endocrine

what actions should the nurse take when assigned a client who is one day post thyroidectomy and while taking the BP, the client's hand starts to tremble? select all: 1. pad the side rails 2. monitor potassium level 3. take blood pressure in opposite arm 4. place trach set at bedside 5. check for airway patency 6. assess heart rhythm

1,4,5,6- parathyroids could have been removed during this surgery, thus causing a decrease in the calcium level and could progress to a seizure and laryngospasms, so pad rails, get trach if spasms, since hypocalcemia then not enough sedative 2. worried about calcium 3. not needed since same results and delays treatment

what assessment data by the nurse would suggest that the client's dose is too high in a client with Addison's disease that is taking fludrocortisone 0.1 mg/day? select all: 1. weight loss of 2 lbs/24 hours 2. elevated serum sodium level 3. bilateral pedal edema 4. crackles in lung fields bilaterally 5. elevated blood pressure

2,3,4,5- will be holding onto fluids so FVE likely 1. would expect weight gain!

what is the PRIORITY nursing assessment for a client postop thyroidectomy? 1. 5 mm dark red drainage 2. temp of 99 F 3. trousseau's sign negative 4. stridor

4. laryngeal/vocal cord edema is the most common cause of stridor within the first 24 hours after thyroidectomy, its usually associated with difficulty breathing 1. normal bc old 2. is expected after surgery 3. normal

what is the PRIORITY concern with this client taking metformin and has poorly controlled type 2 diabetes, lab results include a BUN of 22 mg/dl, creatinine of 1.9 mg/dl, and blood sugar of 218 mg/dl and has current medications of metformin and exenatide? 1. inadequate blood glucose control 2. concomitant administration of metformin and exenatide 3. reports of headache 4. renal function impairment

4. metformin is primarily excreted by the kidneys and the kidneys arent working obvi and giving metformin can lead to toxicity and increased lactic acidosis risk! 1. its not going to kill the patient right away and is not important right now 2. they are both commonly prescribed together to control a client's glucose level so no 3. headache is a side effect but not important right now

what s/s would the nurse expect to assess in a client diagnosed with exocrine pancreatic cancer? select all: 1. dark tea colored urine 2. clay colored stools 3. jaundice 4. coffee ground emesis 5. lower abdominal pain

1,2,3- all of that are results of bile duct blockage 4. is a s/s of bleeding ulcer so no 5. pain in the upper abdomen that radiates to your back is seen with pancreatic cancer, but not lower abdominal pain (diverticulitis)

what should be included in the discharge teaching plan for a client who has lymphedema post right mastectomy? select all: 1. use a thimble when sewing 2. wear a heavy duty oven mitt for removing hot objects from the oven 3. long sleeves should be worn to prevent insect bites 4. shave underarms with an electric razor 5. avoid wearing jewelry

1,2,3,4- bc lymphedema is a lifelong threat, teach the client hand and arm precautions to minimize the risk of injury and infection! and impaired circulation; a minor injury like a pin prick or sunburn can cause painful swelling after lymph node removal! 5. they can still wear jewelry as long it does not inhibit lymph drainage and does not constrict the affected arm!

based on this data, what teaching should the nurse reinforce for a client with type 2 diabetes who is noncompliant and has a HbA1c of 8%, and a finger stick blood sugar is 218 mg/dl at 0900? select all: 1. nutritional counseling to help improve diet compliance 2. the goal of therapy is to have a HbA1c less than 7.0% 3. blood glucose testing before meals and at bedtime 4. vigorous exercise plan to improve glucose control 5. without glycemic control, nerve damage can occur 6. HbA1c measures glycemia control over a period of 6 months

1,2,3,5- want to have HbA1c less than 7% and rest common sense 4. no need for intense and vigorous exercise! 6. it measures glycemic control over a period of 3 months!

what signs/symptoms would the nurse expect to find in a client admitted to the unit with a diagnosis of Cushing's disease? select all: 1. hyperpigmentation 2. buffalo hump 3. hirsutism 4. acne 5. moon face 6. hypotension

2,3,4,5- all s/s of that, which is having too much glucocorticoids, mineralcorticoids, and sex hormones in the body 1. that occurs when the body has too little cortisol, such as with Addison's disease 6. thats the opposite

what action should the nurse take when a 15 year old found unresponsive in the park and is brought to the ED and the nurse sees a medical alert bracelet stating 'diabetic', notes a fruity smell to the breath, and there are no family members available to obtain consent for treatment and attempts to call them have been unsuccessful? 1. obtain consent from the social worker on duty in the ED 2. begin treatment by inserting two large bore IV's for administration of normal saline 3. give glucagon IM and wait for arrival of a parent to consent to further treatment 4. notify the primary healthcare provider

2. consent for a minor is not needed in the event of an emergency so begin treatment for DKA! 1. consent not needed and social worker cant do it 3. patient is in DKA so that wont help and no need to wait 4. the primary healthcare provider cant do anything really since the ED physician and nurses can do it

which questions would yield information that would help the nurse decide that this is a hypoglycemic episode in a client who has diabetes that calls the nurse hot-line reporting shakiness, nervousness, and palpitations? select all: 1. what, and when, have you eaten today? 2. do you feel sleepy? 3. have you been extremely thirsty? 4. can you check your current glucose level? 5. does your skin feel sweaty? 6. is your vision blurry?

1,2,4,5,6- this will help the nurse know how much time has elapsed since last meal and how much carbs and protein; minor delay in meal times result in hypoglycemia and when it worsens, LOC declines so sleepy; as the brain gets less glucose, the eyes are affected! 3. polydipsia is a sign of hyperglycemia

what additional findings would make the nurse suspect the client with a history of alcoholism who arrives at the clinic and reporting severe abdominal pain with N/V may have pancreatitis? select all: 1. bruising at the umbilicus 2. fever with tachycardia 3. positive Trousseau sign 4. pain radiating to back 5. vague pain at night

1,2,4- whether its acute or chronic pancreatitis, s/s are severe and distinct so cullen's sign (bruising around bellybutton; internal bleeding!), febrile and pain due to inflammation of pancreas, pain around location of pancreas that radiates from mid-gastric area to back 3. this indicates low levels of calcium so unrelated 5. pain is severe and continuous, not just at night

what should the nurse include in the teaching when providing foot care to the client who has diabetes? select all: 1. wear socks specifically made for clients who have diabetes 2. wash feet daily with a sponge 3. use a moisturizer daily on feet and toes 4. apply medicated pads to treat corns 5. only walk barefoot while in the home 6. shake out shoes and feel the inside before wearing

1,2,6- wear special socks, good hygiene but gentle, check shoes for rocks and stuff since maybe wont feel them 3. use moisturizer on feet but not toes! 4. eh i dont think so 5. never barefoot

based on the history, what should the nurse anticipate will be the first strategy implement to improve glucose control for this client with poorly controlled type 2 diabetes and does not adhere to the diet and the latest HbA1c is 8% and the serum glucose at this visit is 218 mg/dl and is taking metformin and exenatide? 1. nutritional counseling 2. increased daily exercise regimen 3. education regarding insulin by basal/bolus dosing method 4. more frequent self-monitoring of blood glucose

1. simple education and bc patient is not adhering to the diet to begin with 2. nothing talks about exercise in the question 3. thats not really important since A1c is 8%, if it was 9% or higher then yes 4. that wont help since other issues still there

which food selections would need to be removed from the tray by the nurse for a client recovering from thyroidectomy? 1. roasted almonds 2. mashed vegetables 3. scrambled eggs 4. ice cream

1. they are too hard and crunchy so too risky after thyroid and trachea surgery... want soft foods so remove that!