endocrine

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A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse's best response to this question?

"There is no difference between readings."

A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What signs of common complications of diabetes might the nurse expect to identify when assessing this client? (Select all that apply.) Leg ulcers Loss of visual acuity Thick, yellow toenails Increased growth of body hair Decreased sensation in the feet

1 Leg ulcers 2 Loss of visual acuity 3 Thick, yellow toenails 5 Decreased sensation in the feet Leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy, damage to the microvascular system of the retina (e.g., edema, exudate, and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes, causing microaneurysms in the capillary walls. Thick, yellow toenails result from prolonged inadequate arterial circulation to the feet. Pedal pulses diminish, which can result in gangrene, necessitating amputation. Diabetic neuropathies affect 60% to 70% of people with diabetes. It is theorized that consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that results in impairment via an unknown process. Inadequate arterial circulation to hair follicles results in a lack of hair on the feet and ankles. The skin becomes dry and cracks, predisposing to leg ulcers and infection.

A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? (Select all that apply.)

1. Excessive Thirst 3. Dry Mucous Membrane 6. Decreased urine specific gravity Rationale As excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity (less than 1.005). Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? (Select all that apply.)

1. Tremors 4. Heat intolerance Rationale Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

A nurse is caring for a male client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? (Select all that apply.)

2. Obese trunk 4. Sleep Disturbance 5. Thin arms and legs Rationale Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Polyuria is associated with diabetes mellitus and primary aldosteronism, not Cushing syndrome. Obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome. Hypertension, not hypotension, is associated with Cushing syndrome because of sodium and water retention.

A client is taught how to recognize indications of a hypoglycemic reaction. Which signs and symptoms identified by the client indicate to the nurse that the teaching was effective? (Select all that apply.)

3. Weakness 4. Nervousness 6. Increased perspiration Weakness is related to a decrease in glucose within the central nervous system. Nervousness is caused by increased adrenergic activity and increased secretion of catecholamines. Increased perspiration is related to increased adrenergic activity and increased secretion of catecholamines. Fatigue is related to hyperglycemia, not hypoglycemia . Nausea is related to hyperglycemia, not hypoglycemia. Increased thirst with an excessive oral fluid intake (polydipsia) is associated with hyperglycemia and is one of the cardinal signs of diabetes mellitus.

During the early postoperative period after a subtotal thyroidectomy, the nursing priority is to assess for:

Airway obstruction

The nurse is assessing a client with hyperthyroidism. For which signs and symptoms should the nurse assess the client?

Amenorrhea Flushed appearance Short attention span Rationale Amenorrhea is due to hypothalamic or pituitary disturbances associated with hyperthyroidism. The skin is warm and flushed because of a hyperdynamic circulatory state. A short attention span is related to altered cerebral metabolism from excess thyroid hormones. Hypertension is associated with hyperthyroidism; hypotension is associated with hypothyroidism. Facial edema is not related to hyperthyroidism. Hypothyroidism is associated with decreased renal blood flow that results in fluid retention (e.g., peripheral and facial edema).

A female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. The nurse should base a response on the understanding that:

As long as medication is continued, ovulation will occur Rationale Medication is regulated to maintain the usual blood levels of thyroxine; therefore, ovulation is not affected, and future pregnancy is possible. The client will no longer be hyperthyroid after surgery because the overactive tissue is excised; therefore, pregnancy is not contraindicated. Pregnancy is not contraindicated after a thyroidectomy because the overactive tissue is excised. Pregnancy is not contraindicated; however, thyroid hormone therapy may have to be increased during pregnancy.

A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states, "I will:

Break in my new shoes over the course of several weeks." Rationale A slower, longer period of time to break in new, stiff shoes will help prevent blisters and skin breakdown. The toenails should be cut by a podiatrist; they usually are cut after a foot bath when the nails are softer. Soaking the feet daily for one hour will cause maceration of the skin and should be avoided. Examining the feet using a mirror at least once a week is too long a period of time; the client should examine the feet daily for signs of trauma.

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)

Emotional lability Dyspnea on exertion Abdominal distension Hyperactive deep tendon reflexes Rationale Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurological manifestation related to excessive production of thyroid hormones. Abdominal distension is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant? (Select all that apply.)

Headache Diaphoresis Excessive thirst Rationale Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

A nurse is caring for a client recently diagnosed with type 1 diabetes. For what signs and symptoms of an insulin reaction should the nurse assess this client? (Select all that apply.)

Headache Diaphoresis Nervousness Rationale Hypoglycemia affects the central nervous system, causing headache. Diaphoresis occurs in response to stimulation of the sympathetic nervous system when a person is hypoglycemic. Hypoglycemia affects the central nervous system, causing nervousness. Excessive thirst is a clinical symptom of diabetes, not an insulin reaction. Kussmaul respirations are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

A nurse is caring for a client newly admitted with a diagnosis of pheochromocytoma. Which clinical findings does the nurse expect when assessing this client? (Select all that apply.) Headache Palpitations Diaphoresis Bradycardia Hypotension

Headache, palpitations, diaphoresis Rationale A pounding headache is secondary to the severe hypertension associated with excessive amounts of catecholamines. Palpitations are associated with stimulation of the sympathetic nervous system caused by catecholamines (epinephrine and norepinephrine). Diaphoresis is associated with stimulation of the sympathetic nervous system because of excessive catecholamines. Tachycardia, not bradycardia, is associated with stimulation of the sympathetic nervous system caused by catecholamines. Hypertension, not hypotension, is the principle clinical manifestation associated with pheochromocytoma because of stimulation of the sympathetic nervous system.

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?

Hypernatremia Rationale A client with Cushing syndrome secretes excess amounts of cortisol, a corticosteroid that acts to retain sodium and water, resulting in hypernatremia and edema. Hypervolemia, not hypovolemia, is caused by fluid retention. Hypokalemia, not hyperkalemia, occurs because potassium is lost when there is sodium retention. Hyperglycemia, not hypoglycemia, results from cortisol-induced glucose intolerance.

A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing?

Ketoacidosis Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client?

Kussmaul respirations Kussmaul respirations occur in diabetic coma as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis). HHNS affects people with type 2 diabetes who still have some insulin production; the insulin prevents the breakdown of fats into ketones. Fluid loss is common to both because an increased blood glucose level ultimately leads to polyuria. Glycosuria is common to both conditions. Hyperglycemia is common to both conditions.

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response?

Less thyroid tissue is available to supply thyroid hormone after surgery. Rationale After a thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate. Hypothyroidism is decreased thyroid functioning, not a slowing of functions of the entire body. With hypothyroidism, the level of TSH from the pituitary usually is increased. Thyroid tissue remaining after surgery does not atrophy.

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease?

Mineralocorticoids Mineralocorticoids, such as aldosterone, cause the kidneys to retain sodium ions. With sodium, water is also retained, elevating blood pressure. Absence of this hormone thus causes hypotension. Estrogen is a female sex hormone produced by the ovaries; it does not affect blood pressure. Androgens are produced by the adrenal cortex. Androgens have an effect similar to that of the male sex hormones; they do not affect blood pressure. The major effect of glucocorticoids, such as hydrocortisone, is on glucose metabolism, not on sodium and water concentrations; absence of this hormone will not cause significant hypotension.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe?

Rationale Regular insulin is rapid-acting and should be used for diabetic coma . Insulin lispro is too short-acting and must be administered concurrently with longer-acting insulin. Insulin glargine is long-acting insulin, which is not indicated in an emergency. NPH insulin is intermediate-acting insulin; it is not indicated for use in an emergency.

A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider?

Reduced insulin production Oral hypoglycemics may be helpful when some functioning of the beta cells exists, as in type 2 diabetes. Rapid-acting regular insulin is needed to reverse ketoacidosis. Obesity does not offer enough information to determine the status of beta cell function. Clients with type 1 diabetes have no functioning beta cells; the necessary treatment is insulin, not an oral hypoglycemic.

A client who has type 1 diabetes is admitted to the hospital for major surgery. Before surgery the client's insulin requirements are elevated but well controlled. Postoperatively, the nurse anticipates that the client's insulin requirements will:

Remain elevated Rationale Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period. Insulin requirements will remain elevated rather than decrease. Fluctuating insulin requirements usually are associated with noncompliance, not surgery. A sharp increase in the client's insulin requirements may indicate sepsis, but this is not expected.

A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide:

Stimulates the pancreas to produce insulin Rationale Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client?

Tubular reabsorption of water increases Rationale Reabsorption of sodium and water in the kidney tubules decreases urinary output and retains body fluids. There is no effect on filtration with ADH; ADH increases reabsorption in the tubules. The opposite is true of serum osmolarity increase, urine concentration decrease, and tubular reabsorption of water increase.

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism?

Weight loss Tachycardia Restlessness Exophthalmos Rationale Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.

A client with type 1 diabetes self-administers Novolin N insulin every morning at 8 AM. The nurse evaluates that the client understands the action of the insulin when the client says, "I should be alert for signs of hypoglycemia between:

2 pm and 8 pm."

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon?

Measure the blood glucose level between 2 AM and 4 AM. During the hours of sleep, the Somogyi effect may be caused by a decline in the blood glucose level in response to too much insulin. The resulting hypoglycemia stimulates counterregulatory hormones, which precipitate lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis. Treatment involves decreasing the evening insulin. The dawn phenomenon is characterized by the release of counterregulatory hormones in the predawn hours, precipitating hyperglycemia on awakening. Treatment involves an increase in insulin. Eating a snack before going to bed should be done when insulin is taken before sleep, but it will not help to differentiate between the Somogyi effect and the dawn phenomenon. Administering the prescribed bedtime insulin immediately before going to bed depends on the insulin regimen prescribed by the health care provider and will not help to differentiate between the Somogyi effect and the dawn phenomenon. Both the Somogyi effect and the dawn phenomenon are characterized by hyperglycemia, not hypoglycemia.

A client with diabetes mellitus complains of difficulty seeing. The nurse concludes that the causative factor is:

Neovascularization of the retina Rationale With diabetes mellitus, proliferation of fragile vessels and progressive thickening of the capillary basement membranes lead to decreased retinal perfusion and hemorrhages in the eye. Hemorrhages in the eyes precipitate retinal detachment, resulting in blindness. There is an increase in serum glucose in clients with diabetes mellitus; thickening of the capillary basement membranes can occur, even if the glucose level is maintained within normal limits. Ketones do not affect retinal metabolism; retinopathy is a result of vascular changes, retinal detachment, and hemorrhage within the eye.

A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? (Select all that apply.) A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? (Select all that apply.)

Polyuria Polydipsia Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia, excessive thirst, and fluid intake are the responses to excess fluid loss related to osmotic diuresis. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL, by most standards, is within the expected range of 60-110 mg / dL. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced.

On the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports having a sore throat when swallowing. What should the nurse do first?

Administer analgesics as prescribed before meals. Soreness is to be expected. A progression to a soft diet will provide nutrients needed for healing and energy and will stimulate the return of bowel activity. Analgesics as prescribed will reduce soreness during meals. Reordering the full-fluid diet is not within the legal role of the nurse. Soreness is to be expected; this is not an emergency necessitating medical action. The soreness is not because of drying; when the client is at home, humidified air might help reduce the soreness, but it will not help the client eat the soft diet. Gargling involves hyperextension of the neck, which may put tension on the suture line.

A nurse is formulating a teaching plan for a client recently diagnosed with type 2 DM. What interventions should the nurse include that will decrease the risk of complications? Select all that apply

Examining the feet daily Wearing well-fitting shoes Performing regular exercise Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use. Powdering the feet after showering may cause a pastelike residue between the toes that may macerate the skin and promote bacterial and fungal growth. Generally, visiting the health care provider weekly is unnecessary. Clients with diabetes often have peripheral neuropathy and are unable to accurately evaluate the temperature of bathwater, which can result in burns if the water is too hot.

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? (Select all that apply.)

Hirsutism Buffalo hump Rationale Excessive hairiness, especially a male pattern of hair distribution on a woman (hirsutism), occurs with Cushing syndrome because of an androgen excess. Cushing syndrome results from excess adrenocortical activity. Hypercortisolism causes fat redistribution, resulting in "buffalo hump"; it also contributes to slow wound healing, hirsutism, weight gain, hypertension, acne, thin arms and legs, and behavioral changes. Menorrhagia (excessive menstrual bleeding) does not occur; menses may cease or be scanty because of virilization. Edema does not occur except when severe heart failure is present. Headaches do not occur with this syndrome.

A nurse is caring for a client who was admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder?

Hypoglycemia and hypotension Rationale Adrenocortical insufficiency causes decreased glucocorticoids, resulting in hypoglycemia; also, it causes decreased aldosterone, resulting in fluid excretion that leads to hypotension. Although diarrhea can occur initially with steroid replacement, it should subside; pyrexia will occur only if there is a concomitant infection. Edema and hypertension are not related to Addison disease; they are associated with Cushing disease, because of excessive cortisol and aldosterone, resulting in fluid and sodium retention. Moon face and hirsutism are related to Cushing disease, not Addison disease; moon facies is caused by adipose tissue deposition, and hirsutism is caused by excessive androgen secretion.

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. Which plan reported by the client supports the nurse's conclusion that the teaching was effective?

"Avoid using a sleeping mask at night."

Postoperatively a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing?

Hypocalcemia Rationale The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood. Hypokalemia is characterized by generalized weakness, a decrease in reflexes, shallow respirations, and cardiac dysrhythmias. Thyrotoxic crisis is characterized by tachycardia, hyperpyrexia, and an exacerbation of hyperthyroid symptoms. Hypovolemic shock is characterized by a weak, thready pulse and hypotension.

A client is diagnosed as having type 2 diabetes. A priority teaching goal is, "The client will be able to:

Identify pending hypoglycemia or hyperglycemia. Knowledge of the signs and treatment for hypoglycemia or hyperglycemia is critical to client health and well-being and essential for survival.

The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit:

Lability of mood Rationale Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Increased secretion of androgens results in hirsutism. Capillary fragility results in multiple ecchymotic areas, not skin thickness. Ectomorphism is a term for a tall, thin, genetically determined body type and is not related to adaptations to Cushing syndrome.

A client's parathyroid glands are removed. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery?

Muscle spasms Removal of the parathyroids causes hypocalcemia and associated neuromuscular irritability. Constipation is a sign of hypercalcemia. Hypoactive reflexes are signs of hypercalcemia. Increased specific gravity is a sign of fluid volume deficit.

A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis?

Rapid heartbeat and tremors Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition.

A nurse is caring for a client who is experiencing an underproduction of thyroxine (T 4). Which client response is associated with an underproduction of thyroxine?

Rationale Myxedema is the severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Acromegaly results from excess growth hormone in adults once the epiphyses are closed. Graves disease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids.

A nurse is caring for a client who just had a thyroidectomy. For which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?

TETANY Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death.

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus?

C) Glucocorticoids accelerate the process of gluconeogenesis. - Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH, which causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas.

A nurse is caring for a client who is admitted to the hospital with the diagnosis of primary hyperparathyroidism. Which action should be included in this client's plan of care?

Ensuring a large fluid intake Rationale Fluids help prevent the formation of renal calculi associated with high levels of serum calcium. Additional calcium intake may increase the already high levels of serum calcium. Seizures are associated with low, not high, levels of serum calcium. Bed rest is contraindicated because it accelerates bone destruction.

For which client response should the nurse monitor when assessing for complications of hyperparathyroidism?

Bone pain Hyperparathyroidism causes calcium release from the bones, leaving them porous, weak, and painful

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, the nurse should teach the client to:

Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? (Select all that apply.)

Confusion Tremors Diaphoresis Rationale Confusion is typically the first sign of a hypoglycemic reaction . Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. In addition to these changes, the nurse further assesses this client for: Fatigue Dry skin Anorexia Bradycardia

Fatigue Rationale Excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. Tachycardia is expected because of the increased metabolism associated with hyperthyroidism.

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?

Increased serum lipids Rationale With diabetic ketoacidosis serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to diabetic ketoacidosis. With diabetic ketoacidosis the blood urea nitrogen level generally is increased because of dehydration.

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? (Select all that apply.)

Lability of mood Slow wound healing Rationale Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas.

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? (Select all that apply.)

1. Dry skin 2. Lethargy 5. Sensitivity to cold

A nurse is caring for an alert client who has diabetes and is receiving an 1800-calorie American Diabetic Association diet. The client's blood glucose level is 60 mg/dL. The health care provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. The nurse should:

Ask the client to ingest one tube of glucose gel

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. The nurse's most appropriate response is:

Choose the foods you normally do and follow your food plan wherever you are."

A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? (Select all that apply.)

Cool skin Constipation Periorbital edema Decreased appetite Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edema are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.

While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? (Select all that apply.)

Diaphoresis Weight loss Protruding eyes Rationale Diaphoresis occurs with hyperthyroidism because of increased metabolism, resulting in hyperthermia. Weight loss occurs with hyperthyroidism because of increased metabolism. Bulging eyes occur with hyperthyroidism and are thought to be related to an autoimmune response of the retro-orbital tissue, which causes the eyeballs to enlarge and push forward. Diarrhea occurs because of increased body processes, specifically increased gastrointestinal peristalsis. Heat intolerance occurs because of the increased metabolism associated with hyperthyroidism.

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the:

Dosage can be adjusted to changing needs during recovery from surgery Rationale There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin.

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, "I should call my health care provider if I develop:

Dry hair and an intolerance to cold." Rationale Dry, sparse hair and cold intolerance are characteristic responses to low serum thyroxine. Muscle cramping is associated with hypocalcemia. Low thyroxine levels reduce the metabolic rate, resulting in fatigue, but do not increase the pulse rate. Low thyroxine levels reduce the metabolic rate, resulting in weight gain and bradycardia, not tachycardia.

A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan as a means of encouraging this client to modify dietary intake?

Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium. Lack of mineralocorticoids (aldosterone) leads to loss of sodium ions in the urine and subsequent hyponatremia. Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids. Increasing protein is needed to heal the adrenal tissue and thus cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing, nor will they help the client gain weight.

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant? (Select all that apply.)

Headache Diaphoresis Rationale Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?

Hyperplasia of the adrenal cortex Rationale Hyperplasia of the adrenal cortex leads to increased secretion of cortical hormones, which causes signs of Cushing syndrome. Pituitary hypoplasia is a malfunction of the pituitary that will result in Simmonds disease (panhypopituitarism), which has clinical manifestations similar to those for Addison disease. Cushing syndrome results from excessive cortical hormones. ACTH stimulates production of adrenal hormones. Inadequate ACTH will result in Addisonian signs and symptoms.

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis?

Insulin aspart (NovoLog) Rationale Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of one to two hours; for diabetic acidosis the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis the individual needs rapid-acting insulin.

A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action?

Insulin lispro (Humalog) Insulin lispro has an onset of 0.25 hours, a peak action of 0.5 to 1.5 hours, and a duration of 3 to 4 hours. Insulin glargine has an onset of 1 to 1.5 hours, no peak action, and a duration of 20 to 24 hours. NPH insulin has an onset of 1.5 hours, a peak action of 4 to 12 hours, and a duration of 18 to 24 hours. Regular insulin has an onset of 0.5 hours, a peak action of 1 to 5 hours, and a duration of 6 to 10 hours.

A client who had a subtotal thyroidectomy returns to the unit from the postanesthesia care unit. What is the priority nursing action at this time?

Observe for signs of tetany. Rationale The parathyroids may be excised accidentally during surgery; because they regulate calcium, lowered blood levels of calcium may induce tetany. There is no danger of hypoglycemia at this time. A sandbag under the neck can cause hyperextension and strain on the suture line. Teaching the need to support the head is not the priority at this time, although it is important to prevent tension on the suture line.

A nurse is caring for a client after radioactive iodine is administered for Graves disease. What information about the client's condition after this therapy should the nurse consider when providing care?

Mildly radioactive but should be treated with routine safety precautions Rationale An individual treated for a thyroid problem by intake of radioactive iodine (131I) becomes mildly radioactive, particularly in the region of the thyroid gland, which preferentially absorbs the iodine. Such clients should be treated with routine safety precautions for 48 hours (e.g., avoid prolonged contact or near-contact with others, flush toilet twice after using because radioactive iodine is excreted via the urine, and thoroughly wash hands after toileting). Because radioactive iodine is internalized, the client becomes the source of radioactivity. The amount of radioactive iodine used is not enough to cause high radioactivity.

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis?

Monitoring for signs of hypoglycemia as a result of treatment Rationale During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include:

Parenteral steroids Rationale Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. For what response should the nurse instruct the client to monitor in addition to nervousness and hunger?

Rationale When serum glucose decreases, the sympathetic nervous system is stimulated, resulting in a surge of epinephrine and norepinephrine; this response causes sweating, tremors, tachycardia, palpitations, nervousness, and hunger. Increased thirst (polydipsia) occurs in response to the osmotic diuresis associated with hyperglycemia. The ketosis and acidosis of diabetic ketoacidosis lead to gastrointestinal problems, such as nausea, anorexia, vomiting, and abdominal cramping.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe?

Regular insulin (Novolin R) Regular insulin is rapid-acting and should be used for diabetic coma

A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement?

Regulated food intake is basic to control. Rationale An understanding of the diet is imperative for adherence. A balance of carbohydrates, proteins, and fats, usually apportioned over three main meals and two between-meal snacks, needs to be tailored to the client's specific needs, with consideration of exercise and pharmacological therapy. A total dietary regimen proportioning carbohydrates, proteins, and fats must be followed, not just sugar restriction; salt is not restricted. That small, frequent meals are better for digestion is true; however, digestion is not the basis for the client's problems. Total caloric intake, rather than the size of meals, is the major factor in weight gain.

A client has a thyroidectomy for cancer of the thyroid. To evaluate for nerve injury that may be the result of surgery-related trauma, the nurse assesses the client's ability to:

Speak Rationale The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. The ability to purse the lips tests the seventh cranial (facial) nerve, which is not affected in thyroid surgery. The nerves involved in turning the head are not near the thyroid gland.

A client is scheduled to have a thyroidectomy for cancer of the thyroid. Preoperative instructions for the postoperative period include teaching the client to:

Support the head with the hands when changing position Supporting the head with the hands when changing position relieves tension on the incision and limits the risk of dehiscence. Coughing should be avoided during the early postoperative period to prevent trauma to the operative site. Performing range-of-motion exercises of the head and neck should be avoided until advised by the health care provider, usually after initial healing of the incision occurs. Pressure against the operative area is not necessary to promote the integrity of the incision, and it may act to inhibit swallowing.

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms?

T 3, T 4, and thyroid-stimulating hormone (TSH) T 3, T 4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client's signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

Tachycardia,Exophthalmos Rationale Tachycardia is associated with hyperthyroidism and is caused by the increase in the basal metabolic rate. Exophthalmos is associated with hyperthyroidism and results from accumulation of fluid behind the eyeball. Lethargy is associated with hypothyroidism; hyperactivity occurs with hyperthyroidism. Weight gain occurs with hypothyroidism; weight loss occurs with hyperthyroidism because of the high metabolic rate. Constipation is associated with hypothyroidism; frequent loose stools occur with hyperthyroidism.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." On the basis of this statement, the nurse's best action is to:

Test for Chvostek's and Trousseau's signs and notify the health care provider of the complaints. These symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy. Physical assessment and notification of the health care provider are the priorities.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

-Urine negative for ketones and hyperglycemia In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia.

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia?

1. Use tinted glasses. 3. Elevate the head of the bed 45 degrees. 4. Tape eyelids shut at night if they do not close. Rationale Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive . Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears, not a petroleum-based jelly, are used to moisten the eyes.

A client with type 1 diabetes self-administers NPH insulin (Novolin N) every morning at 8:00 AM. The nurse concludes that the client understands the action of this insulin when the client says, "I should be alert for signs of hypoglycemia between:

12 PM and 8 PM." Rationale NPH insulin's onset of action is 1.5 to 4 hours, peak action is 4 to 12 hours, and duration of action is 18 to 24 hours; if hypoglycemia occurs, it will happen most likely between 12 PM and 8 PM. Regular insulin (Novolin R) peaks in 2 to 5 hours. No insulin peaks in 14 to 16 hours. Lispro (Humolog) peaks in 30 minutes to 1.5 hours.

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant? (Select all that apply.

2. Headache 3. Diaphoresis Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Lethargy is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

A nurse is collecting information about a client who has type 1 diabetes and is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? (Select all that apply.)

3. Excessive emotional stress 4. Running a fever with the flu Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level. Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; this may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia).

A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? (Select all that apply.)

4. Nervousness 5. Increased appetite Rationale Nervousness is associated with hyperthyroidism because of central nervous system irritation. The appetite increases with hyperthyroidism because of the increase in the metabolic rate. Moist skin occurs with hyperthyroidism because of the increase in the metabolic rate. Dry skin occurs with hypothyroidism because of the decrease in the metabolic rate. Tachycardia occurs with hyperthyroidism because of the increase in the metabolic rate. Bradycardia occurs with hypothyroidism because of the decrease in the metabolic rate. Weight loss occurs with hyperthyroidism because of the increase in the metabolic rate. Weight gain occurs with hypothyroidism because of the decrease in the metabolic rate.

Before a client's discharge after a thyroidectomy, the nurse teaches the client to observe for signs of surgically induced hypothyroidism. What clinical indicators identified by the client provide evidence that the nurse's instructions are understood? (Select all that apply.)

A) fatigue B) dry skin Rationale Fatigue is caused by a decreased metabolic rate. Dry skin is caused by decreased glandular function associated with a decreased metabolic rate. Insomnia is caused by an increased metabolic rate associated with hyperthyroidism, not hypothyroidism. Intolerance to heat is associated with hyperthyroidism. Intolerance to cold is associated with hypothyroidism. Progressive weight loss is associated with hyperthyroidism. Progressive weight gain is associated with hypothyroidism because of the reduced metabolic rate.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? (Select all that apply.)

Acetone breath, decreased arterial carbon dioxide level Rationale A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia, the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis. With ketoacidosis the serum bicarbonate level is decreased, not increased, in an effort to neutralize ketones when seeking acid-base balance.

Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematological studies?

C. Phosphorus REASONING: Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorous levels decrease (greater than 3 mg/dL; greater than 0.1 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparathyroidism.

The nurse concludes that a client with type 1 diabetes is experiencing hypoglycemia. Which responses support this conclusion? (Select all that apply.)

Headache Tachycardia Cool clammy skin Rationale Headache is a neuroglycopenic response directly related to brain glucose deprivation. Tachycardia occurs with hypoglycemia because of a neurogenic adrenergic response; it is a sympathetic nervous system response precipitated by a low blood glucose level. Cool, clammy skin is a neurogenic cholinergic response; it is a sympathetic nervous system response precipitated by a low serum glucose level. Vomiting occurs with hyperglycemia because of the effects of metabolic acidosis. Increased respirations are a sign of hyperglycemia and are related to metabolic acidosis; this is a compensatory response in an attempt to blow off carbon dioxide and increase the pH level.

A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated?

Hypotension Rationale After an adrenalectomy, adrenal insufficiency causes hypotension because of fluid and electrolyte alterations. Hypoglycemia, not hyperglycemia, may be a problem stemming from the loss of glucocorticoids. Hyponatremia may occur because of the lack of mineralocorticoid production. Potassium, not sodium, ions may be retained because of the lack of mineralocorticoids.

A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to: A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to:

Improve the cellular uptake of glucose Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.

The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication?

Observe for signs of infection PTU may lower the white blood cell count, making the client prone to infection. Propylthiouracil does not cause hypocalcemia.

A nurse evaluates that a client with diabetes understands the teaching about the treatment of hypoglycemia when the client says, "If I become hypoglycemic I initially should eat:

Sugar and a slice of bread. Rationale The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex carbohydrates and protein produce a more sustained response. Fruit juice and a lollipop are fast-acting sugars, and neither of them will provide a sustained response. The fat content of chocolate candy decreases the rate of absorption of glucose. Neither peanut butter crackers or a glass of milk are a fast-acting sugar; peanut butter crackers and milk can be used to maintain the glucose level after it is raised.

Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

Supports a better response to stress Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus, it enables the body to adapt to stress

A client who is 60 pounds more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept should the nurse include in teaching about diabetes when discussing strategies to lose weight?

a. Obesity leads to insulin resistance REASONING: Excess fat alters glucose metabolism, causing cells to become insulin resistant. Fat cells have no relationship to the function of the kidneys. Fat cells do not absorb insulin and therefore do not prevent the circulation of insulin to other cells. Clients with type 1 diabetes do not produce insulin. If lipids should accumulate in the pancreas of a healthy adult, they do not interfere with insulin production.

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?

Administer intravenous (IV) steroids. Steroid therapy usually is instituted preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample, not high, protein and potassium; however, it must be low in calories, carbohydrates, and sodium to promote weight loss and reduce fluid retention. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?

Hydrocortisone succinate (Solu-Cortef) Rationale Hydrocortisone succinate is a glucocorticoid. A client undergoing bilateral adrenalectomy must be given adrenocortical hormones so that adjustment to the sudden lack of these hormones that occurs with this surgery can take place Methimazole is used to treat a client with hyperthyroidism, not a client with a bilateral adrenalectomy. Because the surgery involves the adrenal glands, not the pituitary gland, secretion of pituitary hormones will not be affected. Regular insulin is not necessary. Insulin is produced by the pancreas, and its function is not altered by this surgery.

A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. The primary cause of the client's ascites is a decrease in:

Plasma protein to maintain adequate capillary-tissue circulation Rationale Malnutrition and liver damage lead to a reduced serum albumin level and failure of the capillary fluid shift mechanism, resulting in ascites. Vitamins are unrelated to ascites. Iron promotes hemoglobin synthesis, which is unrelated to cirrhosis. The sodium level usually is excessive with cirrhosis.

A nurse is caring for an adult client with acromegaly. What clinical manifestation does the nurse expect the client to exhibit?

Prominent jaw

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis?

Receives long-term steroid therapy Rationale Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight-bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Although estrogen promotes deposition of calcium into bone, high levels will not be prescribed for osteoporosis; hormone replacement therapy is associated with an increased risk for breast cancer.

A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T 3 ) and thyroxine (T 4 )? (Select all that apply.)

Weight gain Cold intolerance Rationale A decrease in metabolism will result in a gain in weight. Decreased production of thyroid hormones lowers metabolism, which leads to decreased heat production and cold intolerance. Lethargy, rather than irritability, is expected. Decreased metabolism requires less oxygen, so the pulse rate is generally slower. The skin is dry and coarse, not moist.

When assessing a client with Graves disease, the nurse expects to identify:

Weight loss, exophthalmos, and restlessness Rationale Weight loss and restlessness occur because of an increased basal metabolic rate; exophthalmos occurs because of peribulbar edema. Constipation, dry skin, and weight gain are associated with hypothyroidism because of the decreased metabolic rate. Lethargy and weight gain are associated with hypothyroidism as a result of a decreased metabolic rate; forgetfulness is not related. Although weight loss and exophthalmos occur with hyperthyroidism, the client will be hyperactive, not hypoactive.

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)

1 Emotional lability 2 Dyspnea on exertion 5 Hyperactive deep tendon reflexes Rationale Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurological manifestation related to excessive production of thyroid hormones. Abdominal distension is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

1 Diarrhea 3 Weight loss Rationale Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.

A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply. 1 Hirsutism 2 Round face 3 Pitting edema 4 Buffalo hump 5 Hypoglycemia

1, 2, 4 Pitting edema does not occur except with concurrent severe heart failure. Hypercortisolism increases gluconeogenesis, causing hyperglycemia, not hypoglycemia.

After surgical clipping of a cerebral aneurysm, the client develops the syndrome of inappropriate secretion of antidiuretic hormone (ADH). For which manifestations of excessive levels of ADH should the nurse assess the client? Select all that apply. 1 Polyuria 2 Weight gain 3 Hypotension 4 Hyponatremia 5 Decreased specific gravity

2, 4 Excessive levels of ADH cause inappropriate free water retention; for every liter of fluid retained, the client will gain approximately 2.2 lb. Free water retention results in a hypoosmolar state with dilutional hyponatremia. Oliguria, not polyuria, occurs as ADH acts on nephrons to cause water to be reabsorbed from the glomerular filtrate. Because of water reabsorption, blood volume may increase, causing hypertension, not hypotension. This increases, not decreases, as a result of increased urine concentration.

When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of: When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of: Edema Anorexia Weight loss Hypoglycemic episodes

3 Weight loss Rationale Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes.

A client's laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations should the nurse assess this client? (Select all that apply.)

4 Cardiac dysrhythmias 5 Hypoactive bowel sounds Rationale When the serum calcium level is increased, initially it causes tachycardia; as it progresses, it depresses electrical conduction in the heart, causing bradycardia. Hypercalcemia causes decreased peristalsis identified by constipation and hypoactive or absent bowel sounds.Muscle tremors occur with hypocalcemia, not hypercalcemia. Abdominal cramps occur with hypocalcemia, not hypercalcemia. Increased intestinal peristalsis occurs with hypocalcemia, not hypercalcemia.

A client has a hypoglycemic reaction to insulin. Which client responses should the nurse document as clinical manifestations of hypoglycemia? (Select all that apply.)

Pallor, tremors , diaphoresis Rationale Hypoglycemia triggers the sympathetic nervous system, which releases epinephrine, in turn causing vasoconstriction and pallor. Tremors are a sympathetic nervous system response to hypoglycemia. Diaphoresis results from the release of epinephrine by the sympathetic nervous system. Because blood glucose concentration is decreased in hypoglycemia, the renal threshold is not exceeded and there is no glycosuria. Acetonuria is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get the atomic cocktail?" The nurse explains that the medication is being prescribed because it decreases the:

Production of thyroid hormones. Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? 1 Glargine (Lantus) 2 NPH insulin (Novolin N) 3 Insulin aspart (NovoLog) 4 Insulin detemir (Levemir

3 Insulin aspart (NovoLog) Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of one to two hours; for diabetic acidosis the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis the individual needs rapid-acting insulin.

A nurse is assessing a client with a diagnosis of hypoglycemia, What clinical manifestations support this diagnosis? (Select all that apply) 1. Thirst 2. Palpitations 3. Diaphoresis 4. Slurred speech 5. Hyperventilation

2. Palpitations 3. Diaphoresis 4. Slurred speech Palpitations, an adrenergic symptom, occur as the glucose level decreases; the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the central nervous system (CNS) becomes depressed. Thirst occurs with hyperglycemia in response to dehydration associated with osmotic diuresis. Hyperventilation occurs with diabetic ketoacidosis; Kussmaul respirations are an effort to counteract the effects of a buildup of ketones as the body seeks acid-base balance.

A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient?

Fats Rationale Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism produces nitrogenous waste, causing elevated blood urea nitrogen (BUN), not ketones. Potassium is not oxidized; potassium is not directly associated with ketones. Carbohydrates do not contain fatty acids that are broken down into ketones.

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis?

Breakdown of fat stores for energy Rationale In the absence of insulin , which facilitates the transport of glucose into cells, the body breaks down proteins and fats to supply energy; ketones, a by-product of fat metabolism, accumulate, causing metabolic acidosis (pH below 7.35). The pH of food ingested has no effect on the development of acidosis. The opposite of excessive secretion of endogenous insulin is true. Cholesterol level has no effect on the development of acidosis.

A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription?

Drugs to increase the blood pressure

A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? (Select all that apply.)

Dry skin Abdominal pain Kussmaul respirations Rationale Dry skin is a sign of dehydration in response to polyuria associated with the osmotic effect of an elevated serum glucose level. Abdominal pain is associated with diabetic ketoacidosis. In the absence of insulin, glucose cannot enter the cell or be converted to glycogen, so it remains in the blood. Breakdown of fats as an energy source causes an accumulation of ketones, which results in acidosis. The lungs, in an attempt to compensate for lowered pH, will blow off CO 2 (Kussmaul respirations). An absence of ketones in the urine indicates adequate production of glucose for energy. Insulin deficiency stimulates production of ketones as a by-product of fat oxidation for energy. Blood glucose level of less than 100 mg/dL indicates hypoglycemia, not ketoacidosis.

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse expects that manifestations of excessive levels of antidiuretic hormone are:

Hyponatremia and decreased urine output Rationale Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

A nurse is caring for a client after a thyroidectomy. For which signs of thyroid storm should the client be monitored? (Select all that apply.) Increased heart rate Increased temperature Decreased respirations Increased pulse deficit Decreased blood pressure

Increased heart rate Increased temperature Rationale Thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby causing an increased heart rate (tachycardia). Because of the increased metabolic rate associated with thyroid storm, body temperature will increase. Because of the increased metabolic rate associated with thyroid storm, the respiratory rate increases (tachypnea) to meet the body's oxygen needs. Pulse deficit, the difference between apical and peripheral pulse rates, is not indicative of thyroid storm. The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? (Select all that apply.)

Wear shoes when out of bed; and Dry between the toes after bathing Wearing shoes protects the feet from trauma; they should fit well and should be worn over clean socks. Drying between the toes after bathing prevents maceration and skin breakdown, thus maintaining skin integrity. Soaking the feet is contraindicated because it can cause macerations and skin breakdown, which allow a portal of entry for pathogenic organisms. Clients should not self-treat corns, calluses, warts, or ingrown toenails because of the potential for trauma and skin breakdown; these conditions should be treated by a podiatrist. Use of a heating pad, hot water bottle, or hot water is contraindicated because of the potential for burns; diabetic neuropathy, if present, does not allow the client to accurately evaluate the extremes of temperature.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? (Select all that apply.)

1 Thirst 4 Fruity breath odor 5 Excessive urination Rationale Thirst (polydypsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia . A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a byproduct of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia and hyperglycemia because of central nervous system irritation.

A client had a thyroidectomy. The nurse monitors for thyrotoxic crisis, which is evidenced by:

An increased temperature and pulse rate Thyrotoxic crisis is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature. During crisis there usually is no increase in the difference between the apical and the peripheral pulse rates (pulse deficit). The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during crisis. Because of the increased metabolic rate, the pulse and respiratory rates increase to meet the body's oxygen needs.

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations?

Calcium gluconate; The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia

A nurse is caring for a client who just returned from the postanesthesia care unit after having a thyroidectomy. Which action has priority during the first 24 hours after surgery when the nurse is concerned about thyroid storm?

Checking vital signs every two hours after they stabilize Checking vital signs helps detect complications such as thyrotoxic crisis, hemorrhage, and respiratory obstruction that may occur early in the postoperative period.

A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client?

Presence of infection Infection increases the body's metabolic rate, and insulin is not available for increased demands. Although emotional stress will affect glucose levels, diabetic ketoacidosis will rarely result. Increased insulin dose will lead to insulin coma (hypoglycemia) if diet is not increased as well. Inadequate food intake will result in insulin coma.

The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include? (Select all that apply.)

It can improve A1c levels Clients can exercise without eating more carbohydrates Rationale Maintaining a consistent acceptable blood glucose level will improve A 1c results. Because insulin is administered only as needed, the client will be able to exercise without having to increase the carbohydrate intake. Ketoacidosis may occur if the catheter becomes dislodged and the client does not receive insulin for hours. Insulin pumps can cause weight gain, not loss. An insulin pump is more expensive than subcutaneous insulin injections.

The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? (Select all that apply.) Decreased urinary output Excessive thirst Hyperactivity Fruity-scented breath Confusion

2 Excessive thirst 4 Fruity-scented breath 5 Confusion Rationale Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternate fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? (Select all that apply.)

Irritability, heart palpitations Rationale Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? (Select all that apply.)

Palpitations Tachycardia Rationale Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema. Menstrual disturbances are associated with hypothyroidism and myxedema.

Palpitations, tachycardia, Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Menstrual disturbances are associated with hyperthyroidism; women can experience lightened periods or missed periods. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema.

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