Endocrine Disorders
A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client? 1. postoperative confusion 2. delayed wound healing 3. emboli 4. malnutrition
2. delayed wound healing Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy. Nutritional status should be regained postoperatively.
Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The client is not able to make a sound. The nurse determines that the client is experiencing which complication of the surgery? 1. internal hemorrhage 2. decreasing level of consciousness 3. laryngeal nerve damage 4. upper airway obstruction
3. laryngeal nerve damage Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the health care provider (HCP) immediately. Internal hemorrhage is detected by changes in vital signs. The client's level of consciousness can be partially assessed by asking her to speak, but that is not the primary reason for doing so in this situation. Upper airway obstruction is detected by color and respiratory rate and pattern.
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? 1. elevated serum acetone level 2. serum ketone bodies 3. serum alkalosis 4. below-normal serum potassium level
4. below-normal serum potassium level A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. 1. hyperkalemia 2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection 6. hypotension
skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reabsorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. CNS adverse effects are euphoria, headache, insomnia, confusion, and psychosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress the cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.
A client with diabetes has been diagnosed with hypertension, and the health care provider has prescribed atenolol, a beta-blocker. When teaching the client about the drug, what should the nurse tell the client about how it may interact with the client's diabetes? Atenol may cause: 1. a decrease in the hypoglycemic effects of insulin. 2. an increase in the hypoglycemic effects of insulin. 3. an increase in the incidence of ketoacidosis. 4. a decrease in the incidence of ketoacidosis.
2. an increase in the hypoglycemic effects of insulin. There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for increased hypoglycemic effects of insulin when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored. Ketoacidosis occurs in hyperglycemia. Although a decrease in the incidence of ketoacidosis could occur when a beta blocker is added, the direct result is an increase in the hypoglycemic effect of insulin.
The nurse is teaching the family and a client newly diagnosed with type 1 diabetes how diet and exercise affect insulin requirements. Which statement made by the client indicates understanding of the teaching? 1. "I will need more insulin and food when exercising." 2. "Exercise will decrease my insulin need and decrease my food requirements." 3. "An exercise regimen may cause me to eliminate my bedtime snack." 4. "I can remove my insulin pump when exercising."
4. "I can remove my insulin pump when exercising." The nurse should advise the client that exercise will lower blood sugar and a snack should be eaten prior to exercise. It is recommended that the insulin pump be removed during exercise because it can become dislodged. The diabetic client will typically need less insulin and more food during times of exercise as exercise decreases insulin resistance.
Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? 1. hypokalemia and hypoglycemia 2. hypocalcemia and hyperkalemia 3. hyperkalemia and hyperglycemia 4. hypernatremia and hypercalcemia
1. hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? 1. weight loss, increased appetite, and hyperdefecation 2. weight loss, increased urination, and increased thirst 3. weight gain, decreased appetite, and constipation 4. weight gain, increased urination, and purplish-red striae
3. weight gain, decreased appetite, and constipation Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.
When auscultating an arteriovenous (AV) fistula, a bruit is noted. What is the appropriate action by the nurse? 1. Document the presence of a bruit. 2. Contact the healthcare provider. 3. Assess for signs and symptoms of infection. 4. Assess for signs and symptoms of fluid overload.
1. Document the presence of a bruit. When auscultating an AV fistula, a bruit is an expected finding.The nurse should document the presence of the bruit. While assessing for signs and symptoms of infection at the fistula site is part of the assessment of a hemodialysis client, doing so does not address the finding of a bruit, which is asked in the question. A bruit is not indicative of fluid overload so there is no indication to assess for fluid overload at this time.
A nurse obtains a fingerstick glucose level of 45 mg/dl (2.47 mmol/L) on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? 1. give the client 4 oz (120 mL) of milk and a graham cracker with peanut butter. 2. obtain a serum glucose level. 3. obtain a repeat fingerstick glucose level. 4. notify the physician.
3. obtain a repeat fingerstick glucose level. The nurse should recheck the fingerstick glucose level to verify the original result because the client isn't exhibiting signs of hypoglycemia. The nurse should give the client milk and a graham cracker with peanut butter or a glass of orange juice after confirming the low glucose level. It isn't necessary to notify the physician or to obtain a serum glucose level at this time.
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? 1. "I can avoid getting sick by not becoming dehydrated and by paying attention to my 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 should be sure to limit my food and fluid intake when I'm not feeling well so my blood sugar doesn't go up." 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 my need to urinate, drink, or eat more than usual." Stating the need to remain hydrated and pay attention to eating, drinking, and voiding needs indicates that the client understands 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 nondiet soda would be appropriate for hypoglycemia. Limiting fluids will exacerbate the development of HHNS; limiting food might be acceptable, but it may lead to ketosis. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.
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. 1. serum sodium level 2. hemoglobin and hematocrit 3. serum potassium level 4. blood glucose level 5. white blood cell count 6. creatinine clearance total
1. serum sodium level 3. serum potassium level 4. blood glucose level 5. white blood cell count Cushing's disease results in an excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. Electrolyte disturbance is common for the nurse to report. Sodium retention is typically accompanied by potassium depletion. Clients exhibit frequent hyperglycemia. The white blood cell count is commonly elevated because of an increased number of neutrophils. There is no impact of the hemoglobin or hematocrit or kidney function.
The nursing is caring for a newly admitted client with diabetes insipidus. When forming the plan of care, which nursing diagnoses are anticipated? Select all that apply. 1. fluid volume, excess 2. anxiety 3. impaired physical mobility 4. self-care deficit 5. activity intolerance 6. hyperglycemia
2. anxiety 5. activity intolerance Diabetes insipidus is characterized by excessive output of dilute urine. Common signs and symptoms include massive diuresis, dehydration, and thirst. Additional findings include malaise, lethargy, and irritability. Nursing diagnoses that aim at providing interventions to decrease the symptoms include Anxiety (irritability) and activity intolerance (due to lethargy). The client has a fluid volume deficit due to the excessive output of urine. Though the client urinates frequently, there is no reason to believe that there is an impaired physical mobility or self-care deficit. A client has symptoms of hyperglycemia with diabetes mellitus.
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? 1. encouraging coughing and deep breathing 2. promoting carbohydrate intake 3. limiting fluid intake 4. providing pain-relief measures
3. limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.
The nurse finds a client in a long term care facility, after the evening meal, to be unresponsive with cold, clammy skin to touch. A finger stick blood glucose level reveals 21 mg/dL. What are the nurse's immediate priority actions? Select all that apply. 1. Encourage the client to drink orange juice. 2. Alert the family to the change in condition after the client is stable. 3. Identify if the client has clear breath sounds. 4. Notify the healthcare provider of hypoglycemic event. 5. Administer as needed glucagon 1 mg intramuscularly now.
4. Notify the healthcare provider of hypoglycemic event. 5. Administer as needed glucagon 1 mg intramuscularly now. The nurse will need to notify the healthcare provider of the hypoglycemia. The nurse will also need to treat the hypoglycemia with glucagon 1mg IM now. The client is unresponsive and will not be able to drink orange juice. Breath sounds are not a priority during hypoglycemia. The family will be notified of change of condition when the client is stable, but this is not the priority action.
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? 1. serum potassium level 2.serum sodium level 3.arterial blood gas (ABG) values 4. serum osmolarity
4. serum osmolarity Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.
