Mrs. Tice's Pink Book Endocrine

The nurse receives an order to administer Novolin R 10 units with Novolin N 20 units to be given subcutaneously at 0730 hours. Place the following actions in correct sequence to show how the nurse would mix the medications. Use all the options.

*** This question has a chart as part of the answer and therefore cannot be included as part of this quizlet ***

The nurse should assess for hypocalcemia based on which client statements following a subtotal thyroidectomy? Select all that apply. 1. "I feel like I could vomit." 2. "My lips feel numb and tingly." 3. "Light seems to bother my eyes." 4. "I feel weak when I walk." 5. "I have cramps in my legs." 6. "I feel like my throat is constricting."

1. "I feel like I could vomit." 2. "My lips feel numb and tingly." 5. "I have cramps in my legs." 6. "I feel like my throat is constricting." Hypocalemia can occur after a subtotal thyroidectomy. Signs and symptoms of hypocalcemia include nausea and vomiting, tingling and numbness around the mouth, muscle cramping in the lower extremities, and tightness of the throat (laryngeal spasms). These are commonly the first symptoms noted by a client following a subtotal thyroidectomy. The remaining complaints, weakness and sensitivity to light, are not usually associated with hypocalceinia.

Which statement provides the best evidence that the client understands the postoperative course? 1. "I should avoid people with infectious diseases." 2. "I need to limit my fluid intake to 1 quart per day." 3. "My appearance will never be the same as it was before." 4. "No other treatment is necessary after I recover from surgery."

1. "I should avoid people with infectious diseases." Preoperatively and postoperatively, a client with Cushing's syndrome is at increased risk for acquiring infections because of the anti-inflammatory effects of corticosteroid hormones, which may mask the common signs of inflammation and infection. Therefore, avoiding people with infectious diseases is prudent. The client is also at risk for fluid volume deficits and should maintain an adequate fluid intake. The client's Cushingoid appearance should slowly recede as hormone levels are reestablished at lower-than-preoperative levels. After a bilateral adrenalectomy, hormone replacement therapy is a lifelong necessity. In fact, a medical alert tag should be worn at all times.

Because medical treatment was unsuccessful, the client with acromegaly is scheduled for a transsphenoidal hypophysectomy . The night before surgery, the nurse provides the client with information about what to expect during the postoperative period. Which statement by the client indicates a misunderstanding of the expected surgical outcome? 1. "My appearance will gradually become normal." 2. "I'll need to take replacement hormones." 3. "I'll need to see my physician regularly." 4. "The surgical incision will be inconspicuous."

1. "My appearance will gradually become normal." The treatment of choice for a pituitary tumor that is oversecreting growth hormone is a transsphenoidal hypophysectomy. This involves the surgical removal of the pituitary gland through the nasal passage. The client misunderstands the outcome of surgery when there is a belief that the client's appearance will return to normal. Unfortunately, a client with acromegaly will never regain a normal appearance despite successful treatment of the disease. Hormone replacement therapy is necessary following surgery or irradiation of the anterior pituitary gland. The client should wear a medical alert tag and see a physician regularly. The surgical incision is made through the nose and is invisible

The nurse has prepared 24 units of Humulin N insulin for subcutaneous administration. Identify the preferred location for insulin administration to facilitate rapid absorption. 1. Abdomen 2. Legs 3. Arms 4. Buttocks

1. Abdomen The abdomen is the preferred site for insulin administration to facilitate the most rapid rate of absorption. Absorption is somewhat slower in the arms, slower still in the legs, and slowest in the hip or buttocks area. The abdomen is also generally easier to access for self-administration, and the absorption rate is constant.

Which nursing diagnosis should the nursing team consider when developing this client's care plan? 1. Activity intolerance 2. Self-care deficit 3. Ineffective breathing 4. Impaired swallowing

1. Activity intolerance Despite his large size, a client with acromegaly is likely to suffer from activity intolerance because of the client's size, muscle weakness, joint pain, and joint stiffness. There is no indication that the client with acromegaly will have difficulty providing self-care, although because of the large size, assistance may be needed. Pulmonary functions generally remain adequate. Clients with acromegaly have difficulty chewing because of the malformations in their jaw and teeth, but swallowing is unaffected.

Which nursing assessment is most helpful in evaluating the status of a client with Addison's disease? 1. Blood pressure 2. Bowel sounds 3. Breath sounds 4. Heart sounds

1. Blood pressure If inadequately treated, Addison's disease leads to dehydration and hypotension. If unresolved, it can lead to Addisonian crisis, which is characterized by cyanosis, fever, and the classic signs of shock. Monitoring the blood pressure and its subsequent trends provides some of the best data for evaluating the client's health status. Bowel, breath, and heart sounds are not generally abnormal in Addison's disease.

A client is undergoing treatment for Graves' disease. Which characteristic facial feature would the nurse expect to note during a physical examination of this client? 1. Bulging eyes 2. Bulbous nose 3. Thick lips 4. Large tongue

1. Bulging eyes Exophthalmos (bulging or enlarged eyes) is a common characteristic among clients with Graves' disease or toxic diffuse goiter. The other facial features described are not directly related to this thyroid disorder.

A client diagnosed with hypoparathyroidism develops tetany and comes to the emergency department for treatment. Which I.V. medication can the nurse expect the physician to order to treat the client's condition? 1. Calcium gluconate 2. Ferrous sulfate 3. Potassium chloride 4. Sodium bicarbonate

1. Calcium gluconate Hypoparathyroidism is caused by inadequate secretion of parathyroid hormone, which leads to increased phosphorus levels and a deficiency in blood calcium levels. This deficiency results in hypocalcemia and leads to tetany, the chief symptom of hypoparathyroidism . Tetany is a general muscular condition that results in tremors and spastic, uncoordinated movements. When tetany occurs, calcium gluconate or calcium chloride is the drug of choice for I.V. administration. Ferrous sulfate is a source of iron; it is administered orally to treat anemia. Potassium chloride is given to prevent or relieve hypokalemia. Sodium bicarbonate is administered to maintain normal acid-base balance

Because the client is receiving levothyroxine (Synthroid) for the first time, the nurse recognizes the need to observe the client for adverse effects related to thyroid replacement therapy. Which signs and symptoms should the nurse assess? Select all that apply. 1. Dyspnea 2. Palpitations 3. Excessive bruising 4. Raised, red rash 5. Hyperactivity 6. Insomnia

1. Dyspnea 2. Palpitations 5. Hyperactivity 6. Insomnia Once the client is accurately diagnosed with hypothyroidism and/or myxedema, thyroid replacement therapy may be started. The nurse should watch for signs and symptoms related to hyperthyroidism which could be an indication that the levothyroxine (Synthroid) dosage is too high. The adverse reactions include dyspnea, palpitations, hyperactivity, dizziness, insomnia, excessive hunger, rapid pulse, and gastrointestinal (GI) complaints. Excessive bruising is not associated with thyroid replacement therapy, instead it is associated with anticoagulants. A rash is not associated with thyroid replacement therapy.

The nurse documents that Kussmaul 's respirations were detected during the initial assessment. Which respiratory pattern best describes the client's breathing? 1. Fast, deep, labored respirations 2. Shallow respirations, alternating with apnea 3. Slow inhalation and exhalation through pursed lips 4. Shortness of breath with pauses

1. Fast, deep, labored respirations Kussmaul's respirations, a common sign of diabetic ketoacidosis (DKA), is a compensatory mechanism to eliminate carbon dioxide from the body and prevent a further drop in pH. Respirations are typically fast, rapid, deep, and labored with a longer expiration. The other options are not characteristic of Kussmaul's respirations.

Postoperatively, the nurse should consult the physician before encouraging the client to perform which activity? 1. Forced coughing 2. Deep breathing 3. Ambulating 4. Dangling legs

1. Forced coughing Coughing may precipitate bleeding in and around the surgical area and increase the risk of airway obstruction. Therefore, it is best to consult the physician before encouraging the client to cough postoperatively. The client is encouraged to take deep cleansing breaths, ambulate, and dangle the legs from the side of the bed, as tolerated. These activities will prevent pneumonia and postoperative thrombosis

Which nursing interventions are most appropriate for managing the basic needs of a client with Cushing's syndrome? Select all that apply. 1. Have the client sleep on a convoluted (eggcrate) foam mattress. 2. Ambulate the client at frequent intervals. 3. Advise client to ask for assistance when getting up. 4. Offer high-carbohydrate nourishment. 5. Check client frequently for suicidal tendencies. 6. Instruct the client to wear loose-fitting clothing.

1. Have the client sleep on a convoluted (eggcrate) foam mattress. 3. Advise client to ask for assistance when getting up. 5. Check client frequently for suicidal tendencies. 6. Instruct the client to wear loose-fitting clothing. Clients with Cushing's syndrome have thin, fragile, easily traumatized skin that is susceptible to the effects of prolonged pressure. Therefore, it is appropriate to exercise gentleness when turning and repositioning the client and to use pressure-relieving devices such as a convoluted foam mattress. Loose-fitting clothing will also prevent skin breakdown and pressure. The client needs rest more than activity to accommodate for weakness and fatigue, and because of the weakness, the client needs assistance when getting up from the chair or out of bed. Depression and suicidal tendencies are common in clients with Cushing's syndrome and therefore it is prudent to keep close observation on the client. The client's carbohydrate intake should be limited because of the tendency for hyperglycemia.

A day after having a subtotal thyroidectomy, the nurse suspects that the client is developing clinical manifestations related to thyroid crisis. Which signs and symptoms related to thyroid crisis require immediate notification of the physician? Select all that apply. 1. High fever 2. Falling blood pressure 3. Regular noisy respirations 4. Hand spasms 5. Heart palpitations 6. Decreased urine output

1. High fever 5. Heart palpitations Exaggerated signs of increased metabolism are a manifestation of thyroid crisis (also called thyroid storm or thyrotoxicosis). Some signs include hyperpyrexia (fever) as high as 41°C or 106°F, hypertension, severe tachycardia, chest pain, cardiac dysrhythmias/palpitations, dyspnea, and an altered level of consciousness. Carpal spasms are a sign of hypocalcemia. Noisy respirations may indicate laryngospasm due to hypocalcemia or a partial airway obstruction. Hypotension is not a sign of thyroid crisis nor is decreased urine output.

The results of the diagnostic tests confirm that the client has myxedema. In addition to amenorrhea, which other signs of myxedema is the nurse likely to observe in this client? Select all that apply. 1. Hoarse, raspy voice 2. Oily skin with large pores 3. Thin trunk and extremities 4. Extreme restlessness 5. Low body temperature 6. Decreased blood pressure

1. Hoarse, raspy voice 5. Low body temperature 6. Decreased blood pressure Hypothyroidism is the result of insufficient production of thyroid-stimulating hormone that results in a slowing of metabolic processes. The severe form of hypothyroidism is called myxedema and is life threatening if left untreated. Common signs of myxedema include hypothermia, hypotension, a hoarse and raspy voice, slow speech, lethargy, expressionless face, protruding tongue, coarse and sparse hair, weight gain, and dry skin.

Prior to discharge, the physician orders lypressin (Diapid) to be administered p.r.n . When instructing the client about how to take this drug at home, the client to administer the drug when experiencing which symptoms? 1. Increased thirst 2. Onset of a headache 3. Dark yellow urine 4. A runny nose

1. Increased thirst The need to administer additional doses of lypressin (Diapid) is based on increased thirst and frequency of urination. If more than the prescribed number of doses is required, the interval between routine administrations is generally decreased while the number of sprays at each dose remains the same. Someone with diabetes insipidus would have urine that is colorless, not dark yellow; a dark yellow color indicates that the urine is concentrated and has a high specific gravity. A runny nose is a side effect of excessive use of the nasal spray. Headaches are not typically associated with this disorder.

The physician prescribes glyburide (DiaBeta) orallfor the client to treat diabetes. When the client asks why a diabetic relative cannot take insulin orally, what is the best answer? 1. Insulin is inactivated by digestive enzymes. 2. Insulin is absorbed too quickly in the stomach. 3. Insulin is irritating to the gastric mucosa. 4. Insulin is incompatible with many foods.

1. Insulin is inactivated by digestive enzymes. Insulin is administered parenterally because it is a protein substance readily destroyed in the gastrointestinal (GI) tract. None of the other choices accurately describes the rationale for excluding insulin administration by the oral route.

After the health care team meets to discuss the client's nursing needs, the nursing diagnosis Disturbed Body Image is added to the care plan. The best rationale for adding this nursing diagnosis to the care plan in the case of a female is that females with Cushing's syndrome typically experience which physiologic effect? 1. Masculine characteristics 2. Heavy menstrual flow 3. Extreme weight loss 4. Large, pendulous breasts

1. Masculine characteristics Female clients with Cushing's syndrome acquire masculine characteristics, such as a deep voice and excessive growth of body hair, including facial hair. If premenopausal, they may also develop amenorrhea. Large breasts, heavy menstruation, and severe weight loss are not characteristic of Cushing's syndrome.

Which nursing intervention is essential for monitoring the client's condition? 1. Measuring intake and output 2. Analyzing blood glucose levels 3. Inserting a Foley catheter 4. Sending urine samples to the laboratory

1. Measuring intake and output To prevent dehydration, it is essential to replace fluids based on the deficit between the client's intake and output. Glucose metabolism is unaffected in diabetes insipidus; therefore, monitoring blood glucose values is unnecessary. Although a client with diabetes insipidus might not eat well because of his constant drinking, maintaining an adequate fluid volume is the primary nursing concern; therefore monitoring intake and output is critical in this situation. It is not necessary to insert an indwelling catheter to monitor urine output, however urine does need to be measured. Sending urine to the laboratory is also not needed.

A client with type I diabetes comes to the clinic complaining of persistent bouts of nausea, vomiting, and diarrhea for the past 4 days. The client has skipped insulin injections because of not being able to eat or keep anything down. Which instruction should the nurse give the client about insulin administration during sick days? 1. Monitor blood glucose levels every 2 to 4 hours. 2. Eat candy or sugar frequently. 3. Attempt to drink a high-calorie beverage every hour. 4. Test urine daily for protein.

1. Monitor blood glucose levels every 2 to 4 hours. Insulin is a hormone that regulates glucose in the blood. During times of sickness, dehydration (from persistent vomiting and diarrhea) and the stress of illness can cause the glucose level to increase significantly. This is especially critical for an insulin-dependent diabetic client who may have insufficient insulin to counteract the rising glucose level. Therefore, it is important for the nurse to teach the client about the effects of dehydration and the need for blood glucose monitoring and insulin administration when ill. Blood glucose levels should be monitored every 2 to 4 hours during sick times. Eating candy or drinking high-calorie beverages will cause the blood glucose level to rise, especially if there is insufficient insulin on board to counteract the glucose. Testing the urine daily for protein is not typically done during times of illness

A client seeks medical attention after noticing fullness in the neck. After several diagnostic tests, a large endemic goiter is diagnosed. As the nurse provides care for the client newly diagnosed with a large goiter, which interventions should be implemented? Select all that apply. 1. Observe the client's respiratory status 2. Elevate the client's head of bed 3. Provide a diet high in iodized salt 4. Obtain an order for a soft diet 5. Assess for high fever 6. Administer prescribed antibiotics

1. Observe the client's respiratory status 2. Elevate the client's head of bed 3. Provide a diet high in iodized salt 4. Obtain an order for a soft diet An endemic goiter is caused by a deficiency of iodine in the diet resulting in an enlarged thyroid gland. As a consequence, the client feels a fullness in the neck. Appropriate nursing interventions include observing the client's respiratory status because the client may experience respiratory distress due to pressure on the trachea. Elevating the head of the bed can relieve respiratory symptoms . Because the endemic goiter is a result of iodine deficiency, providing a diet high in iodized salt is also appropriate. Obtaining an order for a soft diet is also prudent because of the pressure of the enlarged thyroid on the esophagus which makes swallowing difficult. There is no need to assess for fever or administer antibiotics because a goiter is not related to an infectious process.

Because propylthiouracil (Propyl-Thyracil) can cause agranulocytosis, the nurse advises the client to notify the physician if which problem occurs? 1. Persistent sore throat 2. Occasional heart palpitations 3. Fatigue upon exertion 4. Prolonged bleeding with trauma

1. Persistent sore throat Agranulocytosis is a decrease in white blood cells that are produced to fight infections. A sore throat, fever, and malaise may indicate that the client has insufficient white blood cells to prevent infection. Heart palpitations, a symptom of Graves' disease, become infrequent as treatment with propylthiouracil (Propyl-Thyracil) continues. Prolonged bleeding is evidence of thrombocytopenia (a decrease in platelets), and is not related to agranulocytosis. Fatigue can be caused by anemia related to a decreased number of circulating red blood cells.

After obtaining the finger stick, the emergency department technician reports to the nurse that the blood glucose level is 760 mgldL. Based on the client's blood glucose measurement, the nurse immediately reevaluates the client. Which physician orders should the nurse anticipate? Select all that apply. 1. STAT serum blood glucose 2. Intravenous Regular insulin 3. Vital signs every 2 hours 4. A diet of six small frequent meals 5. Electronic glucometer measurements a.c. and h.s. 6. Continuous cardiac monitoring

1. STAT serum blood glucose 2. Intravenous Regular insulin 3. Vital signs every 2 hours 6. Continuous cardiac monitoring For clients who are exhibiting signs and symptoms of diabetic ketoacidosis (DKA), the blood glucose must be decreased. In order to verify that the blood glucose measurement is accurate, a STAT serum glucose level must be obtained prior to beginning insulin treatment. Serum blood glucose levels should also be anticipated periodically until the client stabilizes. The nurse should anticipate the intravenous administration of Regular insulin will be ordered because it is the drug of choice to lower blood glucose levels that are critically high. Correcting fluid and electrolyte imbalance is another goal. Potassium is given to help the glucose reenter the cell, thereby lowering glucose levels. The nurse should connect the client to a cardiac monitor to observe changes in cardiac rate and rhythm related to hyperkalemia and peaked T waves and because the client has respiratory problems related to Kussmaul' s (rapid, deep, and noisy) respirations. Vital signs are taken at least every 2 hours or more often during this critical period. After the client is stabilized and admitted to the hospital, dietary orders and orders for glucometer measurements can be written at that time.

The nurse cares for a client with Addison's disease. Which characteristic findings would the nurse expect to assess in a client with Addison's disease? Select all that apply. 1. Salt craving 2. Skin blemishes 3. Moon-shaped face 4. Bronzed skin 5. Hypoglycemia 6. Weight loss

1. Salt craving 4. Bronzed skin 5. Hypoglycemia 6. Weight loss Addison's disease is caused by a deficiency of cortical hormones that develops from adrenal insufficiency. Clients appear unusually tan, bronze, or darkly pigmented. Other signs and symptoms include fatigue, weight loss/emaciation , hypotension, and decreased glucose. Decreased sodium levels result in a craving for salt. An increased potassium level is also a clinical manifestation of this disease. A moon-shaped face, skin blemishes, and obesity are more characteristic of a hyperfunctioning adrenal cortex or endogenous steroid therapy

Because this client is at risk for developing Addisonian crisis, a life-threatening condition, what does the nurse correctly instruct the client to avoid? 1. Stress-producing situations 2. Consuming alcoholic beverages 3. Eating complex carbohydrates 4. Getting too little sleep

1. Stress-producing situations Stress and any of the following factors-salt deprivation, infection, trauma, exposure to cold, or overexertion--can overwhelm the client's ability to maintain homeostasis. This imbalance can lead to the development of Addisonian crisis, a life-threatening condition. Alcohol consumption, eating complex carbohydrates, and sleep deprivation are not relevant factors in Addison's disease.

Preoperatively, which information is most important to teach the client before the subtotal thyroidectomy? 1. Techniques for changing positions 2. Reasons for performing leg exercises 3. Daily dressing changes will be necessary 4. Postoperative use of the incentive spirometer

1. Techniques for changing positions Preoperative instructions must include how to support the head and neck when turning or rising to a sitting or standing position . This prevents tension on the sutures in the neck. The other information is important to include, but it is not as essential for the client to know.

The nurse develops the care plan and documents an expected outcome that states, "The client will be free of infection during the hospital stay. " Based on the nurse's understanding of this disease process, what are the rationales for this expected outcome? Select all that apply. 1. The client 'is at risk for skin breakdown related to thinning of the skin and edema 2. Wound healing is prolonged in clients with this disorder 3. The immunosuppressive effects of the disorder mask symptoms of infection 4. The client is at risk for aspiration pneumonia related to laryngeal nerve damage 5. The client's admission white blood cell count is elevated 6. The client's admission temperature is within normal limits

1. The client 'is at risk for skin breakdown related to thinning of the skin and edema 2. Wound healing is prolonged in clients with this disorder 3. The immunosuppressive effects of the disorder mask symptoms of infection Upon admission to the hospital, the nurse should gather data from the physical assessment findings and from medical, drug and allergy histories and develop a plan of care with expected outcomes based on the data collection. In this case, the nurse should observe for symptoms of an adrenal disorder. Because this disorder masks the signs of infection and there is a potential for prolonged wound healing and risk for skin breakdown, the expectation is that the client will be infection-free during the hospitalization. Laryngeal nerve damage is not related to this disorder. An elevated white count is an indication that an infection already exists. A normal temperature upon admission does not necessarily mean the client will remain afebrile during the hospitalization.

Which of the following provides the best evidence that the dietary measures to control functional hypoglycemia are therapeutic? 1. The client experiences fewer incidences of weakness and tremors 2. The client experiences fewer incidences of thirst and dry mouth 3, The client experiences fewer incidences of muscle spasms and fatigue 4. The client experiences fewer incidences of hunger and abdominal cramps

1. The client experiences fewer incidences of weakness and tremors If dietary measures are appropriate, clients experience fewer symptoms of hypoglycemia such as weakness, tremors, headache, nausea, hunger, malaise, excess perspiration , confusion, and personality changes. The other choices do not relate to functional hypoglycemia .

A 38-year-old client is hospitalized after developing symptoms that resemble Cushing's syndrome. The nurse completes admission documentation. Based on the client's condition, which findings should the nurse document after completing the initial physical assessment? Select all that apply. 1. The client has very thin legs. 2. The client looks emaciated. 3. The client has bulging eyes. 4. The client's skin is pale. 5. The client has bruising. 6. The client's scalp hair is thin

1. The client has very thin legs. 5. The client has bruising. 6. The client's scalp hair is thin Cushing's syndrome is the result of excessive corticosteroid production. When this occurs, the client develops several multisystem clinical manifestations including thin extremities (from muscle wasting and weakness) and a heavy, obese trunk. Other common signs and symptoms include moon face, thinning scalp hair, buffalo hump, red, ruddy complexion, thin and fragile skin, bruising, striae, peripheral edema, hypertension, hirsutism (in women), mood changes, depression, and psychosis.

Because the client is exhibiting signs and symptoms of hypocalcemia following surgery, the nurse assesses for Chvostek's sign. Which technique best describes how Chvostek's sign is elicited? 1. The nurse lightly taps over the client's facial nerve. 2. The nurse strokes the sole of the client's foot. 3. Tue nurse dorsiflexes each of the client's feet. 4. The nurse asks the client to touch the nose.

1. The nurse lightly taps over the client's facial nerve. A client with hypocalcemia will manifest Chvostek's sign which is facial muscle spasms elicited when the cheek over the facial nerve is gently tapped. Stroking the sole of the foot is a means of assessing the Babinski response when suspecting brain injury. Homans' sign is assessed by dorsiflexing the foot when suspecting a deep vein thrombosis. Closing the eyes and touching the nose is a method for testing proprioception, the ability to identify the location of a body part without looking at it.

The nurse includes foot care as a component of diabetes teaching. Which statement by the client about foot care indicates the need for further teaching? 1. "I need to inspect my feet daily." 2. "I should soak my feet each day." 3. "I need to wear shoes whenever I'm not sleeping." 4. "I need to schedule regular appointments with the podiatrist."

2. "I should soak my feet each day." Soaking the feet tends to soften the skin and predisposes it to trauma. The feet are washed daily with soap and water, and then dried thoroughly before the client dons clean socks and supportive shoes. Clients with diabetes should inspect their feet daily for signs of injury or poor circulation. Going befoot is contraindicated because this predisposes the client to foot injuries. The client should see a podiatrist regularly to have the toenails cut and filed.

A dietitian explains how to use the American Diabetes Association exchange list. Which statement by the client provides the best evidence of understanding the principle of an exchange list for meal planning? 1. "I can eat one serving from each category on the exchange list per day." 2. "Measured amounts of food in each category are equal to one another." 3. "The number of servings from the exchange list is unlimited." 4. "I need to use the exchange list to determine the nutrition in food."

2. "Measured amounts of food in each category are equal to one another." The main advantage of using an exchange list is that it eliminates the need to count calories. Instead, clients are prescribed the number of exchanges they may use in particular categories. They can choose among items of equal nutritional value, provided they consume the serving size the list specifies.

The diabetic client tells the nurse that breakfast is always skipped. Which response by the nurse is most appropriate? 1. "If you drink a glass of milk and eat a breakfast bar, that will be sufficient for breakfast." 2. "You should eat each meal and snack at the same time each day." 3. "If you skip breakfast, eat a high-calorie snack at mid-morning ." 4. "Wait to take your medication until you eat your first meal of the day."

2. "You should eat each meal and snack at the same time each day." To maintain stable control of blood glucose levels, it is essential to take medication, eat, and exercise at regular, consistent times each day. Implying that the therapeutic regimen is flexible predisposes clients to develop unstable blood glucose levels and metabolic complications.

After stabilization in the emergency department, the client with DKA is admitted to a step down unitfor further observation and treatment. After several episodes of hyperglycemia, the physician orders sliding scale regular insulin administered subcutaneously for the client. How soon after administering the client's dose of regular insulin subcutaneously should the nurse assess for signs of hypoglycemia? 1. 5 Minutes later 2. 30 Minutes later 3. 6 Hours later 4. 10 Hours later

2. 30 Minutes later The onset of action of most rapid-acting insulins (regular insulin in particular) is within 30 to 90 minutes after administration. Hypoglycemia is even more likely to occur when insulin reaches its peak effect. For regular insulin, this peak is approximately 2 to 5 hours later. The duration of regular insulin is approximately 8 hours.

A 23-year-old manifests symptoms of hyperinsulinism. During the nursing history, the client is most likely to describe symptoms that typically occur when? 1. After fasting more than 6 hours 2. About 2 hours after eating a meal 3. Late in the evening, before bedtime 4. Early in the morning, before breakfast

2. About 2 hours after eating a meal Hyperinsulinism , also known as functional hypoglycemia, is caused by an overproduction of insulin, which occurs about 2 hours after eating a meal, especially one containing refined sugar or simple carbohydrates. This results in a marked drop in blood glucose levels.

Thephysician orders a 24-hour urine collection to aid in the diagnosis of Cushing 's syndrome. The nurse is most accurate in telling the client that the urine collection will begin when? 1. With the client's next voiding 2. After the client's next voiding 3. After drinking a pitcher of water 4. With the first voiding in the morning

2. After the client's next voiding To be precise, a 24-hour urine collection begins after a client empties the bladder and ends with a final voiding at the same time the following day.

A nurse participates in a community-wide screening to identify adults who may have undiagnosed diabetes mellitus. If the screening includes a measurement of postprandial blood glucose, the nurse is correct in explaining that blood will be drawn at which time? 1. Approximately 2 hours before breakfast 2. Approximately 2 hours after a meal 3. Approximately 2 hours before bedtime 4. Approximately 2 hours after fasting

2. Approximately 2 hours after a meal The term postprandial means after eating a meal. The meal acts as a glucose challenge. The blood glucose level normally increases in response to the intake of carbohydrates . Two hours later, the blood glucose level of nondiabetic patients should return to normal. If the blood glucose level remains elevated 2 hours after eating, it suggests a metabolic disorder such as diabetes mellitus.

Which intervention is most appropriate to add to the client's care plan when monitoring for incisional bleeding after a subtotal thyroidectomy? 1. Observing for signs of hypovolemic shock 2. Assess for dampness at the back of the client's neck. 3. Remove the dressing to directly inspect the wound. 4. Weigh all gauze dressings before and after changing.

2. Assess for dampness at the back of the client's neck. Gravity causes the blood to pool in the back of the neck. This interferes with visual inspection of the neck dressing. Gently placing a gloved hand behind the client's neck and checking for dampness allows the nurse to determine if blood or drainage is oozing from the incisional wound. The pillow, bed linen, and dressing should also be inspected for fresh drainage each time the client is turned. Observing for hypovolemic shock is necessary, however, the nurse should be monitoring for blood loss long before hypovolemia becomes an issue. Initially, the physician removes the postoperative dressing to inspect the wound. Weighing the dressing is unnecessary because the physician asks for the number, not the weight, of soiled dressings.

The client's care plan indicates that the nurse should assist the client in selecting foods that are good sources of sodium as part of the treatment for Addison's disease. If the following foods are available, which one should the nurse recommend? 1. Graham crackers 2. Cheddar cheese 3. Raw carrots 4. Canned fruit

2. Cheddar cheese A client with Addison's disease has low sodium levels; therefore, replacing dietary sodium is important. Mille products, such as cheese, and other sources of animal protein are high in natural sodium content. Although baked goods also contain hidden sodium, two graham crackers have half the amount of sodium as 1 oz of cheddar cheese. Fruits and vegetables are considered low in sodium when compared with other food sources.

Diagnostic tests confirm that the client's adrenal glands are producing excessive amounts of adrenocortical hormones. When the nurse explains the disorder to the client's spouse, it is accurate to stress that the client is also likely to experience which effect? 1. Anxiety and occasional panic attacks 2. Depression and suicidal tendencies 3. Impulsiveness and poor self-control 4. Forgetfulness and memory changes

2. Depression and suicidal tendencies Depression is common among clients with Cushing' s syndrome because of the severity of physical changes or excess cortisol from increased adrenal glucocorticoid production; this places clients at increased risk for suicide. The other emotional symptoms are not necessarily associated with Cushing's syndrome, although they may occur randomly in some clients for other psychophysiologic reasons.

The nurse is assessing a client who is experiencing signs and symptoms related to a diagnosis of acromegaly. During the physical assessment of this client, which finding is the nurse most likely to observe? 1. Shortened height 2. Enlarged hands 3. Gonadal atrophy 4. Loss of teeth

2. Enlarged hands Acromegaly results from an overproduction of growth hormone. Growth hormone is secreted by the pituitary gland and if oversecreted, as in the case of a pituitary tumor, and left unchecked, it can lead to organ enlargement, increased blood glucose levels, hyperlipidernia, and lengthening and widening of the bones. When the disorder occurs in adulthood, the bones of the hands, jaw, feet, and forehead enlarge but do not lengthen. Acromegaly that develops at or before puberty generally results in gigantism. Undersecretion of growth hormone results in shortened height and dwarfism. Males with acromegaly are likely to experience impotence, but their testes are not unusually small. Although the disorder may cause wide gaps between the teeth due to jaw changes, acromegaly is not known to cause tooth loss.

During the mid-morning after receiving insulin, the client reports feeling weak, shaky, and dizzy. The nurse asks the patient care technician to get a capillary blood glucose measurement with a glucometer. The nursing assistant reports to the nurse that the client's blood glucose reading is 58 mg/dL. What is the most appropriate nursing action at this time? 1. Administer the next scheduled dose of insulin. 2. Give the client sweetened fruit juice. 3. Report the client's symptoms to the physician. 4. Perform a complete head-to-toe assessment.

2. Give the client sweetened fruit juice. A blood glucose reading below 70 mg/dL is a sign of hypoglycemia. Assuming the glucometer reading is accurate and the client is symptomatic, the best action is to implement some means of increasing the client's blood glucose level. This may be done with a variety of substances such as, sweetened fruit juice, honey, hard candy, cake icing, or packets of granulated sugar. Insulin will drop the blood glucose level further; therefore administering additional insulin is inappropriate in this case. A complete head-to-toe assessment may be done, but will prolong treatment. The physician is usually notified, but only after the nurse implements some method to increase the blood glucose level. The physician may prescribe parenterally administered glucose or glucagon if the client is unresponsive.

When the nurse conducts an admission history, which subjective symptom is the client likely to describe? 1. Difficulty urinating 2. Intolerance to cold 3. Profuse perspiration 4. Excessive appetite

2. Intolerance to cold Because of their lowered rate of metabolism, individuals with myxedema do not generate the same amount of energy and body heat as those with a normal metabolism. Consequently, clients typically complain of being excessively cold. The disorder is not associated with difficulty in urination, profuse perspiration, or excessive appetite.

The client has three of thefour lobes of the parathyroid gland surgically removed. After the client returns from surgery and resumes eating, the nurse should encourage the client to eat foods from which food group? 1. Bread and cereals 2. Milk and cheese 3. Meat and seafood 4. Fruit and vegetables

2. Milk and cheese Postoperatively , it is therapeutic to include sources of calcium in the client's diet because the function of the parathyroid gland is suddenly and severely compromised. Foods that are good sources of calcium include milk and cheese. Calcium gluconate may be administered I.V. if the client experiences severe hypocalcemia.

Following head trauma, a client develops signs and symptoms of diabetes insipidus. Which characteristic symptom of the client's disorder would the nurse expect to find during an assessment? 1. Polyphasia 2. Polyuria 3. Glycosuria 4. Hyperglycemia

2. Polyuria Diabetes insipidus is a disorder of the posterior lobe of the pituitary gland that results in excessive urination caused by inadequate amounts of antidiuretic hormone, or vasopressin. It can occur secondary to head trauma, brain tumors, or infections as meningitis. Clients with diabetes insipidus may excrete as much as 20 L/day of very dilute urine; consequently, they need to compensate for fluid loss and may drink up to 20 to 40 L/day, resulting in frequent voiding that poses limits on activity. Weakness, dehydration, and weight loss will result. They also experience polydipsia (intense thirst) not polyphasia (excessive hunger) and hypematremia. Hyponatremia, glycosuria, and hyperglycemia are not characteristic of this disorder.

A client who develops a benign parathyroid tumor manifests signs of hyperparathyroidism. When the nurse reviews the client's history, which assessment finding is closely associated with the client's diagnosis? 1. Nightly leg cramps 2. Recurrent kidney stones 3. Loose bowel movements 4. Difficulty falling asleep

2. Recurrent kidney stones When there is a disorder of the parathyroid gland, calcium and phosphorus levels are usually affected. In clients diagnosed with hyperparathyroidism, a parathyroid tumor usually causes hypercalcemia and a loss of calcium from the bones to the blood. This leads to the formation of kidney stones and other renal complications. Other signs and symptoms include skeletal tenderness, pain when bearing weight, and brittle, fragile bones. Cardiac dysrhythmias are also common. Hypocalcemia or other etiologies cause leg cramps. Constipation, not loose stools, is more common among clients with hyperparathyroidism. Insomnia is not commonly associated with hyperparathyroidism.

Based on the knowledge that clients with Cushing's syndrome heal slowly, which nursing measure is most appropriate during the client's postoperative period? 1. Monitoring infusion of I.V. antibiotics 2. Removing tape toward the incision site 3. Increasing the client's dietary protein intake 4. Covering the wound with gauze

2. Removing tape toward the incision site Because of the client's thin, fragile skin and tendency to heal slowly, it is necessary to pull tape toward the suture line rather than away from it when changing dressings. This will prevent the sutures from separating. Although it is true that protein promotes healing, and that the nurse needs to monitor I.V. antibiotics and cover the client's wound with gauze, these nursing measures are not as critical to the healing process as preserving an intact incisional site.

The nurse teaches the client with newly diagnosed diabetes mellitus about the signs and symptoms of hypoglycemia. Which of the following should the nurse stress in teaching? Select all that apply. 1. Sleepiness 2. Shakiness 3. Thirst 4. Hunger 5. Diaphoresis 6. Confusion

2. Shakiness 4. Hunger 5. Diaphoresis 6. Confusion A client with diabetes must learn to recognize the signs of hypoglycemia. Shakiness and disturbed cognition/confusion-two classic signs-occur when the central nervous system, which relies entirely on glucose for energy, has insufficient glucose circulating in the blood. The body releases epinephrine in response to low blood glucose, causing such symptoms as palpitations and diaphoresis. Hunger, a homeostatic response, promotes the consumption of calories. Signs of hyperglycemia (not hypoglycemia) include thirst and sleepiness.

At the beginning of thyroid replacement therapy following a thyroidectomy, the nurse must monitor the client closely for side effects. Which findings would the nurse expect to assess? Select all that apply. l. Hyperglycemia 2. Tachycardia 3. Insomnia 4. Hirsutism 5. Tremors 6. Hypertension

2. Tachycardia 3. Insomnia 5. Tremors 6. Hypertension Thyroid replacement therapy can increase metabolism, causing symptoms similar to hyperthyroidism. Until the client adjusts to the replacement therapy or the optimum dosage is determined, the client may experience stimulation of the cardiovascular system, which is manifested by tachycardia and hypertension. Metabolic stimulation can also result in insomnia and tremors. Hyperglycemia and hirsutism are side effects of corticosteroid therapy

The nurse cares for an older client who is insulin dependent and lives in a nursing home. 86.When developing the client's care plan, which intervention is most appropriate to add? 1. Encourage the client to use an electric razor. 2. Tell the client to file rather than cut toenails . 3. Make sure that the client receives mouth care twice per day. 4. Advise the client to use deodorant soap when bathing.

2. Tell the client to file rather than cut toenails Clients with diabetes should consult their physician about trimming or cutting the toenails. An abrasive file may be used to keep the nails short, but it is best to refer clients to a podiatrist for nail maintenance or other foot problems. The other hygiene measures are good to implement, but they are not as pertinent to the care of a client with diabetes.

Which sign is most suggestive that a client with type 2 diabetes is developing hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? 1. The client's blood glucose level is 200 mg/dL. 2. The client urinates copious amounts. 3. The client's skin is warm and dry. 4. The client's urine contains acetone.

2. The client urinates copious amounts. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is an acute complication of diabetes characterized by extremely high blood glucose levels-between 600 and 1,000 mg/dL-without signs of ketoacidosis. The severe hyperglycemia causes fluid to shift from the intracellular space to the extracellular space, and copious amounts of urine are excreted. Warm, dry skin from dehydration is a normal finding. Acetone is not present in the urine of clients experiencing HHNS; it is typically found in the urine of those with ketoacidosis.

When the client asks how to store insulin, where does the nurse correctly respond that it may be stored? 1. In the bathroom, close to the shower 2. In the refrigerator 3. At room temperature 4. In a home freezer

3. At room temperature Insulin deteriorates if exposed to excessive heat or light. It is best kept at room temperature or stored in a cool area. Unopened vials may be kept refrigerated. Insulin should never be frozen.

After 3 months, the client returns for afollow-up appointment with the physician to evaluate the progress of self-care. Which information is most important for the nurse to elicit from the client in order to effectively evaluate compliance with the prescribed therapy? 1. The dosage and frequency of insulin administration 2. The client's glucose monitoring records for the past week 3. The client's weight and vital signs before the office interview 4. The symptoms experienced in the past month

2. The client's glucose monitoring records for the past week The most objective evidence for evaluating how well the client is managing therapy is a record of glucose monitoring values. Some glucometers store the data so that results can be retrieved and evaluated. Otherwise, clients are asked to keep a written record of their monitoring results. Identifying the dosage and frequency of insulin administration does not indicate that the client is actually self-administering the insulin. Maintaining or gradually losing weight is good evaluative information, but it is not as specific as glucose monitoring values. Some clients are not as self-aware of symptoms, and some have an exaggerated awareness of their body functions. Therefore, subjective symptoms are not as valuable as hard objective data.

Immediately after surgery, the nurse assesses the client for bleeding . Where is the best location to assess for bleeding? 1. The skull 2. The nose 3. The ear canal 4. The tongue

2. The nose The surgical incision is made through the upper gingival mucosa, along one side of the nasal septum and through the sphenoid sinus. Postoperatively, the nose is packed with gauze. In addition to checking the saturation and appearance of the gauze packing, the nurse inspects the pharynx where blood or cerebrospinal fluid may drain posteriorly. Examining the client's skull, ear canal, or tongue will not help with the assessment.

Which statement is correct concerning the collection of urine for a 24-hour specimen? 1. The volume of each voiding is measured and recorded. 2. The urine is placed in a container of preservative. 3. Each voiding is taken immediately to the laboratory. 4. The client voids directly into the specimen container.

2. The urine is placed in a container of preservative. To avoid chemical changes in the contents of the urine, a 24-hour specimen is deposited in a container with preservative. Generally, the urine is refrigerated or placed on ice during the collection period. The collection• container is usually kept in the client's room or bathroom. It is unnecessary to measure each voided volume; if this is done, it is for reasons other than specimen collection. Clients generally void into a urinal or container suspended in the toilet; the urine is then added to the collection container.

To prepare for potential postoperative complications related to the thyroidectomy, which item is necessary to keep at the client's bedside? 1. Dressing change kit 2. Tracheostomy tray 3. Ampule of epinephrine 4. Mechanical ventilator

2. Tracheostomy tray Airway obstruction is a potential postoperative complication for clients who undergo thyroidectomy. Therefore, a corrunon standard of practice is to keep a tracheostomy tray in the client's room. A mechanical ventilator will probably be unnecessary once airway patency is reestablished. A dressing change kit can be easily obtained; it is not an emergency item. Epinephrine may be necessary if the client develops a life-threatening cardiac arrhythmia, but this drug is usually stocked in emergency crash carts.

After being is discharged from the hospital, the physician wants the client to continue to self-monitor the response to the dietary diet and medication management. Which monitoring approach is best for the nurse to recommend? 1. Testing the urine with a chemical reagent strip 2. Using a glucometer to check capillary blood glucose levels 3. Having laboratory personnel draw venous blood samples 4. Arranging for testing by a home health agency nurse

2. Using a glucometer to check capillary blood glucose levels Urine testing using reagent tablets or strips is the most economical of diabetic monitoring techniques and measures the amount of spilled glucose into the urine, but a home glucometer is more accurate and preferred for diabetic clients. Self-monitoring with a glucometer is costly but less expensive than the added charges for the services of laboratory personnel or a home health nurse.

The nursing care plan indicates that the client must be weighed each day. When directing the nursing assistant to weigh the client, which instruction is most important for obtaining accurate data? 1. Have the client stand on a bedside scale. 2. Weigh the client at the same time each day. 3. Ask that slippers be removed when being weighed. 4. Ask about the client's predisease weight.

2. Weigh the client at the same time each day. For the sake of comparison, clients are weighed at the same time each day, on the same scale, and wearing similar clothing each time. Nothing in the situation indicates whether a standing scale was used or whether the client wore .Slippers during previous weight assessments. The client's predisease weight has no bearing on the current condition except as a point of reference.

How does the nurse expect the urine that is collected for a routine urinalysis to appear? 1. Tea colored 2. Pale yellow 3. Colorless 4. Light pink

3. Colorless The urine of someone with diabetes insipidus is so dilute that it appears colorless. The specific gravity may be 1.002 or less. The specific gravity measures the concentration of the urine and normal values of the urine are between 1.010 and 1.025. Dark tea or cola-colored urine is commonly associated with glomerulonephritis (a renal disorder), not diabetes insipidus (an endocrine disorder). Normal urine appears pale yellow. Light pink urine indicates hematuria (blood in the urine), which can result from irritation, infection, or renal disorders.

Which statement indicates that a client with an elevated 2-hour postprandial blood glucose level understands the significance of the screening test? 1. "I need to eat less frequently ." 2. "I need to stop eating candy." 3. "I need to consult my physician." 4. "I need to begin taking insulin."

3. "I need to consult my physician." Positive screening test results are an indication that the client requires further evaluation by a physician. Because several factors and disease pathologies can cause hyperglycemia, it is always best to refer hyperglycemic individuals to a physician . Comments about taking insulin or avoiding candy should alert the nurse that the client requires further education about the condition

The client with myxedema is treated with levothyroxine (Synthroid), one tablet P.O. every day. Which statement provides the best evidence that the client understands the prescribed drug therapy? 1. "I must take this drug after meals." 2. "I should avoid driving when sleepy." 3. "I'll need to take this drug for the rest of my life." 4. "I can skip a dose if I'm nauseated."

3. "I'll need to take this drug for the rest of my life." Thyroid replacement therapy is maintained during the course of a client's lifetime. A low dose is given initially, then increased or decreased on the basis of the drug levels in the blood. Dosage adjustments are also made periodically during a client's lifetime based on the client's liver and kidney function, other medications that . the client may be taking, and the client's clinical presentation of signs and symptoms. The physician prescribed the drug to be taken once per day, not after each meal. Levothyroxine (Synthroid) is more likely to cause insomnia than fatigue or sleepiness. The client should consult a physician before omitting or discontinuing the drug, regardless of the reason.

A 35-year-old seeks medical attention to determine the reason menstruation has ceased. The physician orders a radioactive iodine uptake test. After the test, the nurse provides the client with instructions. Which statement of the nurse is most accurate? 1. "You must remain isolated until the radiation level decreases sufficiently ." 2. "You'r free to go without further precautionary instructions." 3. "You must follow special precautions for a short period of time." 4. "You'll be given an antidote for reducing the radioactivity level."

3. "You must follow special precautions for a short period of time." A radioactive iodine uptake test is used in diagnostic scans and destroys thyroid tissue in disorders involving hyperthyroidism and thyroid malignancies. The amount of radiation used in a radioactive iodine uptake test is minute, but special precautions (such as flushing the toilet twice after use, rinsing the bathroom sink and tub, and using separate bath linens) are generally suggested. These precautions are only needed for a few days. Although there is no antidote for radioactive iodine, there is no justification for isolating the client ecause of the minute exposure.

Using the Dietary Exchange Plan for a client who has diabetes and is on a 1,500-calorie diet, which item is appropriate for the client to have in the mid-afternoon? 1. An 8-oz carton of milk 2. Two graham crackers 3. A medium apple 4. A 2-oz slice of turkey

3. A medium apple is the most appropriate choice for this client. The 1,500-calorie Dietary Exchange Plan indicates that a client can have one fruit exchange as a mid-afternoon snack

To reduce or eliminate the symptoms that a client with functional hypoglycemia experiences, it is best for the nurse to recommend eating five or six small meals containing which nutrient? 1. Simple sugars 2. Complete proteins 3. Complex carbohydrates 4. Unsaturated fats

3. Complex carbohydrates To maintain stable blood glucose levels, it is best for clients with functional hypoglycemia to consume small, frequent meals that contain high-fiber complex carbohydrates. Some examples include fruits, vegetables, legumes, and whole grains. Simple sugars, such as glucose, fructose, and galactose, tend to stimulate the release of insulin and lower the blood glucose level drastically . Complete proteins and unsaturated fats in moderate amounts are components of a healthy diet, but they are not as therapeutic for stabilizing the blood glucose.

After diagnostic testing, a client with Graves' disease is informed that it is necessary to undergo a subtotal thyroidectomy. The physician prescribes potassium iodide (Lugol's solution) 4 gtts P.O. to be taken for 10 days before the scheduled surgery. When instructing the client on how to self-administer potassium iodide (Lugol' s solution), which nurse's direction is most appropriate? 1. Swallow the drug quickly. 2. Take the drug before meals. 3. Dilute the drug in fruit juice. 4. Chill the drug before taking it.

3. Dilute the drug in fruit juice. Potassium iodide (Lugol's solution) is given in conjunction with an antithyroid drug such as propylthiouracil (Propyl-Thyracil) to curb thyroid activity before surgery and to decrease postoperative complications. Potassium iodide (Lugol's solution) has a bitter, metallic taste and can cause burning mouth and sore teeth and gums. Diluting the strong Lugol's iodine solution in fruit juice or water tends to disguise its unpleasant taste. Although swallowing the drug quickly may ensure that all of the drug is taken, this is not the best advice. There is no real reason to recommend chilling the drug or taking it before meals.

During the doctor's visit, the client reports researching the use of insulin pumps on the Internet and wants to know the possibility of being a candidate. After evaluating the client and discussing the client' s request, the physician asks the nurse to provide instructions about management of the client' s diabetes using a continuous insulin infusion pump. The nurse teaches the client how the infusion pump operates and correctly points out that the infusion is typically administered in which location? 1. In a vein within the non-dominant hand 2. In the muscular tissue of the thigh 3. In the subcutaneous tissue of the abdomen below the belt line 4. In an implanted l.V. catheter threaded into the neck

3. In the subcutaneous tissue of the abdomen below the belt line Continuous insulin infusions are administered by the subcutaneous route, usually in abdominal tissue. However, any of the subcutaneous sites (such as the buttocks, thighs, arms, and sections of the back) may be used. An insulin infusion pump delivers regular insulin at a carefully regulated rate. Insulin is absorbed too quickly when instilled I.V.

The client asks the nurse to explain the purpose of the preoperative drug therapy. Which response by the nurse about potassium iodide (Lugol's solution) is correct? 1. It firms the gland so it is easily removed. 2. It decreases the postoperative recovery time. 3. It decreases the risk of postoperative bleeding. 4. It eliminates the need for hormone replacement.

3. It decreases the risk of postoperative bleeding. Clients commonly receive antithyroid drugs several weeks before surgery to prevent excessive release of thyroid hormones during and after surgery. Preoperative therapy with antithyroid drugs reduces the potential for postoperative bleeding and the development of a thyroid crisis, or storm. Although the treatment reduces the size of the gland, this is not the underlying reason for the drug therapy. The postoperative recovery period is shortened if complications are prevented, but reducing the potential for bleeding is a more accurate answer. Thyroid replacement therapy may still be required after a subtotal thyroidectomy despite preoperative antithyroid drug therapy.

The nurse knows the diabetic client understands that "free" foods from the exchange list if the client indicates which beverage should be excluded from a meal plan? 1. Iced tea 2. Flavored water 3. Light beer 4. Club soda

3. Light beer "Lite" or "light" is a food-labeling term that means the product contains one-third fewer calories than a similar unaltered item. Thus, light beer contains calories or grams of nutrients that must be calculated in the diabetic client's diet and exchange list. The remainder of the selections are considered "free" and do not contain calories. They therefore do not need to be incorporated into the client's exchange list.

The newly diagnosed client with type 2 diabetes mellitus is referred to the diabetic clinic for teaching. When the client asks the nurse why regular exercise is recommended for diabetic clients, the best answer is that exercise tends to facilitate which positive outcome? 1. Controlled weight gain 2. Decreased appetite 3. Reduced blood glucose level 4. Improved circulation to the feet

3. Reduced blood glucose level Exercise has many beneficial effects, such as controlling weight, reducing appetite, improving circulation, and lowering heart rate, regardless of a person' s health status. For a client with diabetes, however, one of the primary benefits is a reduced blood glucose level. If the blood glucose level decreases with exercise, drug treatment with oral hypoglycemic agents or insulin may be delayed, reduced, or eliminated

After surgery, the client is returned to the nursing unit in stable condition. In which position should the client be maintained following the subtotal thyroidectomy? 1. Supine 2. Sims' 3. Semi-Fowler's 4. Recumbent

3. Semi-Fowler's A subtotal thyroidectomy is the partial removal of the thyroid as treatment for an area that is overproducing thyroid hormones. Semi-Fowler's position, with the head elevated 30 to 45 degrees, is best for reducing postoperative incisional edema and facilitating ventilation. None of the other identified positions is therapeutic for accomplishing this goal.

Emergency medical personnel bring a client who is lethargic and confused to the emergency department. A tentative diagnosis of type I diabetes mellitus and diabetic ketoacidosis (DKA) is made. Which assessment findings would the nurse expect to document if the client has DKA? Select all that apply. 1. The client is hypertensive and tachycardic. 2. The client is dyspneic and hypotensive. 3. The client breathes noisily and smells of acetone. 4. The client stares blankly and smells of alcohol. 5. The client has warm, flushed skin and has vomited. 6. The client complains of abdominal pain and is thirsty.

3. The client breathes noisily and smells of acetone. 5. The client has warm, flushed skin and has vomited. 6. The client complains of abdominal pain and is thirsty. An acetone (sometimes described as sweet or fruity) breath odor, weakness, thirst, anorexia, vomiting, drowsiness, abdominal pain, rapid and weak pulse, hypotension, flushed skin, and Kussmaul's (rapid, deep, and noisy) respirations are manifested by persons with diabetic ketoacidosis (DKA). In severe cases, the client may be comatose or semi-comatose

The client with type 1 diabetes must learn to combine two insulins - regular and intermediate-acting and self-administer the injection before being discharged . Which action best indicates that the client needs more practice in combining two insulins in one syringe? 1. The client rolls the vial of intermediate-acting insulin to mix it with its additive. 2. The client instills air into both the fast-acting and intermediate-acting insulin vials. 3. The client instills the intermediate-acting insulin into the vial of rapid-acting insulin. 4. The client inverts each vial prior to withdrawing the specified amount of insulin.

3. The client instills the intermediate-acting insulin into the vial of rapid-acting insulin. The client needs to take care to avoid mixing the intermediate-acting insulin, which contains an additive, with the additive-free insulin. The additive-free insulin is always withdrawn first. The actions described in the other options are safe and appropriate for mixing two different types of insulins.

The nurse implements a diabetes teaching plan in anticipation of the client's discharge. Which statement indicates that the client has misunderstood the nurse's teaching? 1. "I may need more insulin during times of stress." 2. "I may need more food when exercising strenuously." 3. "My insulin needs may change as I get older." 4. "My dependence on insulin may stop eventually."

4. "My dependence on insulin may stop eventually." Insulin-dependent clients are likely to remain so for the rest of their lives. Therefore, further instruction is needed if the client believes that it may eventually be unnecessary to take the medication. Even some clients with type 2 diabetes eventually become insulin dependent. The client is correct in understanding that insulin needs increase during times of stress, such as infections and emotional crises. Although exercise is beneficial, clients may need additional calories to prevent symptoms of hypoglycemia.

A glucose tolerance test is ordered to determine if the client has functional hypoglycemia. Which instruction by the nurse concerning the test procedure is most accurate? 1. "You need to eat a large meal just before the test." 2. "Bring a voided urie specimen to the laboratory ." 3. "You can drink coffee or tea in the morning before the test." 4. "You will be given a sweetened drink before the test."

4. "You will be given a sweetened drink before the test." A container of 75 to 100 g of glucose is consumed orally or administered I.V. before the glucose tolerance test begins. Otherwise, the client fasts before and during the test and only water is allowed before the test. Urine specimens are collected before the glucose is administered and when subsequent blood samples are taken. The client is instructed to consume an adequate diet containing carbohydrates for at least 3 days before the diagnostic test, then fast for 12 hours before the test.

The nurse instructs the client taking glyburide (DiaBeta) to avoid which food because of the risk of a food-drug interaction? 1. Chocolate 2. Peanuts 3. Strawberries 4. Alcohol

4. Alcohol Clients who take glyburide (DiaBeta) and consume alcohol may have a disulfiram-like reaction. Disulfiram (Antabuse), a drug commonly given to treat alcoholism, interacts with alcohol to produce flushing, throbbing head pain, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitations, tachycardia, hypotension, syncope, blurred vision, and confusion. The remaining choices are not known to cause food-drug interactions.

The nurse plans to monitor the client's response to insulin therapy closely with an electronic glucometer and instructs the emergency department technician to take periodic finger stick blood glucose measurements. Which techniques are correct when using an electronic glucometer to monitor the client's blood glucose level? Select all that apply. 1. Clean the client's finger with povidone-iodine (Betadine). 2. Take a set of vital signs before the test. 3. Pierce the central pad of the client's finger. 4. Apply a large drop of blood to a test strip or area. 5. Don gloves before sticking the client's finger. 6. Perform a quality control before the test.

4. Apply a large drop of blood to a test strip or area. 5. Don gloves before sticking the client's finger. 6. Perform a quality control before the test. Prior to the test, it is important that a quality control check be done on the machine to ensure an accurate reading, especially when a client has diabetic ketoacidosis (DKA). It is also mandatory that the technician don gloves when coming in contact with blood. It is best to let the blood flow passively by gravity onto the test strip or reflecting area of the electronic glucometer. Usually one large drop is sufficient to obtain an accurate reading. The skin is usually cleaned with soap and water, not Betadine. Piercing the central pad of a finger is avoided; the margin around the digit produces less pain. Vital signs may be taken at the same time in an attempt to coordinate care and save time, but it is necessary for this test.

Which assessment technique is most appropriate when checking for laryngeal nerve damage in a client who has had a thyroidectomy? 1. Turning the client's head from side to side 2. Observing the client swallowing 3. Looking for tracheal deviation 4. Asking the client to say "Ah"

4. Asking the client to say "Ah" Although hoarseness may be temporary after a subtotal thyroidectomy, laryngeal nerve damage is manifested by persistent voice changes or the inability to make vocal sounds. None of the other techniques is appropriate for assessing laryngeal nerve function.

The physician prescribes propylthiouracil (Propyl-Thyracil) to treat the client's condition. Before administering this medication, what is essential for the nurse to ask the client? 1. Does the client have trouble swallowing 2. Does the client prefer a liquid form 3. Does the client have digestive disorders 4. Could the client possibly be pregnant

4. Could the client possibly be pregnant Propylthiouracil (Propyl-Thyracil) is used in the medical treatment of hyperthyroidism and is given to block thyroid hormones preoperatively or for clients who are not candidates for surgery. It inhibits the manufacture of thyroid hormones but does not affect the hormones already circulating in the blood or those stored in the gland itself. Propylthiouracil (Propyl-Thyracil) can cause cretinism (hypothyroidism) in a developing fetus. Therefore, asking about the client's pregnancy status is essential. Although the client may have trouble swallowing and the drug may cause gastrointestinal side effects, ensuring the safety of the client and a fetus is the nurse's priority. Propylthiouracil (Propyl-Thyracil) is not available in a liquid form, but the client may be instructed to crush the tablet and mix it with food.

Which laboratory test result is most important for the nurse to monitor to determine how effectively the client's diabetes is being managed? 1. Fasting blood glucose 2. Blood chemistry profile 3. Complete blood count 4. Glycosylated (A1c) hemoglobin

4. Glycosylated (A1c) hemoglobin A glycosylated (A1c) hemoglobin test reveals the effectiveness of diabetic therapy for the preceding 8 to 12 weeks. A fasting blood glucose provides information on the blood glucose status for the immediate period of time. Blood chemistry includes a blood glucose measurement as well as several other diagnostic test results. A complete blood count indicates the status of the client's hematopoietic functions.

After the screening test, one client was referred to a physician for additional follow-up. Further diagnostic tests confirm that the client has type 2 diabetes mellitus. When given the news that the client has diabetes, the client denies the diagnosis and becomes angry, stating there has been a mistake in the tests. Which nursing action is most appropriate at this time? 1. Emphasizing the importance of treatment 2. Reassuring the client that the disease is easily managed 3. Explaining that many people live with diabetes 4. Listening as the client expresses current feelings

4. Listening as the client expresses current feelings The client needs time to accept the diagnosis, demonstrate anger, and to talk about fears and concerns. Listening is the most therapeutic intervention at this point. Stressing the importance of treatment is likely to increase the client's fears. The client with type 2 diabetes may be required to take oral hypoglycemics but telling the client that the disease is easily managed is false reassurance. Telling the client that others manage their diabetes ignores the fact that this disorder is unique to the client newly diagnosed with diabetes.

The nurse discusses the long-term effects of diabetes mellitus with the client and realizes that the client needs further teaching when incorrectly stating that which complication could develop as a result of the illness? 1. Blindness 2. Stroke 3. Renal failure 4. Liver failure

4. Liver failure Clients with diabetes are prone to many systemic vascular and neurologic complications . These include a higher incidence of premature cataract formation, retinal hemorrhage and blindness, stroke, myocardial infarction, renal failure, peripheral neurovascular disease and amputations, and sexual dysfunction. Liver disease is atypical among clients with diabetes mellitus.

The nurse documents that the client has recurrent episodes of hypoglycemia. If a regular diet is ordered, which between-meal snack should the nurse offer to help regulate the client's blood glucose level? 1. Lemonade and peanuts 2. Cola and potato chips 3. Coffee and a muffin 4. Milk and crackers

4. Milk and crackers Clients with Addison's disease are prone to developing low blood glucose levels (hypoglycemia). Snacks such as milk and crackers contain complex carbohydrates that take longer to metabolize than simple sugars. Therefore, they are more likely to help maintain a stable blood glucose level. To reduce episodes of hypoglycemia, it is appropriate to schedule at least six small meals per day or between-meal snacks. Although the other choices contain some complex carbohydrates, they also contain sources of quickly metabolized sugars.

During change of shifts, a nurse discovers that a hospitalized client with diabetes received two doses of insulin. After notifying the physician, which nursing action is most appropriate? 1. Completing an incident report 2. Calling the intensive care unit (ICU) 3. Performing frequent neurologic checks 4. Monitoring the client's blood glucose level

4. Monitoring the client's blood glucose level Insulin lowers blood glucose levels. Because the client received two doses of insulin, he is at risk for developing hypoglycemia. Therefore, the nurse should monitor the client's blood glucose level frequently. In addition, if the client is conscious, the nurse may offer orange juice with added sugar, grape juice, a carbonated beverage, milk, candy, glucose tablets or gel. If the client is unconscious, the nurse should prepare to start an I.V. dextrose infusion. Because a medication error was made, an incident report must be completed; however, this should not take priority over the client's well-being. Calling intensive care unit (ICU) is unnecessary unless the client's glucose level drops dangerously low and treatment is ineffective. Performing neurologic checks and taking vital signs are prudent measures, but they are not as important as frequent blood glucose monitoring in this situation.

The nursing assistant assigned to this client asks why the care plan indicates that the client is at risk for falls and injury. Which is the best explanation by the nurse concerning an effect of hypoparathyroidism? 1. The inability to maintain balance 2. The risk of developing seizures 3. Fainting when changing positions 4. Pathologic bone fractures

4. Pathologic bone fractures Loss of calcium from the bones weakens the skeletal system, which potentiates the risk of pathologic fractures. Impaired equilibrium, seizures, and syncope are not common among clients with hyperparathyroidism.

Which signs and symptoms are most appropriate for the nurse to investigate when screening adults who have come to have their blood glucose tested? 1. Diarrhea, anorexia, and weight gain 2. Constipation, weight loss, and thirst 3. Polycholia , polyemia, and polyplegia 4. Polyuria, polydipsia, and polyphagia

4. Polyuria, polydipsia, and polyphagia Polyuria (excessive secretion and voiding of urine), polydipsia (excessive thirst), and polyphagia (increased appetite) are the classic signs and symptoms of diabetes mellitus. Polycholia (increased secretion of bile), polyernia (increased amount of circulating blood), polyplegia (paralysis of several muscles), diarrhea, constipation, and anorexia are not considered signs and symptoms of this endocrine disorder. Weight gain or loss is seen in some people with diabetes.

When the client practices self-administration of the insulin, which action is correct? 1. Piercing the skin at a 30-degree angle 2. Using a syringe calibrated in minims 3. Using a 29 gauge needle on the syringe 4. Rotating abdominal sites of each injection

4. Rotating abdominal sites of each injection To prevent lipodystrophy and lipoatrophy and promote appropriate absorption of insulin, it is correct to rotate insulin injection sites. Insulin is prepared in an insulin syringe calibrated in units. The needle length is 1/2" to S/8". Insulin is injected at a 45 - or 90 - degree angle, depending on the client's size.

The client is treated with intranasal lypressin (Diapid), 2 sprays q.i.d. and as needed. The nurse observes the client self-administering the medication. Which action indicates that the client is using the medication correctly? I. The client shakes the medication vigorously 2. The client's head is tilted to the side. 3. The client inverts the drug container. 4. The client inhales with each spray.

4. The client inhales with each spray. Lypressin (Diapid) is a synthetic hormone preparation of vasopressin and is prescribed because of its antidiurectic effects. It promotes reabsorption of water by acting on collecting ducts in kidney, thereby decreasing urine excretion. The client's head should be maintained in an upright position when administering lypressin (Diapid) because the tip of the container is inserted upright into a nostril. The client then inhales while compressing the container and releasing the spray. Vigorous shaking does not improve the medication's effectiveness and, therefore, is unnecessary.

Eventually, the client undergoes a bilateral adrenalectomy to correct Cushing's syndrome. Which documentation finding provides the best indication that the client has successfully avoided an adrenal (Addisonian) crisis following surgery? 1. Urine output is approximately 2,000 mL/day. 2. The client's pedal edema has lessened. 3. Capillary blood glucose level is within normal limits. 4. Vital signs are within preoperative ranges.

4. Vital signs are within preoperative ranges. Extreme hypotension, fever, vomiting, diarrhea, abdominal pain, profound weakness, headache, and restlessness are all signs of Addisonian crisis, which occurs from a sudden drop in adrenocortical hormones. Therefore, the client's ability to maintain vital signs within preoperative ranges is the best indication that Addisonian crisis has been avoided. An adequate urine output, normal blood glucose level, and lessening of the pedal edema are all positive outcomes, but they are not the best evidence that Addisonian crisis has been prevented.

The physician orders a low-sodium diet to help treat the client's Cushing's syndrome. Which action by the nurse provides the best data for monitoring the client's therapeutic response to sodium restriction? 1. Monitoring sodium intake 2. Measuring pedal edema 3. Assessing skin turgor 4. Weighing the client

4. Weighing the client A sodium-restricted diet is prescribed to reduce the potential for excess fluid volume and increased serum sodium levels. One of the best ways to monitor the effects of sodium restriction is by weighing the client daily. The client's skin turgor and pedal edema are unlikely to change as much as her weight from one day to the next. Monitoring the amount of sodium that the client consumes from the dietary tray is appropriate to document, but it does not provide as objective an assessment as the daily weight.

Based on the client' s clinical presentation, a diagnosis of thyroid crisis is made. Which nursing interventions are most appropriate at this time? Select all that apply. l. Take the client's vital signs at least every hour 2. Assess Trousseau's sign every shift 3. Limit client's activity 4. Administer antipyretics per order 5. Encourage a diet high in iodized salt 6. Make sure IV calcium gluconate is available

l. Take the client's vital signs at least every hour 3. Limit client's activity 4. Administer antipyretics per order Thyroid crisis is a life-threatening situation and is triggered by manipulation during surgical removal of the thyroid gland, stress, infection, diabetic ketoacidosis, or physical examination of the thyroid gland. The nurse should monitor the client's vital signs at least hourly paying close attention to the client' s temperature (which is elevated), and heart rate and rhythm. Tachycardia and cardiac dysrhythmias are common manifestations of this condition. Because of the increased metabolism, the heart has to work harder and unless managed, could result in cardiac arrest. Therefore, limiting the client's activities decreases the workload on the heart and decreases the need for oxygen. Antipyretics decrease the client's temperature, so this is an important nursing activity . Performing the Trousseau's sign is related to tetany related to hypocalcernia. Making sure IV calcium gluconate is available is related to treatment of hypocalcemia not thyroid crisis. Encouraging a diet high in iodized salt is the treatment for goiter.