Endocrine and Metabolic Disorders

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? 1. "I can avoid getting sick by not becoming dehydrated and by paying attention to m need to urinate, drink, or eat more than usual." 2. "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." 3. "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." 4. "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates."

1. "I can avoid getting sick by not becoming dehydrated and by paying attention to m need to urinate, drink, or eat more than usual." RATIONALE: The client stating that he'll remain hydrated and pay attention to his eating, drinking, and voiding needs indicates understanding of HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of non diet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral anti diabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate at the client's condition, particularly if fluid intake is low.

A client with adrenal hypofunction has been asked to participate in a research study for a new medication. The client is unsure about participating in the study. What would be an appropriate response for the nurse to make to this client? 1. "You have the right to refuse to participate in the study." 2. "You have a responsibility to other patients to participate in the study." 3. "You will get money to participate in the study." 4. "You will get free health care if you participate in the study."

1. "You have the right to refuse to participate in the study." RATIONALES: The client has the right to refuse to participate in a research study. The nurse should not make the client feel guilty by stating that the client has a responsibility to other clients. The nurse may not know the details of the research study, such as whether the client will get paid or get free health care for participating. Making these statements wouldn't be appropriate.

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: 1. muscle weakness. 2. tremors. 3. diaphoresis. 4. constipation.

1. muscle weakness. RATIONALE: Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis and constipation aren't seen in hyperkalemia.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1. 2 to 5 g of a simple carbohydrate. 2. 10 to 15 g of a simple carbohydrate. 3. 18 to 20 g of a simple carbohydrate. 4. 25 to 30 g of a simple carbohydrate.

2. 10 to 15 g of a simple carbohydrate. RATIONALES: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis. Which statements by the client indicate that client teaching has been effective? Select all that apply. 1. "I have to take m steroids for 10 days." 2. "I need to weigh myself daily to be sure I don't eat too many calories." 3. "I need to call my physician to discuss my steroid needs before I have dental work." 4. "I'll call the physician if I suddenly feel profoundly weak or dizzy." 5. "If I feel like I have the flu, I'll carry on as usual because this is an expected response." 6. "I need to obtain and wear a Medic Alert bracelet."

3. "I need to call my physician to discuss my steroid needs before I have dental work." 4. "I'll call the physician if I suddenly feel profoundly weak or dizzy." 6. "I need to obtain and wear a Medic Alert bracelet." RATIONALE: Dental work can be a cause of physical stress; therefore, the client's physician needs to be informed about the dental work and an adjusted dosage of steroids may be necessary. Fatigue, weakness, and dizziness are symptoms of inadequate dosing of steroid therapy; the physician should be noticed if these symptoms occur. A Medic Alert bracelet allows health care providers to access the client's history of Addison's disease if the client is unable to communicate this information. Daily weights should be monitored to monitor changes in fluid balance, not calorie intake. Influenza is an added physical stressor and the client may require an increased dosage of steroids. The client shouldn't "carry on as usual."

A client is taking an oral antidiabetic agent, to treat type 2 diabetes. Which statement indicates the need for further client teaching about treatment of this disease? 1. "I always carry hard candy to eat in case my blood sugar level drops." 2. "I avoid exposure to the sun as much as possible." 3. "I always wear my medical identification bracelet." 4. "I often skip lunch because I don't feel hungry."

4. "I often skip lunch because I don't feel hungry." RATIONALES: A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

A client is diagnosed with diabetes mellitus. Which data collection finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? 1. Recent weight gain of 20 lb (9 kg) 2. Failure to monitor blood glucose levels 3. Skipping insulin doses during illness 4. Crying whenever diabetes is mentioned

4. Crying whenever diabetes is mentioned RATIONALES: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? 1. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess 2. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing 3. Disturbed body image related to weight gain and edema 4. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

4. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess RATIONALES: In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options 2 and 3 may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? 1. Methimazole (Tapazole) 2. Thyroid USP desiccated (Thyroid USP Enseals) 3. Liothyronine (Cytomel) 4. Levothyroxine (Synthroid)

4. Levothyroxine (Synthroid) RATIONALES: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content gives it predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

For a client with Graves' disease, which nursing intervention promotes comfort? 1. Restricting intake of oral fluids 2. Placing extra blankets on the client's bed 3. Limiting intake of high-carbohydrate foods 4. Maintaining room temperature in the low-normal range

4. Maintaining room temperature in the low-normal range RATIONALES: Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.