Endocrine Problems 1

The nurse is caring for a client diagnosed with type 1 diabetes mellitus experiencing the Somogyi effect. Which blood glucose results and treatment would the nurse expect?

0300 blood glucose 190 mg/dL (10.6 mmol/L) and 0700 blood glucose 240 mg/dL (13.3 mmol/L). Instruct to decrease amount of evening insulin.

A client with a recent history of total thyroidectomy has developed iatrogenic hypoparathyroidism. Which observed findings does the nurse determine are associated with the hypoparathyroidism? Select all that apply.

Laryngospasm Positive Chvostek's sign Positive Trousseau's sign

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? * 48.

Administer 5% dextrose intravenously.

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially?

Administer fluid replacement.

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety?

Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms would the nurse monitor for? Select all that apply.

Moon face Hypertension Truncal obesity

The nurse is providing education to a client with type 2 diabetes mellitus. The nurse explains in layperson's language the physiological mechanism behind hypoglycemia. Which response by the client determines that teaching has been successful?

My body increases glucagon production to fight low blood sugars."

The nurse is caring for a client who is 2 days postoperative from abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin based on capillary blood glucose testing 4 times a day. A carbohydrate-controlled diet has been prescribed, but the client has not been eating. On entering the client's room, the nurse finds the client to be pale and diaphoretic. Which action is appropriate at this time?

Obtain a capillary blood glucose level and quickly perform a focused assessment.

A client's laboratory results indicate the serum calcium is 12 mg/dL (3 mmol/L) and the serum phosphorous is 2.1 mg/dL (0.697 mmol/L). Based on these findings, the nurse suspects imbalance of which hormone?

Parathyroid hormone

During physical examination of a client, which finding is characteristic of hypothyroidism? *

Periorbital edema

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply.

Polyuria

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply.

Polyuria Polydipsia Polyphagia Dry mouth Flushed, dry skin

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply.

Polyuria Headache Bone pain

The nurse is monitoring a diabetic client with a blood glucose level of 400 mg/dL (22.2 mmol/L). Which clinical manifestation would indicate diabetic ketoacidosis (DKA)?

Rapid, deep respirations

A client who visits the primary health care provider's office for a routine physical examination reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse would check for which manifestations?

Weight loss and thinning skin

A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit a sign of thyroid storm. Which is an indicator of this complication?

Withdrawn behavior

What information stated by a nursing student about the 15/15 rule for treating a hypoglycemic reaction indicates an understanding of the rule?

f my client's blood glucose is below 70 mg/dL (3.9 mmol/L), I will give 15 g of juice and recheck blood glucose in 15 minutes.

A client's serum blood glucose level is 389 mg/dL (22.2 mmol/L). The nurse would expect to note which as an additional finding when assessing this client?

increased thirst

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions would the nurse anticipate receiving? Select all that apply.

initiate an infusion of 3% NaCl. Elevate the head of the bed to high-Fowler's. Administer a vasopressin antagonist as prescribed.

A client is admitted with a serum glucose level of 650 mg/dL (37.14 mmol/L), and diabetic ketoacidosis (DKA) is suspected. Which additional laboratory result does the nurse identify as being supportive of DKA?

pH of 7.52 on arterial blood gas (ABG) analysis

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching?

"I need to stop my insulin."

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus about measures to take if feeling sick to prevent diabetic ketoacidosis (DKA). The nurse recognizes accurate understanding of measures to prevent DKA when the client makes which statement?

"I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L)."

A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's best response to the client's question?

"It is for the times when your blood glucose is too low from too much insulin."

A client with type 1 diabetes mellitus who takes NPH daily in the morning calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise?

"The best time for me to exercise is after breakfast."

A client has undergone a 2-hour oral glucose tolerance test (OGTT). Which of the listed glucose levels is compatible with diabetes mellitus at the conclusion of the test?

160 mg/dL (9.14 mmol/L)

A home health nurse is visiting a client with type 1 diabetes mellitus. The client states to the nurse "I am not feeling well and had a respiratory problem for the past week, which seems to be getting worse." After interviewing the client, what would be the initial nursing action?

Check the client's blood glucose.

A client with diabetes mellitus has a blood glucose level of 50 mg/dL (2.85 mmol/L) and reports feeling hungry and shaky. Which would the nurse provide the client?

4 oz of apple juice

A client with aldosteronism is being treated with spironolactone. Which finding indicates to the nurse that the medication is effective?

A decrease in aldosterone production

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply.

Comatose state Deep, rapid breathing Elevated blood glucose level

The nurse caring for a client who underwent intracranial surgery is suspected of having diabetes insipidus. Which finding noted by the nurse is consistent with this complication of surgery?

Complaints of excessive thirst

A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA?

Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, Paco2 40, Hco3- 22.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result would the nurse expect to see if the client's long-term control is within acceptable limits?

Glycosylated hemoglobin of <6%

The nurse caring for a client newly admitted to the hospital who is at risk for diabetes mellitus suspects that the client has metabolic syndrome if which characteristics have been identified in this client? Select all that apply.

Hemoglobin A1C of 6.5% Triglycerides 160 mg/dL (1.81 mmol/L)

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed?

Decreased respiratory rate

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data would the nurse identify as a possible complication of thyroid surgery?

Decreased serum calcium level

A nursing instructor is teaching the class about Addison's disease. The instructor determines that the class understands the disease process if they indicate which are affected in this disease? Select all that apply.

Electrolytes Glucocorticoids Mineralocorticoids

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood?

I need to eat foods that have a lot of potassium in them."

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (52.9 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.3 mmol/L). The nurse would next prepare to administer which medication?

IV fluids containing dextrose

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated primary health care provider's prescription?

Intravenous infusion of normal saline

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump?

It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem?

Lack of knowledge

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis?

Serum potassium is 6.8 mEq/L (6.8 mmol/L).

During health history taking, the client complains of weight loss and diarrhea and says "I can feel my heart beating in my chest." The nurse anticipates that which diagnostic test will most likely be prescribed by the primary health care provider (PHCP) in order to determine the underlying condition leading to the client's signs and symptoms?

Serum thyroid-stimulating hormone (TSH)

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose needs to be taken if which symptoms develop? Select all that apply.

Shakiness Palpitations Light-headedness

A client's serum blood glucose level is 48 mg/dL (2.74 mmol/L). The nurse would expect to note which as an additional finding when assessing this client?

Slurred speech

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse would take which initial action?

Test the drainage for glucose.

The nurse is interviewing a client with type 2 diabetes mellitus who is taking a sulfonylurea. Which statement by the client indicates an understanding of this treatment for this disorder?

The medications I'm taking help release the insulin I already make."

A client newly diagnosed with diabetes mellitus is started on multiple-component insulin therapy and will receive a two-dose insulin protocol combination of short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given before breakfast, and what portion is given before the evening meal?

Two thirds before breakfast and one third before the evening meal

Which findings would raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply.

Urine specific gravity is 1.001. Serum osmolality is 320 mOsm/kg (320 mmol/kg) of water. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what would the nurse monitor as the priority?

Vital signs

The nurse teaches a class on foot care for clients diagnosed with diabetes mellitus. Which instructions would the nurse include in the class? Select all that apply.

Wear closed-toe shoes. Cut toenails straight across and file the edges. Pat feet dry gently, especially between the toes.