia. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. There is no mention of dysrhythmias in the scenario; they are not a universal finding in diabetic ketoacidosis (and are commonly absent) and hypokalemia does not always cause these to occur.

The nurse is preparing to administer insulin to a client with diabetes. In which order will the nurse perform the actions associated with insulin administration? 1. Wash hands with soap and water. 2. Rotate the vial of insulin between the palms of the hands. 3. Wipe the top of the insulin vial with an alcohol swab. 4. Instill air into the vial of insulin equal to the desired dose. 5. Withdraw the correct amount of insulin from the inverted vial.

12345 Washing the hands prevents cross-contamination. Rotating the insulin vial distributes the medication evenly throughout the vial. Wiping the seal on the insulin vial prevents contamination of the needle and the fluid. Instilling air into the vial increases the pressure in the closed space so that the correct amount of fluid finally can be withdrawn.

Which manifestation would the nurse include when teaching a client about ketoacidosis? Select all that apply. One, some, or all responses may be correct. Confusion Hyperactivity Excessive thirst Fruity-scented breath Decreased urinary output

Confusion Excessive thirst Fruity-scented breath Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include confusion, excessive thirst, fruity-scented breath, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, and shortness of breath. Weakness or fatigue, not hyperactivity, is a symptom. Frequent urination, not decreased urination, is a symptom.

A client is taking thyroxine to manage hypothyroidism. Which developments indicate to the nurse that the dosage should be reduced? Select all that apply. One, some, or all responses may be correct. Diaphoresis Weight gain Tachycardia Nervousness Cold intolerance

Diaphoresis Tachycardia Nervousness Diaphoresis, tachycardia, and nervousness are signs of hyperthyroidism, which indicate that too much medication is being taken. Weight gain and cold intolerance indicate that the medication has not yet been effective.

Which action will the nurse take to safely administer 10 mL of a 10% solution (100 mg/mL) of calcium gluconate intravenously in a client who has an intravenous (IV) solution of D 5W? Administer IV push over 2 minutes into the current IV line. Insert a separate IV line and administer the medication as a continuous infusion. Dilute with 100 mL normal saline and piggyback the medication into the current IV line. Request insertion of a central line for administration of this medication.

Dilute with 100 mL normal saline and piggyback the medication into the current IV line. Calcium gluconate may be administered either directly or by infusion. Calcium gluconate should be administered at a rate not to exceed 200 mg/minute; because the client is prescribed 1000 mg, administration should take at least 5 minutes. It is compatible with D 5W, so a separate line is not required. A central line is recommended only if calcium chloride, a less preferred option than calcium gluconate, will be administered by IV push because it is irritating to veins and should not be injected into tissues.

Intravenous fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect? Hypokalemia Hypoglycemia Hypernatremia Hypercalcemia

Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.

A client with type 1 diabetes self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? 9:00 AM to 10:00 AM 10:00 AM to 11:00 AM Noon to 8:00 PM 8:00 PM to midnight

Noon to 8:00 PM The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulin peaks in 4 to 12 hours. Nine to 10:00 AM and 10:00 AM to 11:00 AM are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8:00 PM and after noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

When would the nurse plan to administer pancrelipase to a child with cystic fibrosis? With meals and snacks In the morning and at bedtime On awakening and every 3 hours while the child is awake After each bowel movement and after postural drainage is performed

With meals and snacks Pancrelipase must be taken with food and snacks because it is essential for the digestion of nutrients. The enzyme is ineffective when taken without food; it is contraindicated at any other time.

A client with thyroid cancer is scheduled for a thyroidectomy. Which information will the nurse teach the client? The dietary intake of carbohydrates must be restricted. Thyroxine replacement therapy will be required indefinitely. Chemotherapy will be used in conjunction with the surgery. A tracheostomy is required for clients having this procedure.

Thyroxine replacement therapy will be required indefinitely. Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related to respiratory distress.

Which explanation will the nurse give as to why potassium iodide solution should be taken before a subtotal thyroidectomy? "The metabolic rate of the body will increase." "It will reduce the risk of hemorrhage during surgery." "It will maintain the functioning of the parathyroid glands." "The amount of thyroid hormones being secreted will decrease."

"It will reduce the risk of hemorrhage during surgery." Potassium iodide, which aids in decreasing vascularity of the thyroid gland, decreases the risk for hemorrhage. Thyroid hormone antagonists help decrease the body's metabolism. Potassium iodide does not regulate parathyroid function. Thyroid hormone antagonists help decrease the amount of thyroid hormones being secreted.

Which medications would the nurse anticipate teaching the parents about for a preschooler newly diagnosed with cystic fibrosis? Select all that apply. One, some, or all responses may be correct. Steroids Antibiotics Antihistamines Pancreatic enzymes Fat-soluble vitamins

Antibiotics Pancreatic enzymes Fat-soluble vitamins Antibiotics are prescribed to treat recurrent respiratory tract infections. Thick secretions obstruct the pancreatic ducts, and essential pancreatic enzymes are blocked from reaching the duodenum; therefore pancreatic enzymes are administered with meals to aid digestion. Fat-soluble vitamins are necessary because of the decreased absorption of fat. Steroids are not indicated in the treatment of cystic fibrosis. Antihistamines are not used because of their drying effect on the already tenacious mucus.

The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin? This medication has a wax matrix frame that is difficult to crush. The medication has an unpleasant taste, which most clients find intolerable if crushed. If crushed, this medication irritates mucosal tissue and can cause oral and esophageal ulcer formation. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.

Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring. The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this medication should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

Which increased risk would the nurse consider when assessing a client with diabetes who is receiving long-term corticosteroid therapy and is admitted with leg ulcers? Weight loss Hypoglycemia Decreased blood pressure Inadequate wound healing

Inadequate wound healing Because the anti-inflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason? It encourages the child to stay on the diet. Energy is needed for immediate utilization. Extra calories will help the child gain weight. Nourishment helps counteract late insulin activity.

Nourishment helps counteract late insulin activity. A bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4 to 12 hours later and lasts for 18 to 24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active. The snack is important for diet-insulin balance during the night, not encouragement. There are no data to indicate that extra calories are needed; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. The snack must contain mainly protein-rich foods, not simple carbohydrates, to help cover the intermediate-acting insulin during sleep.

Several hours after administering insulin, the nurse assesses the client's response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. One, some, or all responses may be correct. Tremors Anorexia Confusion Glycosuria Diaphoresis

Tremors Confusion Diaphoresis Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

Which clinical manifestation exhibited by a client taking levothyroxine for hypothyroidism for 3 months would cause a nurse to suspect that a decrease in dosage is needed? Select all that apply. One, some, or all responses may be correct. Tremors Bradycardia Somnolence Heat intolerance Decreased blood pressure

Tremors Heat intolerance Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, heat intolerance, tachycardia, hypertension, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

Which time for medication scheduling would a nurse teach to a client prescribed the oral pancreatic enzymes pancrelipase? At bedtime With meals One hour before meals On arising each morning

With meals The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum, so at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase 1 hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly? Glucose with insulin increases metabolism, which accelerates potassium excretion. Increased potassium causes a temporary slowing of the pancreatic production of insulin. Increased insulin accelerates the excretion of glucose and potassium, thereby decreasing the serum potassium level. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.

Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level and preventing fatal dysrhythmias. Potassium is not excreted as a result of this therapy; it shifts into the intracellular compartment. The potassium level has no effect on pancreatic insulin production. Insulin does not cause the excretion of these substances.

Which instruction about medications would the nurse include when teaching a client with type 1 diabetes who tells the nurse, "I take guaifenesin cough syrup when I have a cold."? "Substitute an elixir for the cough syrup." "Increase fluid intake and use a humidifier to control the cough." "The small amounts of sugar in medications are not a concern with diabetes." "Include the glucose in the cough syrup when calculating daily carbohydrate allowance."

"Include the glucose in the cough syrup when calculating daily carbohydrate allowance." Cough syrup contains a glucose base; the client should use a glucose-free product or account for the glucose. Elixirs contain natural sweeteners. Although increasing fluid intake and using a room humidifier will also loosen secretions, this does not include important information about the medication. Additional sweeteners, even the amounts in medications, may increase serum glucose levels beyond the desired range; once control is achieved, it is unwise to alter dietary intake or medications without supervision.

A client has type 2 diabetes controlled with oral antidiabetic medications. When admitted for elective surgery, the health care provider prescribes regular insulin. Which information would the nurse include when teaching the client about the addition of insulin? 'You will need a higher serum glucose level while on bed rest.' 'The stress of surgery may cause hypoglycemia.' 'With insulin, dosage can be adjusted to your changing needs during recovery from surgery.' 'The possibility of surgical complications is greater when a client takes oral hypoglycemics.'

'With insulin, dosage can be adjusted to your changing needs during recovery from surgery.' There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible; elevated glucose levels are not desirable for clients on bed rest. The stress of surgery will precipitate hyperglycemia (not hypoglycemia), which is best controlled with exogenous insulin. Oral hypoglycemics do not increase surgical complications.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops an infection with anorexia. Which advice will the nurse provide to the client? Select all that apply. One, some, or all responses may be correct. Avoid solid food. Continue to take the oral medication. Drink fluids throughout the day. Monitor capillary glucose levels. Do not take medication until tolerating food.

Continue to take the oral medication. Drink fluids throughout the day. Monitor capillary glucose levels. Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake will be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.