saunders endocrine ch 79
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?
A primary health care provider has prescribed propylthiouracil for a client with hyperthyroidism, and the nurse assists in developing a plan of care for the client. Which nursing measure would be included in the plan regarding this medication?
Signs and symptoms of hypothyroidism
The medication is withheld and the PHCP is called to question the prescription for the client. Exenatide is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin.
The primary health care provider (PHCP) prescribes EXENATIDE for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which is the most appropriate intervention?
Tremors and double vision
Which client complaint should alert the nurse to a possible hypoglycemic reaction?
Hypotension and vomiting postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability.
Which signs/symptoms should the nurse expect to note when collecting data on a client with Addison's disease?
1.Fever 2.Weakness 3.Hypotension 4. Mental status changes
is identified by cool, clammy skin; shakiness; and hunger.
Hypoglycemia
is identified by cool, clammy skin; shakiness; and hunger.
Apply a moisturizing lotion to dry feet, but not between the toes.
The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?
Blood pressure of 80/60 mm Hg Signs/symptoms associated with thyroid storm include a fever as high as 106° F (41.1° C), severe tachycardia, profuse diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hyperreflexia, abdominal pain, diarrhea, and dehydration. With this disorder, the client's condition can rapidly progress to coma and cardiovascular collapse.
The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring?
Treat hypocalcemic tetany
The nurse is caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed. The nurse determines that this medication has been prescribed for which reason?
Positive Trousseau's sign
The nurse is caring for a client with a diagnosis of hypoparathyroidism. The nurse reviews the client's laboratory results and notes that the calcium level is extremely low. The nurse should expect to note which sign/symptom on data collection?
Graham crackers and warm milk Of particular importance is that food or beverages that contain caffeine (e.g., chocolate, coffee, tea, and cola) are prohibited.
The nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. Which is the appropriate choice for this client to meet nutritional needs?
VITAL SIGNS Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness.
The nurse is caring for a client with pheochromocytoma. The client is scheduled for an adrenalectomy. During the preoperative period, the priority nursing action should be to monitor which criterion?
Congestion heard on auscultation of the lungs is indicative of heart failure (HF). The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, heart failure (HF), increased platelet aggregation, and stroke. Death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic aneurysm. Congestion heard on auscultation of the lungs is indicative of heart failure (HF).
The nurse is caring for a client with pheochromocytoma. Which data are indicative of a potential complication associated with this disorder?
Reassure the client that this is usually a temporary condition.
The nurse is collecting data regarding a client after a thyroidectomy and notes the development of a hoarse and weak voice. Which nursing action is appropriate?
"I am urinating a lot."
The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus warrant primary health care provider (PHCP) notification?
High-sodium, high-carbohydrate diet
The nurse is preparing to reinforce instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which diet should be prescribed for this client?
The nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse should focus on which potential problem for this client?
dehydration Increased blood glucose will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes causing an osmotic diuresis that leads to dehydration.
Diabetic ketoacidotic coma
is usually identified with a fruity breath odor; dry, cracked mucous membranes; hypotension; and rapid, deep breathing.
Excessive thirst and urine output
After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder?
DKA s/s
D-ehydration DM 1 1K-etones in the urine and blood, Kussmaul Resp and K+ A-cidosis, Acetone breath, Anorexia d/t nausea
Hyperglycemic Hyperosmolar State (HHS)
Hyperglycemic hyperosmolar state is seen primarily in individuals with type 2 diabetes who experience a relative deficiency of insulin. The onset of symptoms may be gradual. The symptoms may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness.
The nurse is caring for a postoperative parathyroidectomy client. Which would require the nurse's immediate attention?
Laryngeal stridor
Test the drainage for glucose. After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid (CSF) leak.
When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is essential?
"I will notify my primary health care provider if my blood glucose level is consistently greater than 250."
When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?
restful envoirment
Which measure should the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves' disease?
Monitor the client's blood pressure.
Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma?
Hyperglycemia symptoms
- dizziness - Headache - Anxiety - Shakiness - Diaphoresis - Excessive hunger - Confusion - clumsy or jerky movement - Tremors - Palpitations or fast heart rate - blurred vision
IV infusion containing 5% dextrose
A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial serum glucose level was 950 mg/dL. Intravenous (IV) insulin was started along with rehydration with IV normal saline. The serum glucose level is now 240 mg/dL. The nurse who is assisting in caring for the client obtains which item anticipating a primary health care provider's prescription?
Rotate the insulin injection sites systematically.
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge
The client needs immediate education before discharge.
A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client states to the nurse, "I will call the doctor next time I can't eat for more than a day or so." The nurse plans care understanding that which statement accurately reflects this client's level of knowledge?
"I should not exercise in the late afternoon." A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. Humulin N insulin peaks between 6 and 14 hours; therefore, late-afternoon exercise would occur during the peak of the medication.
A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?
Take a blood glucose test before exercising.
A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is reinforcing instructions to the client regarding the program. Which instruction should the nurse include?
"I forgot to take my usual mid-afternoon snack yesterday."
A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse that yesterday the late afternoon blood glucose was 60 mg/dL and that she "felt funny." Which statement by the client indicates an understanding of this occurrence?
Hyperglycemic Hyperosmolar State (HHS)
A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the primary health care provider's documentation and would expect to note which diagnosis?
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding should the nurse expect to note as confirming this diagnosis?
Elevated blood glucose and low plasma bicarbonate
Check the urine specific gravity.
Following hypophysectomy, a client complains of being very thirsty and having to urinate frequently. Which is the initial nursing action?
Toothbrushing will not be permitted for at least 2 weeks following surgery.
The nurse caring for a client scheduled for a transsphenoidal hypophysectomy to remove a tumor in the pituitary gland assists in developing a plan of care for the client. The nurse suggests including which specific information in the preoperative teaching plan?
Constipation Cold intolerance Dry skin
The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? Select all that apply.
Check the client's capillary blood glucose.
The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pulse and respiratory rate are elevated from the client's baseline. Which action should the nurse implement?
Administer intravenous (IV) regular insulin.
The nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). Which is the priority nursing action for this client who is in the acute phase?
"I need to stop my insulin."
The nurse is assigned to care for a client at home who has a diagnosis of type 1 diabetes mellitus. When the nurse arrives to care for the client, the client tells the nurse that she has been vomiting and has diarrhea. Which additional statement by the client indicates a need for further teaching?
Increased thirst The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse sweating and shakiness would be noted in a hypoglycemic condition.
The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication should be included on the list?
"I can eat foods that contain potassium." A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.
The nurse is reinforcing discharge teaching to a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood?
Less than 50 mg/dL The principal adverse effect of insulin therapy is hypoglycemia. The normal blood glucose level ranges from 90 to 110 mg/dL.
The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia?
Monitor blood glucose level frequently.
The nurse is reinforcing instructions to a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize?
3.Morphine sulfate
The nurse is reviewing a primary health care provider's prescriptions for a client with newly diagnosed, untreated hypothyroidism. Which medication prescribed for the client should the nurse question and verify? 1. Atenolol 2.Levothyroxine 3.Morphine sulfate 4.Docusate sodium
Plan for injection rotation
The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection?
"I need to buy special dietetic foods."
The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates the need for further teaching?
Shakiness
The nurse reinforces teaching to a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?
Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur. Instruct the client about thyroid replacement therapy. Encourage the client to consume fluids and high-fiber foods
The nurse should expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply.
"Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones.
The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's syndrome. Which statement by the student indicates an accurate understanding of this disorder?
