Endocrine and Metabolic Disorders

The nurse is teaching a client with type I diabetes self-administration of insulin. Which statement by the client would be an expected outcome of the teaching session? Select all that apply.

"I need to make sure that I eat my meals and snacks on time after I take my insulin." "If I monitor and control my blood glucose levels carefully, there is less likelihood of suffering long-term complications." "If I exercise more than is normal, there is a risk that I might become hypoglycemic."

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?

"Ketones will tell us if your body is using other tissues for energy."

The health care provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. The nurse should tell the client:

"You do not mix insulin detemir; the solution is clear."

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.

5

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

Adrenal cortex

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise for thirty minutes. Which of the exercise frequency would meet the goals of planned exercise?

At least five times per week

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 would the nurse assess on the dexamethasone suppression test?

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

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?

Decreased cardiac output

A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose?

Goiter

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply.

Numbness Tingling Muscle twitching and spasms

A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus?

Obtaining, reporting, and documenting fingerstick glucose levels

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl (26.1 mmol/L). Which finding is most likely to accompany this blood glucose level?

Rapid, thready pulse

While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that she forgot to administer insulin to client with diabetes mellitus. She's made numerous errors in the past few weeks and is now afraid her job is in jeopardy. What is her best course of action?

Report the error, complete the proper paperwork, and meet with the unit manager

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?

Restricting fluids to 800 ml/day

A client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases?

Serum bicarbonate of 28 mEq/L

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids?

The importance of watching for signs of hyperglycemia.

A client with diabetes mellitus has a foot ulcer. The physician orders bed rest, a wet-to-damp dressing change every shift, and blood glucose monitoring before meals and at bedtime. Why are wet-to-damp dressings used for this client?

They debride the wound and promote healing by secondary intention.

A client with diabetes has been diagnosed with hypertension, and the health care provider (HCP) has prescribed atenolol, a beta-blocker. When performing discharge teaching, it is important for the nurse to emphasize that the addition of atenolol can cause:

an increase in the hypoglycemic effects of insulin

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

consuming a low-carbohydrate, high-protein diet and avoiding fasting.

The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel?

decreasing contact with blood and blood-contaminated fluids

The nurse should assess a client taking chlorpropamide for:

hypoglycemia.

Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, the nurse should recommend that the client:

maintain a regular program of weight-bearing exercise.

A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:

performing capillary glucose testing every 4 hours.

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately report:

sore throat

When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to:

take glipizide 30 minutes before breakfast.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

tetany

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering:

vasopressin.

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect?

with each meal and snack

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication?

with meals or with an antacid

The nurse is receiving results of a blood glucose level from the laboratory over the telephone. The nurse should:

write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller.

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:

myxedema coma.

The nurse should teach the diabetic client that which is most indicative of hypoglycemia?

nervousness

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?

70% NPH insulin and 30% regular insulin

Which nursing diagnosis takes highest priority for a client with hyperthyroidism?

Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results below, how would the nurse interpret the client's acid-base balance?

Metabolic acidosis.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?

Serum potassium level of 5.8 mEq/L (5.8 mmol/L)

The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply.

Serum sodium level Serum potassium level Blood glucose level White blood cell count

Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. The nurse is aware that the client is at increased risk for hypothyroidism. Which signs and symptoms would the nurse anticipate in a client with hypothyroidism? Select all that apply.

Hair loss. Dry skin. Cold intolerance. Fatigue.

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 the condition and how to control it?

"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual."

The nurse is assessing a client with hepatitis A and notices that the aspartate transaminase (AST) and alanine transaminase (ALT) lab values have increased. Which statement by the client indicates the need for further instruction by the nurse?

"I take acetaminophen for arthritis pain."

The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?

0100, while sleeping.

On a medical-surgical floor, a nurse is caring for a cluster of clients with diabetes mellitus. Which client should the nurse assess first?

A 55-year-old complaining of chest pressure

The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. Which of the following would be expected findings?

Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet

The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for Hydrocortisone 100 mg intravenously at a rate of 10 cc/hour for a client in acute adrenal crisis. The nurse is most correct to understand that this treatment is common in clients with which disease process?

Addison's disease

When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the nurse would expect which urine characteristics to be abnormal? Select all that apply.

Amount Odor Glucose level Ketone bodies

During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should:

Check with the physician for his complete order.

The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply.

Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.

Upon shift report, the nurse learns the following laboratory values: pH, 7.44; PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance is the client most likely experiencing?

Compensated respiratory alkalosis

Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease?

an abnormality in the body's mucus-secreting glands

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client? Select all that apply.

Excessive thirst Excessive hunger Frequent, high-volume urination

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?

Related to bone demineralization resulting in pathologic fractures

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?

Sweating, tremors, and tachycardia

After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide:

at breakfast

An elderly client with type 2 diabetes had hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent:

cerebral edema.

When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should:

inject air in the vial with the long-acting insulin first.

The nurse should teach the client with chronic pancreatitis to monitor the effectiveness of pancreatic enzyme replacement therapy by:

observing stools for steatorrhea.

A client with insulin-dependent diabetes develops a seizure disorder and has been prescribed phenytoin. Which information should the nurse include in the teaching plan? The client should: (Select all that apply.

report changes in blood glucose levels to the health care provider. use a soft toothbrush and floss the teeth daily

Which instruction about levothyroxine administration should a nurse teach a client?

"Take the drug on an empty stomach."

The nurse is evaluating a client with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which statement from the client indicates the drug is effective?

"I am able to sleep and rest at night."

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."

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, (2.3 mmol/L) and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

15 g of a simple carbohydrate

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?

Bicarbonate

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?

Cerebral edema

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus

Confusion and seizures

A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply.

High-fiber, low-calorie diet Use of stool softeners Thyroid hormone replacements

The nurse is caring for a client on the urinary unit. When providing report to the next shift, it is noted that the client has osteopenia and history of renal calculi. Which of the following disorders would the nurse suspect?

Hyperparathyroidism

The nurse is caring for a client in a diabetic coma. The nurse is aware that this is caused by an excess of which substance in the blood

Ketones from rapid fat breakdown, causing acidosis

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer?

Lactated Ringer's solution

Which intervention is the most critical for a client with myxedema coma?

Maintaining a patent airway

For a client with Graves' disease, which nursing intervention promotes comfort?

Maintaining room temperature in the low-normal range

A male client expresses concern about how a hypophysectomy will affect his sexual function. Which statement provides the most accurate information about the physiologic effects of hypophysectomy in a male?

Removing the source of excess hormone should restore the client's libido, erectile function, and fertility.

The nurse is educating a client on diabetes management. The client is asking questions that cause the nurse to be concerned about the client's ability to retain the information. Which of the following would be the best technique for the nurse to use to enhance the retention of information by the client?

Repeat important information during the presentation.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?

Restrict sodium.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

Restricting fluids

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

Serum glycosylated hemoglobin (Hb A1c)

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?

Tachycardia

A nurse is teaching a client with diabetes mellitus about self-management. Which of the following would be correct about the administration of lispro insulin?

Take the insulin at around the same time each day at a meal.

For a client with hyperthyroidism, treatment is most likely to include:

a thyroid hormone antagonist

The nurse is teaching the client to self-administer insulin. Learning goals most likely will be attained when they are established by the:

client, nurse, pharmacist, and health care provider so the client can participate in planning care with the entire team.

The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy?

hypopituitarism

The nurse should teach the client with hepatitis A to:

increase carbohydrates and protein in the diet.

Which action is most effective when a nurse is assessing the client suspected of developing diabetes insipidus

measuring urine output hourly

he client who has been hospitalized with pancreatitis does not drink alcohol because of religious convictions. The client comes upset when the health care provider (HCP) persists in asking about alcohol intake. The nurse should explain that the reason for these questions is that:

there is a strong link between alcohol use and acute pancreatitis

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?

Initiate fluid replacement therapy

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?

"Test your blood glucose every 4 hours."

An adolescent is to receive radioactive iodine for Graves' disease. Which statement by the client reflects the need for more teaching?

"The advantage of radioactive iodine is that I will not need future medication for my disease."

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, a problem that was accompanied by a random blood glucose reading of 31.9 mmol/L (575 mg/dL), vomiting, and shortness of breath. This client has experienced which of the following phenomena?

Exacerbation

A nurse should perform which intervention for a client with Cushing's syndrome?

Explain that the client's physical changes are a result of excessive corticosteroids.

A client recently diagnosed with hyperparathyroidism demands to see what the physician has written about him in the chart. What is the nurse's best response?

"I'll get the chart and set up a time for you to review it with your physician."

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

Glucagon

A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?

"I will increase my fluid and calcium intake."

The nurse is teaching a client about insulin administration. Which statement if made by a client would indicate to the nurse the client understands insulin administration teaching?

"I will use my abdominal injection site if I want to jog."

Because of steroid excess after a bilateral adrenalectomy, the nurse should assess the client for:

delayed wound healing

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. The nurse should assess this client for:

tachycardia

Which of the following client statements during a health history would indicate to the nurse that immediate further investigation is warranted?

"No matter how much I drink, I am still thirsty all the time."

A client is brought to the emergency department after wandering on the street. The client is confused, verbalizes double vision, headache, and shakiness. Laboratory data reveal a serum blood glucose of 52 mg/dL (52 mmol/L). Which questions, asked by the nurse, may reveal more data related to the client's condition? Select all that apply.

"What have you eaten today?" "Do you take insulin or oral antidiabetic medication?" "Have you ever felt this way before?"

A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

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

A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?

Acromegaly

A client is ordered prednisone daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning?

Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolbutamide. Which laboratory test is the most important for confirming this disorder?

Serum osmolarity

A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do?

Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should assess the client for which alteration in fluid and electrolyte balance?

decreased serum sodium level

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 client's efforts, the nurse should check:

glycosylated hemoglobin level.

The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation?

having wisdom teeth extracted

A nurse is teaching an 8-year-old with diabetes and her parents about managing diabetes during illness. The nurse determines the parents understand the instruction when they indicate that when the child is ill they will provide:

more insulin.

When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about which change in the menstrual cycle?

oligomenorrhea

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:

phosphorus.

When a client demonstrates the technique for self-administering NPH insulin, which action indicates that the client needs additional teaching?

pulling back on the syringe plunger as soon as the needle is in subcutaneous tissue

Which finding should the nurse report to the client's health care provider (HCP) for a client with unstable type 1 diabetes mellitus? Select all that apply

systolic blood pressure, 145 mm Hg diastolic blood pressure, 87 mm Hg high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) glycosylated hemoglobin (HbA1c), 10.2% (0.1) triglycerides, 425 mg/dL (23.6 mmol/L

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?

"Maintain a moderate exercise program."

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?

Hypercalcemia

Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m. (1400), the client has a capillary glucose level of 250 mg/dl for which he receives 8 units of regular insulin. The nurse should expect the dose's:

onset to be at 2:30 p.m. (1430) and its peak to be at 4 p.m.(1600).

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion?

Hydrocortisone

Parathyroid hormone (PTH) has which effects on the kidney?

Stimulation of calcium reabsorption and phosphate excretion

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result

Serum sodium level of 124 mEq/L