Endocrine and Metabolic Disorders

An older child has received diet instruction as part of the treatment plan fro type 1 diabetes. Which statement by the older child indicates to the nurse the need for additional instruction?

"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."

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 avoid coughing, sneezing, and blowing your nose."

"During preoperative teaching for a client who will undergo a subtotal thyroidectomy, the nurse should include which statement?

"You must avoid hyperextending your neck after surgery"

A child is diagnosed with diabetes insipidus. Which characteristics will the nurse recognize in the health history?

Abrupt onset of polyuria, nocturia, and polydipsia

A client reports muscle weakness, anorexia, and darkening of the skin. The nurse reviews laboratory data and notes findings of low serum sodium and high serum potassium levels. The nurse recognizes these signs and symptoms as associated with which condition?

Addison's disease

Which of the following does the nurse incorporate in her teaching about the most common cause of hyperaldosteronism?

An adrenal adenoma

A nurse records a client's finger stick 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?

Assess both clients, and call the appropriate healthcare providers to notify them of the errors.

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

When plotting height and weight on a growth chart, which observation by the nurse would indicate that a 4 year old child has a growth hormone deficiency?

Downward shift of 2 percentiles or more

Which condition could possibly cause hypoglycemia?

Excessive exercise without a carbohydrate snack

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the clients efforts, the nurse is preparing to draw laboratory values. Which laboratory test should the nurse perform?

Glycosylated Hemoglobin Level

A client is diagnosed with pituitary gigantism. The nurse reviews the laboratory findings of which hormone value?

Growth Hormone

The physician diagnoses type 1 diabetes in a client who has classic manifestations of the disease and a random blood glucose level of 350 mg/dl. In addition to dietary modifications, the physician prescribes insulin. Initially, most clients receive the least antigenic form of insulin. Therefore, the nurse expects the physician to prescribe...

Human Insulin

A client with type 1 diabetes has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension to be taken before breakfast. At about 4:30 p.m (1630) the client experiences headache, sweating, tremor, pallor, and pallor, and nervousness. What is the most probable causes of these signs and symptoms.

Hypoglycemia

A nurse is preparing to administer regular insulin 4 units subcutaneously to client with type 1 diabetes. Which equipment does the nurse need to preform the injection?

Insulin Syringe 27 Gauge, 1/2-inch Needle medication administration record

The nurse admits a client diagnosed with hypothyroidism. The nurse expects the client to report which health concerns?

Puffiness of the face and hands

A client with diabetes insipidus has had limited fluid intake over the past 12 hours. For which complications should the nurse monitor the client?

Severe dehydration and hypernatremia

A client with a family history of diabetes asks the nurse which measures can be practiced to decrease the chance of developing the disease. Which statement would be the nurse's BEST response?

Start a moderate exercise program

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse obtains data from the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

Thyroid Crisis

A health care provider prescribes diet, exercise, and oral anti-diabetic agents for a client with diabetes. Which type of diabetes will the nurse reinforce educating the client about?

Type 2 Diabetes

The nurse is assigned to care for the following clients. Which client should the nurse see first?

a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute

A client has been admitted after reporting acute abdominal pain in the mid-epigastric region, back tenderness, nausea, and vomiting. The nurse recognizes these findings to be associated with which condition?

acute pancreatitis

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter is measured with the dexamethasone suppression test?

cortisol levels before and after the system is challenged with a synthetic steroid

The nurse is reinforcing education with parents of a child with growth hormone deficiency. What sport should the nurse encourage?

gymnastics

A nurse is caring for a client with pheochromocytoma. What is the most important intervention by the nurse?

promoting an environment free from emotional distress

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

The nurse is caring for a client who developed ketoacidosis. Which prescribed treatment does the nurse anticipate administering?

insulin and IV fluids

A nurse reviews the laboratory data of a client. The data reveals increased blood and urine levels of Triiodothyronine (T3) and Thyroxine (T4). The nurse determines these values are associated with which condition

Hyperthyroidism

"A client with primary diabetes insipidus is prescribed desmopressin (DDAVP). Which instruction should the nurse provide before the client is discharged?

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage"

A client whose physical findings suggest a hypopituitary 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 avoid coughing, sneezing, and blowing your nose."

The nurse is assessing a client with Cushing's Syndrome. Which observation should the nurse report to the physician immediately?

An irregular Apical Pulse

A client brings her food journal containing her dietary intake for the past 3 days to the diabetic clinic. A nurse notes that despite dietary teaching about carbohydrate intake, the client consumed 3 servings of bread each day. What should the nurse do with this information?

Ask the diabetes educator to review with the client ways to decrease carbohydrate intake.

A home care nurse is making a visit with a client who has a colostomy. While the nurse is changing the client's appliance, the client's next-door neighbor wants to visit. Which intervention by the nurse is most appropriate? Select all that apply.

Ask the neighbor to come back in 20 minutes. Have the neighbor wait in the next room until the appliance is changed.

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which medication should the nurse anticipate administering?

Calcium Gluconate

The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?

Calibrate the machine after installing a new battery

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?

Cushing Syndrome

When teaching a client about insulin administration, the nurse should include which instruction?

Draw up clear insulin first when mixing two types of insulin in one syringe

Which outcome indicates that treatment of a client with diabetes insipidus has been effective?

Fluid intake is less than 2,500 ml/day

A client, age 23, is diagnosed with type 1 diabetes. The physician prescribes 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles the appropriate equipment, washes her hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use?

Inject 35 units of air into the NPH vial; inject 15 units of air into the regular insulin vial and withdraw 15 units of regular insulin; and withdraw 35 units of NPH.

The newly diagnosed diabetes mellitus client is to receive his first insulin dose. The nurse administers the insulin into his abdomen. How does absorption at the abdominal site compare to absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

The nurse is caring for a client suspected to have an endocrine disorder. Which clinical manifestations are common are common for an endocrine disorder?

Intolerance to Heat or Cold Altered sleep patterns Change in sexual function/characteristics

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). The client becomes confused and develops crackles and dyspnea. What is the priority action of the nurse?

Notify the health care provider.

A nurse is evaluating a client for signs of hypoxemia. Which diagnostic procedure would the nurse expect to perform FIRST to monitor the client's respiratory status?

Pulse Oximetry

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, complete the proper paperwork, and meet with the unit manager.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneous (SC). She awakens in 5 minutes. Why should her husband offer a complex carbohydrate term-5snack to her as soon as possible?

To restore liver glycogen and prevent secondary hypoglycemia

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

"A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:

Trousseau's Sign

An older adult client who has recently been diagnosed with hypothyroidism lives independently in an apartment in a community development designed for older adults. The clients asks the nurse assigned to the complex for advice about managing this condition. What is the BEST response by the nurse?

Increase fiber and fluids in your diet

A clients blood sugar is 185 mg/dl. Two hours have passed since the client has breakfast. Which test should the nurse review that would yield the most conclusive diagnostic information about the clients glucose utilization?

Serum glycosylated hemoglobin (HbA1c)

A client experiences polydipsia and voiding large amounts of waterlike urine with a specific gravity of 1.003. What do these clinical manifestations indicate to the nurse?

diabetes insipidus

A client with hyperthyroidism develops high fever, extreme tachycardia, and altered mental status. Which condition does the nurse suspect is developing?

thyroid storm