Endocrine and Metabolic Disorders
When teaching a client about insulin administration, the nurse should include which instruction? "Inject insulin at a 45-degree angle into the deltoid muscle." "Shake the insulin vial vigorously before withdrawing the medication." "Administer insulin after the first meal of the day." "Draw up clear insulin first when mixing two types of insulin in one syringe."
"Draw up clear insulin first when mixing two types of insulin in one syringe."
The nurse is collecting data from an older adult client being screened for hypothyroidism. Which statement by the nurse demonstrates understanding the effects of aging? "Older adults receiving thyroid replacement drugs have a decreased risk of adverse reactions." "Older adults diagnosed with hypothyroidism require larger doses of thyroid replacement." "Hypothyroidism can be difficult to diagnose in older adults because symptoms may resemble normal aging." "Thyroid disorders are rare in the older adult population."
"Hypothyroidism can be difficult to diagnose in older adults because symptoms may resemble normal aging."
An older child has received diet instruction as part of the treatment plan for type 1 diabetes. Which statement by the older child indicates to the nurse the need for additional instruction? "I should eat meals as scheduled, even if I'm not hungry, to prevent hypoglycemia." "I can have an occasional low-calorie drink as long as I include it in my meal plan." "I can eat whatever I want as long as I cover the calories with sufficient insulin." "I will need a bedtime snack because I take an evening dose of NPH insulin."
"I can eat whatever I want as long as I cover the calories with sufficient insulin."
A client with type 1 diabetes must learn how to self-administer insulin. The physician has prescribed 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Rotate injection sites within the same anatomic region, not among different regions." "Inject insulin into healthy tissue with large blood vessels and nerves." "Administer insulin into sites above muscles that you plan to exercise heavily later that day." "Administer insulin into areas of scar tissue or hypotrophy whenever possible."
"Rotate injection sites within the same anatomic region, not among different regions."
A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? "You must report ringing in your ears immediately." "You must lie flat for 24 hours after surgery." "You must restrict your fluid intake." "You must avoid coughing, sneezing, and blowing your nose."
"You must avoid coughing, sneezing, and blowing your nose."
After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl. The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take glyburide: at bedtime. 30 minutes before breakfast. 30 minutes after dinner. in the mid-morning.
30 minutes before breakfast.
A client who is diagnosed with hyperthyroidism is admitted to the hospital. The nurse anticipates that the client's treatment is most likely to include which medication? A synthetic thyroid hormone A thyroid hormone antagonist Emollient lotions Thyroid extract
A thyroid hormone antagonist
The nurse is teaching the client about risk factors for diabetes mellitus. Which risk factor for diabetes mellitus is nonmodifiable? Current or recent foot trauma Inappropriate foot care Poor control of blood glucose levels Advanced age
Advanced age
When providing information about treatment of diabetes insipidus to parents, a nurse explains the use of nasal spray and injections. Which indication might deter a parent from choosing nasal spray treatment? Applications must be repeated every 8 to 12 hours. Applications must be repeated every 2 to 4 hours. Measurements are too difficult. Nasal sprays can't be used on infants.
Applications must be repeated every 8 to 12 hours.
A nurse records a client's fingerstick blood glucose level and gives 2 units of regular insulin as ordered. At the next scheduled blood glucose assessment, the nurse realizes that the wrong client was tested and given insulin. What is the nurse's priority action related to this incident? Recheck blood glucose levels, and then determine whether the healthcare providers need to be notified. Notify the charge nurse of the error, and document it in the client's chart. Assess both clients, and call the appropriate healthcare providers to notify them of the errors. Explain the error to the client, and document it in the client's chart.
Assess both clients, and call the appropriate healthcare providers to notify them of the errors.
Which intervention should the nurse perform when caring for a client who is being treated for hyperthyroidism? Balance the client's periods of activity and rest. Encourage the client to ambulate to prevent constipation. Provide extra blankets and clothing to keep the client warm. Monitor the client for signs of restlessness and sweating.
Balance the client's periods of activity and rest.
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? Coma, anxiety, confusion, headache, and cool, moist skin Polyuria, polydipsia, hypotension, and hypernatremia Polyuria, polydipsia, polyphagia, and weight loss Kussmaul respirations, dry skin, hypotension, and bradycardia
Coma, anxiety, confusion, headache, and cool, moist skin
Observation of a client reveals thin extremities, but an obese truncal area and a "buffalo hump" at the shoulder area with reports of weakness and disturbed sleep. The nurse interprets this data as indicating which disorder? hyperparathyroidism Addison's disease Graves' disease Cushing syndrome
Cushing syndrome
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. The client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? Hypocalcemia Hyponatremia Hypermagnesemia Hyperkalemia
Hypocalcemia
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction would be most important to include in the client's teaching plan? Jog at least 2 miles (3.2 km) per day. Rest as much as possible. Maintain a moderate exercise program. Lose weight.
Maintain a moderate exercise program.
Which intervention is the most critical for a client with myxedema coma? Maintaining a patent airway Administering an oral dose of levothyroxine Measuring and recording accurate intake and output Warming the client with a warming blanket
Maintaining a patent airway
A client with type 2 diabetes hasn't received insulin coverage for his afternoon blood glucose levels for 2 days. After further investigation, a nurse discovers that the afternoon blood glucose levels were phoned in from the laboratory but weren't documented in the client's medical record. What should the nurse do with this information? Call the responsible individual at home and discuss the reason for her failure to document the client's blood glucose levels. Administer insulin with the next afternoon glucose level. Notify the physician and complete an incident report. Leave a note on the chart for the physician informing him of the name of the nurse who didn't document the blood glucose results.
Notify the physician and complete an incident report.
A child is diagnosed with diabetes insipidus has developed a viral illness including congestion, nausea, and vomiting. What instructions should the nurse reinforce? Make no changes in the medication regimen. Give medications only once per day. Give medication 1 hour after vomiting has occurred. Obtain an alternate route for desmopressin acetate administration.
Obtain an alternate route for desmopressin acetate administration.
While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that the nurse forgot to administer insulin to client with diabetes mellitus. The nurse has made numerous errors in the past few weeks and is now afraid this job is in jeopardy. What is the best course of action? Report the error and request a private meeting with the unit manager. Contact the physician and follow their instructions. Administer the medication immediately and chart it as given on time. Report the error, complete the proper paperwork, and meet with the unit manager.
Report the error, complete the proper paperwork, and meet with the unit manager.
A client with type 2 diabetes was diagnosed with retinopathy. While a nurse reviews the client's medication dosage, the client states, "I can't read the names on the medicine bottles, so I hope I'm taking the right pills at the right time." What should the nurse do with this information? Teach the client how to tell the difference between the medicine bottles. Ask the physician if there's any way that the number of medications for the client can be reduced. Document the client's concerns in the medical record. Tell the client's son.
Teach the client how to tell the difference between the medicine bottles.
A client is being returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? Tracheostomy set Cardiac monitor Indwelling urinary catheter kit Humidifier
Tracheostomy set
The nurse is assigned to care for the following clients. Which client should the nurse see first? a client diagnosed with Graves disease and a heart rate of 94 beats per minute a client diagnosed with type 2 diabetes and a glucose level of 137 mg/dL a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute a client diagnosed with Cushing disease and 1+ edema
a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute
A child is diagnosed with diabetes insipidus. Which characteristics will the nurse recognize in the health history? gradual onset of personality changes, lethargy, and blurred vision delayed closure of the fontanels, coarse hair, and hypoglycemia in the morning abrupt onset of polyuria, nocturia, and polydipsia vomiting early in the morning, headache, and decreased thirst
abrupt onset of polyuria, nocturia, and polydipsia
The client is being evaluated for hypothyroidism. The nurse should stay alert for: systolic murmur at the left sternal border. exophthalmos and conjunctival redness. decreased body temperature and cold intolerance. flushed, warm, moist skin.
decreased body temperature and cold intolerance.
The nurse is collecting data on a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: deposits of adipose tissue in the trunk and dorsocervical area. thick, coarse skin. hypotension. weight gain in arms and legs.
deposits of adipose tissue in the trunk and dorsocervical area.
A client with a history of diabetes has serum ketones and a serum glucose level above 300 mg/dL. Which condition does the nurse expect is the cause? Somogyi phenomenon hypoglycemia diabetes insipidus diabetic ketoacidosis
diabetic ketoacidosis
The nurse is caring for a client with type I diabetes who does not adhere to an insulin regimen regularly. The nurse identifies that the client is at risk for which complication? diabetic ketoacidosis hypoglycemia respiratory failure pancreatitis
diabetic ketoacidosis
After a client is admitted with an adrenal malfunction, the nurse demonstrates an understanding of the function of the adrenal gland by identifying which hormones as being released by the adrenal medulla? glucocorticoids, mineralocorticoids, and androgens epinephrine and norepinephrine insulin, glucagon, and somatostatin thyroxine (T4), triiodothyronine (T3), and calcitonin
epinephrine and norepinephrine
A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings will the nurse most likely observe in this client? constipation urine retention excessive hunger excessive thirst weight gain Frequent, high-volume urination
excessive thirst excessive hunger Frequent, high-volume urination
Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for: hypoglycemia. hypocortisolism. hyperglycemia. hypercalcemia.
hypocortisolism
A client with hyperparathyroidism develops renal calculi. The nurse should expect to see which electrolyte levels? increased potassium levels increased calcium levels decreased calcium levels increased magnesium levels
increased calcium levels
Which method is considered the definitive treatment for hypopituitarism due to growth hormone deficiency? replacement of antidiuretic hormone treatment with testosterone or estrogen replacement with biosynthetic growth hormone treatment with desmopressin acetate
replacement with biosynthetic growth hormone
A client with hyperthyroidism develops high fever, extreme tachycardia, and altered mental status. Which condition does the nurse suspect is developing? hepatic coma thyroid storm hyperosmolar hyperglycemic nonketotic syndrome (HHNS) myxedema coma
thyroid storm
A client is diagnosed with diabetes insipidus. The nurse assists with the development of a care plan based on the understanding that which hormone is deficient? vasopressin androgen epinephrine norepinephrine
vasopressin
