Endocrine

A nurse is reinforcing dietary teaching with a client who has diabetes mellitus. Which of the following actions should the nurse take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from nonadherence to the dietary plan

B. Ask the client to identify the types of foods she prefers The nurse should apply the nursing process priority-setting framework when planning client care and prioritizing nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will help promote adherence to the dietary plan. Incorrect answers: A. The nurse should work with a registered dietitian to provide the client with appropriate materials to use during reinforcement of dietary teaching. Sample menus can be helpful in providing the client with ideas for new foods or exchanges; however, there is another action that the nurse should take first. C. The nurse should identify the recommended blood glucose range that the client should maintain through diet, medication, and lifestyle changes; however, there is another action that the nurse should take first. D. The nurse should identify the long-term complications so the client understands the importance of adherence to the dietary plan; however, there is another action that the nurse should take first.

A nurse is reinforcing teaching with a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce her total hours of sleep B. Keep her immediate environment warm C. Increase her caloric intake with meals D. Gradually increase her activity

C. Increase her caloric intake with meals. Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in a loss of protein stores and a negative nitrogen balance. Even with an increased appetite, it is often difficult to meet energy demands, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake. Incorrect answers: A. Clients who have hyperthyroidism often report an inability to sleep. A decreased attention span and mild to severe hyperactivity are common. The nurse should suggest frequent rest periods in a quiet environment. B. Clients who have hyperthyroidism often have a low-grade fever and diaphoresis due to their hypermetabolic state. A cool environment can decrease the discomfort of heat intolerance. D. Clients who have hyperthyroidism are often restless and have an increased systolic blood pressure, tachycardia, and other dysrhythmias. During the acute phase, increased activity is not an appropriate recommendation.

A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure

C. Kussmaul respirations The nurse should expect the client to experience Kussmaul respirations with DKA. These deep and rapid respirations are the body's attempt to exhale carbon dioxide to reverse the metabolic acidosis that occurs with DKA. Incorrect answers: A. The nurse should expect ketones to be present in the urine and blood of a client who has DKA due to excessive glucose production. B. Distended neck veins are not an expected finding of DKA. Signs of dehydration such as flattened neck veins, hypotension, dry skin, and sunken eyeballs are common. D. A client who has DKA is more likely to have orthostatic hypotension due to the dehydration caused by the excessive blood glucose and osmotic diuresis.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? A. "My cells are resistant to the effects of insulin" B. "My body breaks down sugars too efficiently." C. "My pancreas does not produce insulin." D. "My body produces antibodies against pancreatic beta cells."

A. "My cells are resistant to the effects of insulin" This client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells. Incorrect Answers: B. A client who has type 2 diabetes mellitus does not secrete enough insulin by the pancreatic beta cells to break down enough glucose. C. A client who has type 1 diabetes mellitus does not secrete insulin because of the destruction of beta cells by the body. Although insulin is still produced, it is of insufficient quantity to maintain homeostasis. D. The client who has type 1 diabetes mellitus has destruction of the beta cells because of the body producing blood antibodies. This is not a manifestation of type 2 diabetes mellitus.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse make? A. "Let's discuss this with your doctor; giving up pasta might not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."

C. "You don't have to give up pasta; just adjust the amount you eat." The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful evaluation of usual dietary practices and modifications is an important part of helping clients manage this disorder. Incorrect Answer: A. The nurse is capable of using resources as necessary and counseling clients about appropriate dietary choices without consulting the provider. B. The client is expressing dismay about giving up pasta. Often, there is no substitute for a food the client really enjoys. D. While a reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta and does not relate to glycemic control, which is the critical issue for this client.

A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? A. Proteinuria B. Oliguria C. Polyuria D. Glycosuria

C. Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity. Incorrect answers: A. Protein in the urine is called proteinuria and is a manifestation of kidney disease. B. Oliguria is a manifestation of kidney failure. D. Glucose in the urine is a manifestation of type 1 diabetes mellitus.

A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A. Irritability B. Excessive thirst C. Urinary frequency D. Dry mucous membranes

A. irritability A client with irritability is displaying early an manifestation of hypoglycemia for type 1 diabetes mellitus. The early manifestations include fatigue, a headache, difficulty thinking, sweating, and nausea. The others are manifestations of hyperglycemia.

A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria

B. Diaphoresis A nurse should expect a client who has a blood glucose level below 70 mg/dL to exhibit indications of hypoglycemia. Expected findings associated with hypoglycemia include weakness, hunger, diaphoresis, nausea, shakiness, and confusion Incorrect Answers: A. The nurse should expect Kussmaul respirations in a client who has hyperglycemia C. The nurse should expect dehydration and decreased skin turgor in a client who has hyperglycemia. D. The nurse should expect ketonuria in a client who has hyperglycemia.

A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicate that the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors

B. Increased urination Increased urination (polyuria) is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis. Incorrect Answers: A. Increased hunger is a manifestation of hypoglycemia due to a cholinergic response from central glucose deprivation. C. Cold, clammy skin is a manifestation of hypoglycemia due to a cholinergic response from central glucose deprivation. D. Tremulousness is a manifestation of hypoglycemia due to an adrenergic response from central glucose deprivation.

A nurse is assisting with the care of a client who has Addison's disease and was admitted with muscle weakness and dehydration, as well as nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone

C. Hydrocortisone This client with Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids such as hydrocortisone to restore hormone levels. Incorrect answers: A. Rifampin is an antiviral medication used to treat tuberculosis. B. Loperamide is an antidiarrheal agent; this client is experiencing nausea and vomiting. D. Spironolactone is a potassium-sparing diuretic. A client who has Addison's disease has increased potassium levels and low sodium levels as a result of fluid depletion. The nurse should anticipate the client receiving fluids and electrolytes to restore the volume lost.