Week 3

How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 82 mg/dL (mmol/L) and an A1c of 5.9%? A. The values indicate that the client has poorly managed his or her disease. B. The values indicate that the client has managed his or her disease well. C. The client's glucose control for the past 24 hours has been good but the overall control is poor. D. The client's glucose control for the past 24 hours has been poor but the overall control is good.

B. The values indicate that the client has managed his or her disease well. Rationale: Fasting blood glucose levels provide an indication of the client's adherence to drug and nutrition therapy for DM has been for the previous 24 hours. This client's FBG is well within the normal range.

A client newly diagnosed with type 1 diabetes says she is not ready to learn everything about diabetes control right now. Which information has the greatest priority for the nurse to teach this client and her family for now to prevent harm? (Select all that apply.) Select all that apply. A. Causes of type 1 diabetes B. What to do when ill? C. Symptoms and treatment of hypoglycemia D. Insulin administration E. Dietary control of blood glucose F. Importance of regular exercise

B. What to do when ill? C. Symptoms and treatment of hypoglycemia D. Insulin administration Rationale: The priority information for safety and preventing harm that the nurse needs to teach the client and family about diabetes are: Symptoms and management of hypoglycemia because it is a life-threatening condition. Proper insulin administration is essential for the management of type 1 diabetes and to prevent death. Knowing what to do when ill is critical information because illness will require changes in the client's day-to-day use of insulin and may need contact with the client's diabetes health care provider to prevent harm. The causes of diabetes, dietary control, and exercise are less important for immediate safety and can be taught at another time.

A client at continuing risk for hyperparathyroidism is prescribed to take furosemide 40 mg and to drink at least 3 to 4 L of fluid daily. He tells the nurse he believes taking a "water pill" and then drinking so much seems wrong. How will the nurse respond? A. "This combination of a water pill and drinking more ensures protects you from buildup of excess sodium in the kidney." B. "The furosemide makes you lose water and you need to increase your intake to keep from becoming dehydrated." C. "The drug helps you to get rid of calcium and drinking more helps dilute your blood calcium so the level doesn't get too high." D. "You are correct. I will check with your primary health care provider to determine whether you should restrict your fluid intake."

C. "The drug helps you to get rid of calcium and drinking more helps dilute your blood calcium so the level doesn't get too high." Rationale: The purpose of the furosemide and hydration therapy is to lower the blood calcium levels to manage the hypercalcemia associated with hyperparathyroidism. Although it is true that increasing fluid intake while on furosemide can help prevent dehydration and also helps excrete sodium, that is not the desired outcome in hyperparathyroidism.

Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "dawn phenomenon" to achieve better control? A. Eat a bedtime snack containing equal amounts of protein and carbohydrates." B. Avoid eating any carbohydrate with your evening meal." C. Take your evening insulin dose right before going to bed instead of at supper time." D. Inject the insulin into your arm rather than into the abdomen around the navel."

C. Take your evening insulin dose right before going to bed instead of at supper time." Rationale: A client with "dawn phenomenon," diagnosed by checking blood glucose levels during the night, has morning hyperglycemia that results from a nighttime release of adrenal hormones causing blood glucose elevations at about 5 to 6 a.m. It is managed by providing more insulin for the overnight period (e.g., giving the evening dose of intermediate-acting insulin at 10 p.m. instead of with the evening meal).

Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." and has vital signs of: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air? A. Administering oxygen B. Connecting a cardiac monitor C. Assessing arterial blood gas (ABG) values D. Assessing blood glucose level

D. Assessing blood glucose level Rationale: The nurse would first obtain the client's glucose level. Breathing deeply and stating, "I can't catch my breath" is indicative of Kussmaul respirations which is a sign of diabetic ketoacidosis (DKA).

The nurse reviews the vital signs of a client diagnosed with Graves disease and notes that the client's temperature is 99.6° F (37.6° C). After notifying the primary health care provider, what is the nurse's best next action? A. Administering acetaminophen B. Observing for the presence of chills C. Initiating the Rapid Response Team D. Assessing cardiac status

D. Assessing cardiac status Rationale: Graves disease is manifested by symptoms of hyperthyroidism and increased metabolic rate, including fever. The nurse must next assess the client's cardiac status as atrial fibrillation or other dysrhythmias may have developed. If the client has a cardiac monitor, the nurse needs to check for any dysrhythmias

Which precaution is a priority for the nurse to teach a client prescribed semaglutide to prevent harm? A. Only take this drug once weekly. B. Report any vision changes immediately. C. Do not mix in the same syringe with insulin. D. This drug can only be given by a health care professional.

A. Only take this drug once weekly. Rationale: Semaglutide is a long-acting GLP-1 agonist given only once weekly and comes only as a self-injection pen. It does not have to be administered by a health care professional. It is not associated with any vision changes.

How will the nurse modify insulin injection technique for a client who is 5 feet 10 inches tall and weighs 106 lb (48.1 kg) A. Use a 6 mm needle and inject at a 90-degree angle. B. Use a 6 mm needle and inject at a 45-degree angle. C. Use a 12 mm needle and inject at a 90-degree angle. D. Use a 12 mm needle and inject at a 45-degree angle.

B. Use a 6 mm needle and inject at a 45-degree angle. Rationale: The client is very thin. Using either a longer needle or injecting the insulin at a 90-degree angle increases the likelihood of performing an intramuscular injection instead of a subcutaneous one, which would affect insulin absorption. Selecting a shorter needle and injecting at a 45-degree angle prevents an intramuscular injection into this client.

What is the nurse's best response when family members of a client with hyperthyroidism express concern about the client's frequent mood swings? A. "Do the client's mood swings make you feel angry?" B. "The medications will make the mood swings disappear completely." C. "Your family member is sick. You must be patient." D. "Mood swings are common should diminish with treatment."

D. "Mood swings are common should diminish with treatment." Rationale: Telling the family that the client's mood swings should diminish over time with treatment provides information to the family, as well as reassurance that this behavior is expected.

What is the nurse's best response to a client newly diagnosed with diabetes who asks why he is always so thirsty? A. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." B. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." C. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost." D. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

D. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." Rationale: The high blood glucose levels that are present, because movement of glucose into cells is impaired, increase the osmolarity of the blood. The increased osmolarity stimulates the osmoreceptors in the hypothalamus, which triggers the thirst reflex. In response, the person drinks more water (not sugary fluids or hyperosmotic fluids), which helps dilute blood glucose levels and reduces blood osmolarity.

Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? A. A 55-year-old client who has hypoglycemic unawareness B. An 80-year-old client with type 2 diabetes mellitus C. A 45-year-old client with type 1 diabetes mellitus D. A 75-year-old client whose blood glucose levels show little variation

D. A 75-year-old client whose blood glucose levels show little variation Rationale: Comparison studies have shown wide variation between fingertip and alternate sites, and variation is most evident during times when blood glucose levels are rapidly changing. Clients are taught that there is a lag time for blood glucose levels between the fingertip and other sites when blood glucose levels are changing rapidly and that the fingertip reading is the only safe choice at those times. Because of this lag time, clients who have hypoglycemic unawareness are warned to not ever use alternate sites for SMBG.

Which statement by a client indicates to the nurse correct understanding of what to do when the sensations of hunger and shakiness occur? A. "I will eat three graham crackers." B. "I will drink a glass of water." C. "I will sit down and rest." D. "I will give myself a dose of glucagon."

A. "I will eat three graham crackers." Rationale: Feeling hungry and shaky are symptoms of mild hypoglycemia. Correct understanding of what the client needs to do when these symptoms occur is to eat three graham crackers. This is the correct management strategy for mild hypoglycemia.

Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed? A. "If I continue to lose weight, I may need an increased dose." B. "I will have more energy with this medication." C. "If I often am constipated and feel tired, I may need an increased dose." D. "I will take the medication every morning."

A. "If I continue to lose weight, I may need an increased dose." Rationale: The statement, "If I continue to lose weight, I may need an increased dose," indicates a need for further teaching. Weight loss indicates a need for a decreased dose, not an increased dose.One of the symptoms of hypothyroidism is lack of energy. Thyroid replacement therapy would cause the client to have more energy. The correct time to take thyroid replacement therapy is in the morning. Frequent constipation and continuing to feel tired are indications that the dose may need to be increased.

What action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot? A. "Make an appointment with your podiatrist as soon as possible." B. "Make an appointment with a pedicurist and have them cut or file off the callus." C. "Soak your feet nightly in warm water and peel of a little of the callus every day." D. "Apply an over-the-counter callus-dissolving pad and follow the package directions."

A. "Make an appointment with your podiatrist as soon as possible." Rationale: The client with diabetes is taught to see his or her diabetes health care provider or a podiatrist for calluses, corns, or any other foot lesion and never to self-treat such problems. The risk for development of an ongoing injury with chronic infection is very high could lead to eventual amputation.

Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that clarification is needed about injection site selection and rotation? A. "The abdominal site is best because it is closest to the pancreas." B. "I can reach my thigh best, so I will use different areas of the same thigh." C. "If I change my injection site from the thigh to an arm, the inulin absorption may be different." D. "By rotating sites within one area, my chance of having skin changes is less."

A. "The abdominal site is best because it is closest to the pancreas." Rationale: The abdominal site has the fastest and most consistent rate of absorption because of the blood vessels in the area and not because of its proximity to the pancreas. The other statements demonstrate correct understanding about injection site selection and rotation.

How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible? A. "You can have a beer with a meal if you test yourself for hypoglycemia an hour later." B. "You can have a beer with a meal if you test yourself for hyperglycemia an hour later." C. "There are nonalcoholic beers available that you can substitute for a regular beer." D. "If you gave up dessert, you can still have one beer."

A. "You can have a beer with a meal if you test yourself for hypoglycemia an hour later." Rationale: Alcohol consumption contributes to hypoglycemia. This risk is reduced if the alcohol is consumed with or shortly after a meal. The client is instructed to check blood glucose levels about an hour after alcohol is consumed to determine if either more food is needed or if insulin dosage needs to be adjusted.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." B. A 30 year old with type 1 diabetes who is reporting thirst. C. A 40 year old with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L). D. A 50 year old with type 2 diabetes with a blood pressure of 150/90 mm Hg.

A. A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." Rationale: The client the nurse sees first is the client with type 1 diabetes whose insulin pump is beeping "occlusion." Because glucose levels will increase quickly in clients whose continuous insulin pumps malfunction, the nurse must assess this client and the insulin pump first to avoid hyperglycemia or diabetic ketoacidosis.

Which trends in serum electrolyte values will the nurse expect to find in a client who has untreated hypoparathyroidism? A. Below normal calcium levels; above normal phosphorus levels B. Below normal calcium levels; below normal phosphorus levels C. Above normal calcium levels; above normal phosphorus levels D. Above normal calcium levels; below normal phosphorus levels

A. Below normal calcium levels; above normal phosphorus levels Rationale: With hypoparathyroidism, the lack of parathyroid hormone (PTH) decreases serum calcium levels by increasing kidney calcium excretion and inhibiting calcium absorption from the GI tract. Low levels of calcium cause a corresponding increase in serum phosphorus levels because calcium and phosphorus exist in a balanced reciprocal relationship in which a decrease in one always causes an increase in the other.

Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.) A. Elevated temperature B. Tachycardia C. Somnolence D. Elevated systolic blood pressure E. Abdominal pain and nausea F. Slow respiratory rate

A. Elevated temperature B. Tachycardia D. Elevated systolic blood pressure E. Abdominal pain and nausea Rationale: Symptoms of thyroid storm are caused by excessive thyroid hormone release, which dramatically increases metabolic rate. Key symptoms include fever, tachycardia, and systolic hypertension. Additional symptoms include abdominal pain, nausea, vomiting, diarrhea, tremors, and anxiety.The increased metabolic rate causes the respiratory rate to increase. Clients are agitated, not somnolent.

Which physiological processes directly prevent severe hypoglycemia in a healthy adult without diabetes who is NPO for 12 hours? Select all that apply. A. Gluconeogenesis B. Glycogenesis C. Glycogenolysis D. Ketogenesis E. Lypogenesis F. Lypolysis

A. Gluconeogenesis C. Glycogenolysis Rationale: Gluconeogenesis is the conversion of protein into glucose. This process increases blood glucose levels and prevents hypoglycemia during fasting. Glycogenolysis is the breakdown of stored glycogen in the liver and skeletal muscle and conversion to glucose. It is the main process that prevents hypoglycemia during fasting. Glycogenesis is the conversion by the liver of excess circulating glucose into glycogen. This process reduces blood glucose levels and does not directly prevent hypoglycemia. Ketogenesis is the breakdown of fats (lipids) into ketone bodies that can be used for fuel by some cells. It does not raise blood glucose levels and does not directly prevent hypoglycemia. Lypogenesis is the conversion of glucose (and other substances) into body fats, usually as free fatty acids. This process does not prevent hypoglycemia during fasting. Lypolysis is the breakdown of fatty acids but does not convert them to glucose and does not directly prevent hypoglycemia during fasting.

Performance of which assessment is a priority for the nurse before giving a client the first oral dose of hormone replacement for hypothyroidism? A. Measuring heart rate and rhythm B. Checking core body temperature C. Asking about previous allergic drug reactions D. Listening to bowel sounds in all four abdominal quadrants

A. Measuring heart rate and rhythm Rationale: The side effects and adverse effects of thyroid hormone replacement drugs increase metabolic rate and cardiac activity. Checking heart rate and rhythm before giving the drug provides a baseline to determine whether or not the drug is working correctly or is causing an overdose effect. Although changes in core body temperature and bowel sounds will eventually indicate responses to the prescribed therapy, the most critical to assess are those related to cardiac function. Thyroid replacement hormone has not been taken by this client before and is not associated with any other types of drug allergies.

Which new-onset symptoms will the nurse instruct a client with diabetes who is prescribed to take the sodium-glucose cotransport inhibitor, empagliflozin, to report to the diabetes health care provider to prevent harm? (Select all that apply.) Select all that apply. A. Muscle weakness and dizziness on standing B. Redness and tenderness at the injection site C. Rapid weight gain and shortness of breath D. Redness and tenderness of the perineum E. Sensations of hunger, tremors, sweating, and confusion F. Pain and burning on urination

A. Muscle weakness and dizziness on standing D. Redness and tenderness of the perineum E. Sensations of hunger, tremors, sweating, and confusion F. Pain and burning on urination Rationale: Drugs from the lower blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine. This filtered glucose is excreted in the urine rather than moved back into the blood. Hypoglycemia (symptoms of hunger, tremors, sweating, confusion) is possible as is dehydration with excessive sodium loss (muscle weakness and orthostatic hypotension with dizziness on standing). The excess glucose in the urine increases the risk for urinary tract infections with pain and burning on urination. These drugs increase the risk for Fournier gangrene with perineal fasciitis, which has early symptoms of redness and tenderness of the perineal skin. The drug is taken orally and not by injection. It is not associated with heart failure that may manifest with symptoms of rapid weight gain and shortness of breath.

Which assessment finding of a client 8 hours after a subtotal thyroidectomy does the nurse consider most relevant as an indication of a possible complication? A. The client's hand spasms during blood pressure measurement. B. The respiratory rate has dropped from 18 to 14 breaths per minute. C. The dressing has a moderate amount of serosanguinous drainage. D. The client responds to questions correctly but does not open the eyes while talking.

A. The client's hand spasms during blood pressure measurement. Rationale: Hand spasms in the presence of decreased oxygen (as would happen while a blood pressure cuff was inflated above systolic pressure) is an indication of hypocalcemia, a possible complication of reduced parathyroid function that can result from thyroid surgery. The respiratory rate is within normal limits for a healthy adult. A moderate amount of drainage may be more than expected but is not an indication of obstruction. After general anesthesia, most clients are sleepy. Not opening his or her eyes during a response to a question is not an indication of a complication.

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm? A. "Check your hands and feet weekly for chronic excessive sweating." B. "Change positions slowly when moving from sitting to standing." C. "Avoid drinking caffeine or caffeinated beverages." D. "Be sure to take your blood pressure drug daily."

B. "Change positions slowly when moving from sitting to standing." Rationale: Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels. This problem contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance. Most often, CAN leads to orthostatic (postural) hypotension and syncope (brief loss of consciousness on standing). These problems are from failure of the heart and arteries to respond to position changes by increasing heart rate and vascular tone. As a result, blood flow to the brain is interrupted briefly. Orthostatic hypotension and syncope increase the risk for falls, especially among older adults.

Which health promotion activity(ies) will the nurse recommend to prevent harm in a client with type 2 diabetes? Select all that apply. A. "Avoid all dietary carbohydrate and fat." B. "Have your eyes and vision assessed by an ophthalmologist every year." C. "Reduce your intake of animal fat and increase your intake of plant sterols." D. "Be sure to take your antidiabetes drug right before you engage in any type of exercise." E. "Keep your feet warm in cold weather by using either a hot water bottle or a heating pad." F. "Avoid foot damage from shoe-rubbing by going barefoot or wearing "flip-flops" when you are at home."

B. "Have your eyes and vision assessed by an ophthalmologist every year." C. "Reduce your intake of animal fat and increase your intake of plant sterols." Rationale: Regardless of whether diabetes is type 1 or type 2, the long-term complications are the same as are most prevention activities. The microvascular complications of diabetes increase the risk for eye and vision problems for all who have the disorder. Annual examinations by an ophthalmologist are critical to preventing or delaying reduced vision. Hypercholesterolemia is common in diabetes and contributes to hypertension, as well as microvascular and macrovascular complications, especially cardiovascular problems. Reducing animal-sourced fats and using plant-based sterols is recommended for everyone. Controlling carbohydrate and fat intake is important but they cannot be avoided or eliminated from the diet. Exercising increases the risk for hypoglycemia. Taking antidiabetes drugs immediately before exercising increases this risk and should not be done. Most patients with diabetes, even type 2 diabetes, have some degree of peripheral neuropathy and an increased risk for development of foot ulcers and the need for amputation. Using hot water bottles and heating pads on the feet should never be done because the reduced sensory perception does not allow the client to know when feet are being damaged by the heat. Adults with diabetes should never walk bare-foot or just use "flip-flops" even in the home. They need to wear properly fitting shoes with sturdy soles to prevent any foot injury.

Which statement made by the client alerts the nurse to the possibility of hypothyroidism? A. "I seem to feel the heat more than other people." B. "I am always tired, even when I get 10 or 12 hours of sleep." C. "Food just doesn't taste good without a lot of salt." D. "My grandmother had thyroid problems."

B. "I am always tired, even when I get 10 or 12 hours of sleep." Rationale: Clients with hypothyroidism usually feel tired or weak and often report an increase in time spent sleeping, sometimes up to 14 to 16 hours per day. Thyroid problems are very common among women and do not demonstrate a specific pattern of inheritance.

Which specific action is a priority for the nurse to teach a client with diabetes who has peripheral neuropathy to prevent harm? A. "Wear a medical alert bracelet." B. "Never go barefoot." C. "Never reuse insulin syringes." D. "Drink at least 3 L of fluids daily."

B. "Never go barefoot." Rationale: All the actions are important for the client with diabetes to perform for safety and to prevent a variety of complications. However, the most important action to prevent harm from peripheral neuropathy is to never go barefoot and wear shoes and slippers with firm soles.

A client with diabetes who now has chronic albuminuria asks the nurse how this change will affect his health. How will the nurse answer this question? A. "You will need to limit your intake of dietary albumin and other proteins to reduce the albuminuria." B. "This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage." C. "Your risk for developing urinary tract infections is greatly increased, requiring the need to take daily antibiotics for prevention." D. "From now on you will need to keep your fluid intake to just 1 L daily and completely avoid caffeine to protect your kidneys."

B. "This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage." Rationale: The microvascular complications of diabetes reduce kidney perfusion and damage the glomeruli, leading to chronic kidney disease. The first indication of this problem is chronic albuminuria from increased filtration of proteins through damage glomeruli. Although this problem cannot be reversed, the rate of progression can be slowed with tight glycemic control. With albuminuria, proteins are lost from the body and do need to be replaced, not restricted, at this stage. The risk for urinary tract infections is increased with glucose in the urine, not albumin or other protein. Reducing fluid intake has the potential to damage the kidneys further and is not helpful.

With which client will the nurse be aware of an increased risk for hypoparathyroidism? A. A 28-year-old woman with pregnancy-induced hypertension B. A 35-year-old woman who had radiation therapy for Graves disease C. A 50-year-old man starting on insulin therapy for type 2 diabetes mellitus D. A 55-year-old man with moderate heart failure after myocardial infarction

B. A 35-year-old woman who had radiation therapy for Graves disease Rationale: Hypoparathyroidism is a relatively rare disorder. It is most often caused by treatment for hyperthyroidism that resulted in injury to the parathyroid glands. None of the other client health problems increase the risk for development of hypoparathyroidism.

Which assessment findings in a client with hyperthyroidism indicates to the nurse that the client is in danger of thyroid storm? Select all that apply. A. Increased salivation B. Client report of increased palmar sweating C. Decreased pulse pressure from 40 mm Hg to 36 mm Hg D. Diminished bowel sounds in all four abdominal quadrants E. An increase in temperature from 99.5o F (37.5o C) to 101.3o F (38.5o C) F. Serum sodium level increase from 136 mEq/L (mmol/L) to 139 mEq/L (mmol/L) G. Increase in premature ventricular heart contractions from 4 per minute to 28 per minute

B. Client report of increased palmar sweating E. An increase in temperature from 99.5o F (37.5o C) to 101.3o F (38.5o C) G. Increase in premature ventricular heart contractions from 4 per minute to 28 per minute Rationale: The changes most associated with impending thyroid storm (thyroid crisis) are the increase in sweating, body temperature, and irregular heartbeats. This client requires immediate attention. Increased salivation and diminished bowel sounds are not associated with thyroid storm. The changes in pulse pressure and serum sodium values are still within normal limits and not insignificant.

Which hormones help prevent hypoglycemia? Select all that apply. A. Aldosterone B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon F. Insulin G. Norepinephrine H. Proinsulin

B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon G. Norepinephrine Rationale: Cortisol decreases glucose uptake by cells and increases liver production and release of glucose. Epinephrine and norepinephrine rapidly increase liver glycogen breakdown and release of glucose into circulation. Growth hormone also rapidly increases liver glycogen breakdown and increases release of glucose into circulation. Glucagon is the major hormone preventing hypoglycemia. It is produced and secreted by alpha cells of the pancreatic islets as soon as blood glucose levels begin to drop below normal. Aldosterone is an adrenal hormone that affects water and mineral metabolism, not glucose metabolism. Insulin decreases blood glucose levels and can cause hypoglycemia. Proinsulin is an inactive compound that does not directly affect blood glucose levels until it is metabolized into insulin.

What is the nurse's best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet? A. Testing the sensory perception of the client's hands B. Examining both feet for indications of injury C. Explaining to the client that peripheral neuropathy is now present D. Documenting the finding as the only action

B. Examining both feet for indications of injury Rationale: When reduced peripheral sensory perception is present, the likelihood of injury is high. Any open area or other problem on the foot of a person with diabetes is at great risk for infection and must be managed carefully and quickly. Checking for sensory perception on the hands and other areas is important but can come after a thorough foot examination.

While making rounds the nurse finds a client with type 1 diabetes mellitus pale, sweaty, slightly confused, and can still swallow. The client's blood glucose level check is 48 mg/dL (2.7 mmol/L). What is the nurse's best first action to prevent harm? A. Call the pharmacy and order a STAT does of glucagon B. Immediately give the client 30 grams of glucose orally C. Start an IV and administer 50 mL of a 50% dextrose solution D. Recheck the blood glucose level and call the rapid response team

B. Immediately give the client 30 grams of glucose orally Rationale: The client's blood glucose level is seriously low and will get even lower quickly. Because the client can still swallow, giving 30 grams of glucose (following the 15-15 rule) is the best course of action. Obtaining a dose of glucagon from the pharmacy or starting an IV are too slow to prevent severe hypoglycemia. Just rechecking the blood glucose level without giving glucose is very dangerous when the client already has symptoms of hypoglycemia.

What is the nurse's best response when a client with diabetes who is being treated for hypoglycemic asks why people without diabetes don't become severely hypoglycemic even after fasting for 8 hours? A. In a person without diabetes, fasting for 8 hours converts proteins into glycose (gluconeogenesis) so that hypergycemia develops rather than hypoglycemia. B. In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis). C. Normal metabolism is so slow when a person without diabetes fasts that blood glucose does not enter cells to be used for energy. As a result, hypoglycemia does not occur. D. Lipolysis (fat breakdown) in fat stores occurs faster in the nondiabetic person, which converts fatty acids into glucose to maintain blood glucose levels.

B. In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis). Rationale: Glucagon is a counter-regulatory hormone secreted by pancreatic alpha cells when blood glucose levels are low, as they would be during an 8 hour fast. The body's metabolic rate does decrease during sleep (which is not stated in this question) but not sufficiently to prevent hypoglycemia. Glucagon works on the glycogen stored in the liver, breaking it down to glucose (glycogenolysis) molecules that are then released into the blood to maintain blood glucose levels and prevent hypoglycemia.

Which statements regarding hyperthyroidism are accurate? (Select all that apply.) A. Has a sudden onset of symptoms. B. Is much more common among women than among men. C. Produces symptoms of a hypermetabolic state. D. Most common form is Graves disease. E. Can be diagnosed by the presence of a goiter. F. Often occurs weeks after exposure to ionizing radiation.

B. Is much more common among women than among men. C. Produces symptoms of a hypermetabolic state. D. Most common form is Graves disease. Rationale: Hyperthyroidism increases the metabolism and function of all systems. The most common cause of hyperthyroidism is Graves disease, which is an autoimmune disorder, often occurring after an episode of thyroid inflammation leading to the production of autoantibodies (thyroid-stimulating immunoglobulins [TSIs]) that attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid gland. The increased stimulation of TSH receptors greatly increases thyroid hormone production. All thyroid problems are from five to ten more common among women than men.

Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) A. Goiter B. Nonpitting edema of hands and feet C. Warm, moist skin D. Decreased deep tendon reflexes E. Agitation and inability to sleep F. Pulse rate below 60 beats/min

B. Nonpitting edema of hands and feet D. Decreased deep tendon reflexes F. Pulse rate below 60 beats/min Rationale: Hypothyroidism slows the metabolism and function of all systems and the ones that are usually first noticed and can lead to life-threatening complications are the cardiac and central nervous systems. Thus, the heart rate is usually slower than 60 beats/min, and the deep tendon reflexes are decreased. Metabolites that are compounds of proteins and sugars called glycosaminoglycans (GAGs) build up inside cells, which increase the mucus and water, forming cellular edema that is nonpitting.

Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed? A. Hypoactive bowel sounds B. Apical pulse of 92 beats/min C. Bilateral leg muscle twitching D. Dry mouth

C. Bilateral leg muscle twitching Rationale: Clients are at risk for hypocalcemia and seizures after removal of the parathyroid glands. Muscle twitching is an indication of hypocalcemia and requires assessment and intervention. The other findings are abnormal but not associated with complications from the surgery.

Why is a goiter often present in clients who have Graves disease? A. The low circulating levels of thyroid hormones stimulates the feedback system and triggers the anterior pituitary gland to secrete more thyroid-stimulating hormone, which increases the numbers and size of glandular cells in the thyroid gland. B. The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland. C. The autoantibodies stimulate blood vessel growth and blood storage within the thyroid gland, increasing its overall size. D. The autoantibodies stimulate the inflammatory and immune responses to increase the number of white blood cells circulating in the thyroid gland, which increases tissue size without increasing the number of glandular cells.

B. The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland. Rationale: Graves disease is an autoimmune disorder in which antibodies (thyroid-stimulating immunoglobulins [TSIs]) are made and attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid tissue. The thyroid gland responds by increasing the number and size of glandular cells, which enlarges the gland, forming a goiter and overproduces thyroid hormones (thyrotoxicosis).

Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)? A. "Increase the amount of fiber in your diet to prevent the side effect of constipation." B. "Stop this drug immediately if you discover you are pregnant." C. "Avoid over-the-counter medications unless prescribed by your primary health care provider." D. "If you miss a dose, double your next day's dose."

C. "Avoid over-the-counter medications unless prescribed by your primary health care provider." Rationale: The amount of drug in synthetic thyroid hormone tablets is very small and many other foods and drugs interfere with its absorption. The client is instructed to not take over-the-counter medications without approval from the primary health care provider. Fiber greatly interferes with the drug's absorption and is not to be taken with or within 4 hours of HRT. In addition, the drug does not cause constipation. Thyroid HRT must continue during pregnancy. The therapy works best when blood levels are maintained. The client is taught to take the forgotten drug as soon as it is remembered and not to double the next day's dose.

What is the nurse's best response to a client newly diagnosed with type 1 diabetes who asks why insulin is only given by injection and not as an oral drug? A. "Injected insulin works faster than oral drugs to lower blood glucose levels." B. "Oral insulin is so weak that it would require very high dosages to be effective." C. "Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes." D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

C. "Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes." Rationale: Because insulin is a small protein that is easily destroyed by stomach acids and intestinal enzymes, it cannot be used as an oral drug. Most commonly, it is injected subcutaneously.

Which statement made by a client who is undergoing therapy with radioactive iodine (RAI) for Graves disease indicates a lack of understanding about the disorder and its treatment? A. "Luckily, I have my own bathroom, so I won't be exposing the rest of my family to radiation. B. "If this treatment works, maybe I will stop sweating all the time. C. "It will be great to lose my "bug-eyed" appearance. D. "I hope I don't gain too much weight when my thyroid function is normal.

C. "It will be great to lose my "bug-eyed" appearance. Rationale: Although successful radioactive iodine (RAI) therapy for Graves disease results in reducing most physical symptoms, the exophthalmia does not respond to this therapy. Other measures, such as drug therapy targeted to the exophthalmos and not the hyperthyroidism and surgery to remove tissue from behind the eye, are needed to improve the eye appearance. All other client statements demonstrate accurate understanding of the disorder and its treatment.

What is the nurse's best response to a client with type 2 diabetes controlled with metformin who asks why now that he is recovering from surgery, is he prescribed to receive insulin therapy for a few days? A. "Your insurance doesn't permit metformin to be used during hospitalization." B. "Your presurgical testing indicates that you now have type 1 diabetes and require daily insulin." C. "You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two." D. "You must take insulin from now on because the surgery has aggravated the intensity of your diabetes."

C. "You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two." Rationale: The nurse's best response is that due to the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for clients with diabetes who use oral antidiabetic agents. For those receiving insulin, dosage adjustments may be required until the stress of surgery subsides.

When (at which time) will the nurse plan to monitor for hypoglycemia in a client with type 1 diabetes received regular insulin at 7:00 a.m.? A. 7:30 a.m. B. 7:30 p.m. C. 11:00 a.m. D. 2:00 p.m.

C. 11:00 a.m. Rationale: Regular insulin is a short-acting type of insulin. Onset of action to regular insulin is ½ to 1 hour. The peak effect time is when hypoglycemia may start to occur. Peak time for regular insulin is 2 to 4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m. The other options for peak times for regular insulin are incorrect.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 50 year old taking repaglinide who has nausea and back pain. B. A 55 year old taking pioglitazone who has bilateral ankle swelling. C. A 45 year old taking metformin who has abdominal cramps. D. A 40 year old taking glyburide who is dizzy and sweaty.

C. A 45 year old taking metformin who has abdominal cramps. Rationale: The nurse needs to first assess the client taking glyburide who is dizzy and sweaty and has symptoms consistent with hypoglycemia. Because hypoglycemia is the most serious adverse effect of antidiabetic medications, this client must be assessed as soon as possible. Nausea is a documented side effect of repaglinide. Checking the client's back pain requires assessment, which can be performed after the nurse assesses the client displaying signs and symptoms of hypoglycemia. Metformin may cause abdominal cramping and diarrhea, but the client taking it does not require immediate assessment. Ankle swelling is an expected side effect of pioglitazone.

Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.) A. Hypertonic saline B. Furosemide C. Calcium gluconate D. Oxygen E. Suction F. Emergency tracheotomy kit

C. Calcium gluconate D. Oxygen E. Suction F. Emergency tracheotomy kit Rationale: Calcium gluconate needs to be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema occludes the airway. Oxygen always needs to be at the bedside and especially for the thyroidectomy client who may experience respiratory distress from swelling or damage to the laryngeal nerve leading to spasm. It is also important to have suction available at the client's bedside because of the risk for increased secretions.

The nurse reviewing the laboratory values of a client with hypoparathyroidism finds a serum calcium level of 7.9 mg/dL (1.76 mmol/L). Which parameter is most important for the nurse to assess to prevent harm? A. Temperature B. Heart rate and rhythm C. Deep tendon reflexes D. Level of consciousness

C. Deep tendon reflexes The serum calcium is low, placing the client in danger of increased muscle contractions and tetany. The client's deep tendon reflexes should be evaluated for hyperreflexia, which is an indicator of impending tetany. The other parameters are much less affected by hypocalcemia.

Which precaution is a priority for the nurse to teach a client prescribed pramlintide to prevent harm? A. Only take this drug once weekly. B. Do not drink alcohol when taking this drug. C. Do not mix in the same syringe with insulin. D. Report any genital itching to your primary health care provider.

C. Do not mix in the same syringe with insulin. Rationale: Pramlintide is an amylin analog injected subcutaneously several times daily with or right before any meal. It has a pH that is different from and incompatible with insulin and is not to be mixed in the same syringe. It does not increase the risk for genital yeast infections. It does not increase the risk for lactic acidosis when alcohol is comsumed.

Which type of drug therapy will the nurse prepare to teach about to a client who has mild hyperparathyroidism? A. Antipyretics B. Opioid analgesics C. Furosemide diuretics D. Calcium supplements

C. Furosemide diuretics Rationale: High ceiling or loop diuretics, such as furosemide increase calcium excretion and are used to manage calcium levels in clients who have mild hyperparathyroidism. Antipyretics are not routinely prescribed because fever is not associated with the disorder. Opioid analgesics are used only when a problem causing acute pain is present and not for typical management of mild hyperparathyroidism. Calcium supplements are contraindicated because hyperparathyroidism results in chronic hypercalcemia.

Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy? A. Loss of sensation in both feet B. Hyperglycemia C. Intermittent constipation D. Increased thirst

C. Intermittent constipation Rationale: Autonomic neuropathy can affect the entire GI system. The most common GI problem from diabetic automonic neuropathy is sluggish intestinal movement and chronic intermittent constipation.

An assistive personnel reports that a nursing home client who has hypothyroidism has a pulse of 48 beats per minute this morning. Which assessments have the highest priority for the nurse to perform immediately? Select all that apply. A. Checking body temperature B. Testing deep tendon reflex responses C. Measuring oxygen saturation by pulse oximetry D. Checking blood pressure, heart rate, and rhythm E. Determining level of consciousness and cognition F. Identifying presence or absence of the swallowing reflex G. Examining feet and ankles for indications of peripheral edema

C. Measuring oxygen saturation by pulse oximetry D. Checking blood pressure, heart rate, and rhythm Rationale: with hypothyroidism whose metabolism is decreasing. However, the most common cause of death for a client with severe hypothyroidism is respiratory failure with reduced gas exchange and perfusion. Thus, measuring oxygen saturation should be performed first followed by assessment of cardiac function in order to implement the most effective interventions as soon as possible.

Which action is appropriate for the nurse to delegate to the assistive personnel (AP) when caring for clients with diabetes? A. Monitoring a client who reports palpitations and anxiety B. Verifying the infusion rate on a continuous infusion insulin pump C. Performing a blood glucose check on a client who requires insulin D. Assessing a client who reports tremors and irritability

C. Performing a blood glucose check on a client who requires insulin Rationale: Performing bedside glucose monitoring is a task that may be delegated to an AP who has been educated in this technique because it does not require extensive clinical judgment to perform. There is no evidence the client is unstable at this time. The nurse will follow up with the results and insulin administration after assessing the less stable clients. Intravenous therapy and medication administration are not within the scope of practice for AP. The client with tremors and irritability is displaying symptoms of hypoglycemia requiring further assessment and intervention that are not within the scope of practice for AP. The client reporting palpitations and anxiety may have hypoglycemia, requiring further intervention. This client must be assessed by licensed nursing staff.

Which assessment is a priority for the nurse to make when a client with diabetic ketoacidosis (DKA) who is being monitored while receiving an insulin infusion begins to show an irregular heart beat with inverted T-waves? A. Rate of IV infusion B. Urine output C. Potassium level D. Breath sounds

C. Potassium level Rationale: After DKA therapy starts, serum potassium levels drop quickly. An ECG showing an irregular pattern and inverted T-waves is most likely related to low potassium levels (hyperkalemia). Hypokalemia is a common cause of death in the treatment of DKA. Detecting and treating the underlying cause of the cardiac irregularities is essential. The cardiac issues are not associated with changes in urine output even though hyperglycemia will cause osmotic diuresis. The client with DKA is not at risk for hypoventilation or poor gas exchange. Increased fluids treat the symptoms of dehydration secondary to DKA, but do not treat the hypokalemia.

Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min? A. Increasing the IV infusion rate B. Initiating the Rapid Response Team C. temperature D. Applying oxygen by mask

D. Applying oxygen by mask Rationale: The most common cause of death with severe hypothyroidism is respiratory failure with decreased gas exchange. The nurse would apply oxygen first and then initiate the Rapid Response Team. Although a decreased body temperature would support the findings that a client with severe hypothyroidism is worsening, assessing it would not be helpful in this situation. Increasing the IV flow rate may not even improve cardiac output because the slow heart rate is not related to a volume deficit but to reduced myocardial contractility.

When preparing to administer a prescribed subcutaneous dose of NPH insulin from an open vial taken from a medication drawer to a client with diabetes, the nurse notes the solution is cloudy. What action will the nurse perform to ensure client safety? A. Warm the vial in a bowl of warm water until it reaches normal body temperature. B. Return the vial to the pharmacy and open a fresh vial of NPH insulin. C. Roll the vial between the hands until the insulin is clear. D. Check the expiration date and draw up the insulin dose.

D. Check the expiration date and draw up the insulin dose. Rationale: The character of NPH insulin is uniformly cloudy. If the expiration date has not passed it can be safely used. Insulin should never be warmed by placing the vial in water.

Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management? A. Current energy level and rest patterns B. Sexual orientation C. Current lifestyle for diet and exercise D. Education and literacy levels

D. Education and literacy levels Rationale: The most important factor for the nurse to determine before providing instruction to the newly diagnosed client with diabetes is the client's educational level and literacy level. A large amount of information must be synthesized. Written instructions are typically given. The client's ability to learn and read is essential to provide the client with instructions and information about diabetes. Although lifestyle would be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential.

For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider? A. Calf muscle cramping B. Runny nose C. Anorexia D. Hand tremors

D. Hand tremors Rationale: Hand tremors are an indication of HRT toxicity with increased central nervous system stimulation. The dose must be decreased to prevent more serious neurologic and cardiac toxicities. Anorexia, runny nose, and muscle cramping are neither side effects of the drug nor indications of toxicity.

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? A. Administering morphine for pain B. Assessing the wound dressing for bleeding C. Hyperextending the neck D. Monitoring oxygen saturation

D. Monitoring oxygen saturation Rationale: Airway assessment and management is always the first priority with every client, especially for a client who has had surgery that involves potential bleeding and edema near the trachea.

Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys? A. White blood cells (WBCs) in the urine during a random urinalysis B. Ketone bodies in the urine during acidosis C. Glucose in the urine during hyperglycemia D. Protein in the urine during a random urinalysis

D. Protein in the urine during a random urinalysis Rationale: Urine should not contain protein and the presence of proteinuria in a client with marks the beginning of renal problems known as diabetic nephropathy, that progresses eventually to end-stage renal disease. Chronically elevated blood glucose levels cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. The excess leakiness allows larger substances, such as proteins, to be filtered into the urine.

Which changing trends in a client's serum laboratory values indicate to the nurse that thyroid hormone replacement therapy for hypothyroidism is effective? A. Declining thyroglobulin (Tg) levels; rising thyrotropin receptor antibody (TRAb) levels B. Declining thyroid hormone (TH) levels; rising thyroid-stimulating hormone (TSH) levels C. Rising thyroglobulin (Tg) levels; declining thyrotropin receptor antibody (TRAb) levels D. Rising thyroid hormone (TH) levels; declining thyroid-stimulating hormone (TSH) levels

D. Rising thyroid hormone (TH) levels; declining thyroid-stimulating hormone (TSH) levels Rationale: Drug therapy for hypothyroidism hormone replacement therapy with synthetic thyroid hormones, which would result in rising TH levels. As these levels rise, the negative feedback loop, which tries to stimulate the thyroid gland to produce TH would be suppressed, causes declining TSH levels. Thyroglobulin levels are related to active thyroid tissue. In hypothyroidism, these levels are low and drug therapy does not increase them. TRAbs are not a cause of hypothyroidism and do not develop with drug therapy.

The nurse reviewing the preadmission testing laboratory values for a 62-year-old client scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding? A. The client's A1C is completely normal B. The client has type 1 diabetes mellitus C. The client has type 2 diabetes mellitus D. The client has prediabetes mellitus

D. The client has prediabetes mellitus Rationale: The normal range for A1C (glycosylated hemoglobin A1c) is between 4% and 6%, with diabetes defined as a consistent level above 6.5%. However, clients whose AIC range between 5.7% and 6.4% are considered to have prediabetes with a greatly increased risk for development of actual diabetes mellitus within the next 5 years. Thus this value is not completely normal and is of concern. A1C levels do not distinguish between type 1 and type 2 diabetes.