Med surg Endocrine review

7. The nurse is reinforcing discharge teaching to a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? 1. "I can eat foods that contain potassium." 2. "I will need to limit the amount of protein in my diet." 3. "I am fortunate that I can eat all the salty foods I enjoy." 4. "I am fortunate that I do not need to follow any special diet."

1. I can eat foods that contain potassium A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encour- aged for a client with Cushing's syndrome. Such a diet pro- motes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted

The nurse reinforces teaching to a client with dia- betes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demon- strates an understanding of the teaching by stating that glucose will be taken if which symptom develops? 1. Polyuria 2. Shakiness 3. Blurred vision 4. Fruity breath odor

2 shakiness Shakiness is a sign of hypoglycemia, and it would indicate the need for food or glucose. Fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.

A client is taking humulin NPH insulin daily every morning the nurse reinforces instructions to the client and should tell the client that which is the most likely time for a hypoglycemic reaction to occur 1. 2 to4 hours after administration 6 to 14 hours after administration 16 to 18 hours after administration 18 to 24 hours after administration

2. 6 to 14 hours after administration

A client who has been newly diagnosed with diabe- tes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge? 1. Keep insulin vials refrigerated at all times. 2. Rotate the insulin injection sites systemati- cally. 3. Increase the amount of insulin before unusual exercise. 4. Monitor the urine acetone level to determine the insulin dosage.

2. I'll take the insulin injection site systematically Insulin dosages should not be adjusted or increased hefore unusual exercise. If acetone is found in the urine, it may 2ossibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption. subject, reinforcement

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed dia- betic diet. Which statement made by the client indicates the need for further teaching? 1. "I'll eat a balanced meal plan." 2. "I need to drink diet soft drinks." 3. "I need to buy special dietetic foods." 4. "I will snack on fruit instead of cake."

3. I need to buy special diabetic foods It is important to emphasize to the client and fam- ily that they are not eating a diabetic diet, but rather follow- ing a balanced meal plan. Adherence to nutrition principles is an important component of diabetic management, and an individualized meal plan should be developed for the client. It is not necessary for the client to purchase special dietetic foods.

The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus war- rant primary health care provider (PHCP) notification? 1. I am urinating a lot 2. my pulse really slow 3. I am sweating for no reason 4. my blood pressure is really high

1 i am urinating a lot The classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options 2, 3, and 4 are not signs of hyperglycemia.

The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroid- ism. The nurse educator determines that student understands this disorder if which included the student's response? Select that apply .1. Dry skin 2. Irritability 3. Palpitations 4. Weight loss 5. Constipation 6. Cold intolerance

1, 5, 6 Signs of hypothyroidism include dry skin, hair, and loss of body hair; constipation; cold intolerance; lethargy and fatigue; weakness; muscle aches; paresthesia; weight gain; bra- dycardia; generalized puffiness and edema around the eyes and face; forgetfulness; menstrual disturbances; cardiac enlarge- ment; and goiter. Irritability, palpitations, and weight loss are signs of hyperthyroidism.

client is admitted to the emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Monitor intravenous fluids. 4. Administer thyroid hormone.

2. Maintain a patent air way The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement. The nurse would also keep the client warm, monitor intravenous fluids, and administer thyroid hormones.

The nurse is collecting data regarding a client after thyroidectomy and notes the development of hoarse and weak voice. Which nursing action appropriate? 1. Check for signs of bleeding. 2. Administer calcium gluconate. 3. Notify the registered nurse immediately. 4. Reassure the client that this is usually a rary condition.

4. Reassure the client that this is usually a temporary condition Weakness and hoarseness of the voice can occur as a result of trauma to the laryngeal nerve. If this develops, the cli- ent should be reassured that the problem will subside in a few days. Unnecessary talking should be discouraged. It is not nec- immediately. These signs essary to notify the registered nurse do not indicate bleeding or the need to administer calcium gluconate.

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection? 1. Plan for injection rotation 2. Consistency of aspiration 3. Preparation of the injection site 4. Angle at which the medication is administered

1. Plan of injection rotation Lipodystrophy (i.e., the hypertrophy of subcutane- ous tissue at the injection site) occurs in some diabetic clients when the same injection sites are used for prolonged periods of time. Thus clients are instructed to adhere to a rotating injec- tion site plan to avoid tissue changes. Preparation of the site, aspiration, and the angle of insulin administration do not pro- duce tissue damage.

The nurse is caring for a postoperative parathyroid- ectomy client. Which would require the nurse's immediate attention? 1. Incisional pain 2. Laryngeal stridor 3. Difficulty voiding 4. Abdominal cramps

2. Larngeal stridor During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which causes swell- ing and the compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard during inspiration and expi- ration that is caused by the compression of the trachea and leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway.

The nurse is assisting is preparing a teaching plan for the client with diabetes Mellitus regarding proper foot care. Which instruction should be included in the plan of care? 1. Soak the feet in hot water. 2. Avoid using soap to wash the feet. 3. moisturizing lotion to dry feet, but not apply a between the toes. 4. Always have a podiatrist cut your toenails; never cut them yourself.

3. Moisturizing lotion to dry feet but not applied to between the toes The client should use a moisturizing lotion on his or her feet, but should avoid applying the lotion between the toes. The client should also be instructed not to soak the feet and to avoid hot water to prevent burns. The client may cut the toenails straight across and even with the toe itself, but he or she should consult a podiatrist if the toenails are thick or hard to cut or if his or her vision is poor. The client should be instructed to wash the feet daily with a mild soap.

The nurse is reinforcing instructions to a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize? 1. Eat six small meals daily. 2. Test the urine ketone level. 3. Monitor blood glucose level frequently. 4. Receive appropriate follow-up health care.

3. Monitor blood glucose level frequently Client education after DKA should emphasize the for home glucose monitoring four to five times per day. It is also important to instruct the client to notify the PHCP when illness occurs. The presence of urinary ketones indicates that DKA has already occurred. The client should eat well-balanced meals with snacks, as prescribed.

The nurse is caring for a client after a thyroidec- tomy and notes that calcium gluconate is pre- scribed. The nurse determines that this medication has been prescribed for which reason? 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes, or muscle spasms or twitching, the PHCP is notified immediately. Calcium gluconate should be accessible for the client who underwent thyroidectomy.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise? 1. "I should not exercise after lunch." 2. "I should not exercise after breakfast." 3. "I should not exercise in the late evening." 4. "I should not exercise in the late afternoon."

4. I should not exercise in the late afternoon A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. Humulin N insulin peaks between 6 and 14 hours; therefore, late-afternoon exercise would occur during the peak of the medication.

When the nurse is reinforcing instructions to a cli- ent who has been newly diagnosed with type 1 dia- betes mellitus, which statement by the client would indicate that teaching has been effective? 1. "I will stop taking my to insulin if im too sick 2. "I will decrease my dose during tome of illness." 3. "I will adjust my insulin does according to the level of glucose in my urine 4. "I will notify my primary health care blood glucose level is consistently greater my than 250."

4. I will notify my healthcare provider if blood glucose level is consistently greater than 250 During illness, the client should monitor the blood glucose level, and he or she should notify the PHCP if the level is greater than 250 mg/dL (13.9 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased dur- ing times of illness. Doses should not be adjusted without the PHCP's advice.