PrepU endocrine
A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching? Select all that apply. -Use scissors to trim toenails. -Wear cotton socks. -Apply foot powder after bathing. -Go barefoot only when you know your home environment. -See a podiatrist regularly to have your feet checked. -Wear loose-fitting shoes.
-Wear cotton socks. -Apply foot powder after bathing. -See a podiatrist regularly to have your feet checked.
A 34-year-old female is diagnosed with hypothyroidism. What information should the nurse obtain from conducting a focused assessment? Select all that apply. -rapid pulse -decreased energy and fatigue -weight gain of 10 lb (4.5 kg) -fine, thin hair with hair loss -constipation -menorrhagia
-decreased energy and fatigue -weight gain of 10 lb (4.5 kg) -constipation -menorrhagia Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone. Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse hair, constipation, and menorrhagia are common signs and symptoms of hypothyroidism.
The nurse is caring for a client with diabetes insipidus. Which laboratory findings are indicative of this disorder? Select all that apply. -elevated serum creatinine -decreased serum sodium -elevated serum hematocrit -decreased blood urea nitrogen (BUN) -decreased serum creatinine
-elevated serum creatinine -elevated serum hematocrit A client with diabetes insipidus is likely to present with clinical manifestations and laboratory values associated with dehydration. These clients are likely to have elevated serum creatinine and hematocrit levels. These clients are more likely to present with an elevated serum sodium. These clients are also more likely to present with increased BUN and an elevated serum creatinine.
A client diagnosed with hypothyroidism (myxedema) is receiving levothyroxine. Which assessment findings would require a nursing intervention? Select all that apply. -dysuria -mild chest pain -dysrhythmias -heart rate of 132 beats/min -adventitious breath sounds
-mild chest pain -dysrhythmias -heart rate of 132 beats/min Levothyroxine (thyroid hormone replacement medication) increases cardiac demand, which can cause increased heart rate, palpitations, and chest pain. These clients are at risk for a myocardial infarction. Adventitious breath sounds are abnormal, extra sounds, but are not related to receiving levothyroxine. Dysuria means painful urination and is not a side effect of levothyroxine.
The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply. -serum sodium level -hemoglobin and hematocrit -serum potassium level -blood glucose level -white blood cell count -creatinine clearance total
-serum sodium level -serum potassium level -blood glucose level -white blood cell count Cushing's disease results in an excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. Electrolyte disturbance is common for the nurse to report. Sodium retention is typically accompanied by potassium depletion. Clients exhibit frequent hyperglycemia. The white blood cell count is commonly elevated because of an increased number of neutrophils. There is no impact of the hemoglobin or hematocrit or kidney function.
A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment being received for SIADH is effective? Select all that apply. decrease in body weight rise in blood pressure and drop in heart rate absence of wheezing increase in urine output decrease in urine osmolarity
decrease in body weight increase in urine output decrease in urine osmolarity SIADH is an abnormality involving an excessive release of ADH. The predominant feature is water retention with oliguria, edema, and weight gain. Successful treatment would result in a reduction in weight, increased urine output, and a decrease in urine osmolarity (concentration). Wheezes are not typically associated with SIADH. The client's blood pressure would remain the same or decrease after treatment.
A nurse is performing a skin assessment on a client with type 2 diabetes. Which client statements would the nurse assess in detail for client skin changes? Select all that apply. "I have noticed more moles on my legs in the last few years." "Over the last few months, I have noticed tingling and numbness in my feet." "I have no trouble controlling body odor with just soap and water." "I stepped on a stone the other day and didn't feel a thing, but my foot was bleeding." "I get itching in my ears when I eat strawberries."
"Over the last few months, I have noticed tingling and numbness in my feet." "I stepped on a stone the other day and didn't feel a thing, but my foot was bleeding." There is a concern with diabetic clients that they will develop peripheral neuropathy. If this occurs, the client would have numbness or tingling and a change in ability to feel touch. The client may have skin disorders related to allergies, or have birthmarks or moles, but these do not relate to skin breakdown. The client with trouble with body odor would need to have this assessed, but it doesn't relate to risk for skin breakdown.
A homeless client is brought to the emergency department by the police after being found unconscious on the street. Following examination and evaluation of laboratory test results, a diagnosis of diabetic ketoacidosis is confirmed. Which information is most crucial to document on the client's medical record? Select all that apply. - size of pupils and reaction of pupils to light - response to verbal and painful stimuli -skin condition and presence of any rashes, lesions, or ulcers -blood pressure -length of time the client has had diabetes -hourly urine output
-size of pupils and reaction of pupils to light - response to verbal and painful stimuli -skin condition and presence of any rashes, lesions, or ulcers -blood pressure -length of time the client has had diabetes -hourly urine output Diabetic ketoacidosis is a potentially life-threatening problem. The state of unconsciousness requires very astute monitoring of the neurologic condition. Frequent assessments of neurologic status (including the client's ability to respond to stimuli), blood pressure, and urinary output need to be documented. Assessment of skin condition for the presence of lesions, bruises, ulcers, or bumps is documented to assess for possible injuries, such as falls associated with head injury or internal injuries. Although it would be helpful to know how long the client has had diabetes, this information is not essential to document.
A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. ECG changes tachycardia low body temperature nervousness bradycardia dry mouth
ECG changes low body temperature bradycardia In hypothyroidism, the body is in a hypometabolic state. Therefore, ECG changes with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.
During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which action should the nurse take? Administer I.V. glucagon bolus as needed. Administer a saline bolus as needed.
Administer a saline bolus as needed. The rapid, deep (Kussmaul) respirations are compensatory and indicate metabolic acidosis. There is an immediate need for correction of the acidosis with a saline bolus to prevent hypovolemia. This will be followed by assessment of glucose level and insulin administration to allow the glucose to reenter the cells. Oxygen therapy is not indicated because there is no indication that the increased respiratory rate is related to hypoxemia. Administration of glucagon will further increase the blood sugar levels.
The nurse finds a client in a long term care facility, after the evening meal, to be unresponsive with cold, clammy skin to touch. A finger stick blood glucose level reveals 21 mg/dL. What are the nurse's immediate priority actions? Select all that apply. Encourage the client to drink orange juice. Alert the family to the change in condition after the client is stable. Identify if the client has clear breath sounds. Notify the healthcare provider of hypoglycemic event. Administer as needed glucagon 1 mg intramuscularly now.
Notify the healthcare provider of hypoglycemic event. Administer as needed glucagon 1 mg intramuscularly now. The nurse will need to notify the healthcare provider of the hypoglycemia. The nurse will also need to treat the hypoglycemia with glucagon 1mg IM now. The client is unresponsive and will not be able to drink orange juice. Breath sounds are not a priority during hypoglycemia. The family will be notified of change of condition when the client is stable, but this is not the priority action.
A client with type 2 insulin-requiring diabetes has the flu with nausea, body aches, and lack of appetite. The client's blood sugar is 180 mg/dL (10 mmol/L). The vital signs are temperature 101ºF (38.3ºC), pulse 88 bmp, and respirations 20 breaths/min. What should the nurse instruct the client to do? Select all that apply. Stop taking insulin. Check blood sugar every 4 hours. Drink 240 mL fluids every hour. Check urine for ketones. Take two 325 mg aspirin.
Check blood sugar every 4 hours. Drink 240 mL fluids every hour. The nurse should instruct the client with insulin-requiring diabetes who has the flu to check the blood sugar every 4 hours. The client should try to drink 240 mL of fluid every hour. If the blood sugar levels become low, the client should drink liquids with sugar in them. The client should continue to take insulin. It is not necessary to check for ketones until the blood glucose level is above 240 mg/dL. The nurse cannot prescribe aspirin for this client. If the symptoms of the flu continue, the nurse should instruct the client to contact the health care provider.
A client visiting the clinic is scheduled for an outpatient thyroid scan in 2 weeks. Which instructions should the nurse include to ensure that this client is prepared for the test? Select all that apply. Stop using iodized salt or iodized salt substitutes 1 week before the scan. Stop eating seafood 1 week before the scan. Do not consume any food or fluids after midnight on the night before the scan. Do not take any prescribed thyroid medication on the day of the scan. Do not take prescribed thyroid medication until the results of the scan are known. Maintain bed rest for 24 hours after the scan.
Stop using iodized salt or iodized salt substitutes 1 week before the scan. Stop eating seafood 1 week before the scan. Do not take any prescribed thyroid medication on the day of the scan. A thyroid scan visualizes the distribution of radioactive dye in the thyroid gland. Interventions before the scan include stopping the ingestion of iodine, which is found in iodized salt, salt substitutes, and seafood. The client should also be instructed not to take thyroid medication because it may interfere with the scan. The client does not have to refrain from consuming food or fluids after midnight if the scan is done on an outpatient basis. The radioactive dye is administered intravenously. Routinely prescribed medications can be taken after the scan. Bed rest is maintained with a thyroid biopsy, not a scan.
A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. hyperkalemia skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection hypotension
skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reabsorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. CNS adverse effects are euphoria, headache, insomnia, confusion, and psychosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress the cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.
