Medical Surgical Nursing - Endocrine and Metabolic Disorders

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of fresh fruits. dairy products. processed meats. cereals and grains.

fresh fruits.

When obtaining the nursing history of a client who has diabetes mellitus, the nurse should assess the client for which of the following early symptom of renal insufficiency? dysuria hematuria oliguria polyuria

polyuria

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? potassium chloride normal saline solution hydrocortisone fludrocortisone

potassium chloride

The nurse teaches the client with type 1 diabetes mellitus about the importance of maintaining stable blood glucose levels. The nurse should suggest the client include which type of food to minimize the rise in blood glucose level after meals? dairy products dietary fiber vitamin-fortified foods meats

dietary fiber

A nurse is assessing a client with hyperparathyroidism. Which finding should the nurse report immediately to the physician? urinary output of 30 mL/hour blood pressure of 118/79 mm Hg loss of appetite flank pain

flank pain

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? above-normal urine and serum osmolality levels below-normal urine and serum osmolality levels above-normal urine osmolality level, below-normal serum osmolality level below-normal urine osmolality level, above-normal serum osmolality level

below-normal urine osmolality level, above-normal serum osmolality level

A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus? obtaining, reporting, and documenting fingerstick glucose levels treating hypoglycemia teaching the client dietary changes necessary with diabetes mellitus assessing the client experiencing a hypoglycemic reaction

obtaining, reporting, and documenting fingerstick glucose levels treating hypoglycemia

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. What should the nurse explain to the client about the expected outcome of using this drug? The drug helps: slow progression of exophthalmos. reduce the vascularity of the thyroid gland. decrease the body's ability to store thyroxine. increase the body's ability to excrete thyroxine.

reduce the vascularity of the thyroid gland.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? "Maintain a moderate exercise program." "Rest as much as possible." "Lose weight." "Jog at least 2 miles (3.2 kilometers) per day."

"Maintain a moderate exercise program."

A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. What should the nurse do next? Assess for gastrointestinal (GI) bleeding. Withhold the lactulose. Increase protein in the diet. Monitor serum bilirubin levels.

Assess for gastrointestinal (GI) bleeding.

A nurse should perform which intervention for a client with Cushing's syndrome? Offer clothing or bedding that's cool and comfortable. Suggest a high-carbohydrate, low-protein diet. Explain that the client's physical changes are a result of excessive corticosteroids. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

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

The nurse is caring for a client who is administering insulin for diabetes mellitus for the first time. The nurse is instructing the client on mixing Humulin N insulin and Humulin R insulin in one syringe. Arrange the instructions in order. All options must be used. 1. Double check the total number of units in syringe. 2. Gently roll both insulins between your hands. 3. Wipe with alcohol and inject air (equal to units ordered) into the Humulin N insulin. 4. Withdraw Humulin N insulin. 5. Wipe with alcohol and inject air (equal to units ordered) into the Humulin R insulin. 6. Withdraw the Humulin R.

Gently roll both insulins between your hands. Wipe with alcohol and inject air (equal to units ordered) into the Humulin N insulin. Wipe with alcohol and inject air (equal to units ordered) into the Humulin R insulin. Withdraw the Humulin R. Withdraw Humulin N insulin. Double check the total number of units in syringe.

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? related to exhaustion secondary to an accelerated metabolic rate related to edema and dry skin secondary to fluid infiltration into the interstitial spaces related to bone demineralization resulting in pathologic fractures related to tetany secondary to a decreased serum calcium level

related to bone demineralization resulting in pathologic fractures

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in serum glucose level. hair loss. bone mineralization. menstrual flow.

serum glucose level.

A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. hyperkalemia skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection hypotension

skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection

The nurse is assessing a client with an A-V fistula. Which finding should the nurse report to the healthcare provider? a murmur auscultated over the fistula skin discoloration distal to the fistula fistula covered with long-sleeve clothing pulse palpated over the fistula site

skin discoloration distal to the fistula

A client is newly diagnosed with pernicious anemia. The nurse is teaching the client to increase the vitamin B12 intake. Which is the most effective way for this client to increase vitamin B12 intake? increasing dietary intake of vitamin B12 taking an oral vitamin B12 replacement taking vitamin B12 injections or nasal spray replacement using chelation therapy

taking vitamin B12 injections or nasal spray replacement

When caring for a client with diabetes insipidus, the nurse expects to administer vasopressin. furosemide. regular insulin. 10% dextrose.

vasopressin

On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 0600 glucose level is 300 mg/dL (16.7 mmol/L). What should the nurse do? Withhold all medications. Administer the insulin dose dictated by the sliding scale. Call the health care provider (HCP) for specific prescriptions based on the glucose level. Notify the surgery department.

Call the health care provider (HCP) for specific prescriptions based on the glucose level.

A client with a history of Addison's disease is experiencing weakness and headache. The vital signs are blood pressure of 100/60 and heart rate of 80. Laboratory values are Na 130, potassium 4.8, and blood glucose 70. Which solution would the nurse expect to administer? I.V. total parenteral nutrition and insulin coverage I.V. normal saline and glucocorticoids I.V. lactated Ringer's solution and packed cells I.V. 5% dextrose and dopamine

I.V. normal saline and glucocorticoids

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the healthcare team take first? Initiate fluid replacement therapy. Administer insulin. Correct diabetic ketoacidosis. Determine the cause of diabetic ketoacidosis.

Initiate fluid replacement therapy.

A nurse explains to a client that the nurse will administer the client's first insulin dose in the client's abdomen. How does absorption at the abdominal site compare with absorption at other sites? Insulin is absorbed more slowly at abdominal injection sites than at other sites. Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Insulin is absorbed unpredictably at all injection sites.

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

A nurse is administering an IV antineoplastic agent when the client says, "My arm is burning by the IV site." What should the nurse do first? Slow the infusion rate and check the IV site. Double check that the dose is correct. Stop infusing the medication. Place a warm, moist pack on the IV site area.

Stop infusing the medication.

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The kidneys react rapidly to compensate for imbalances in the body. The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. The kidneys regulate the bicarbonate level in the intracellular fluid.

The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.

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

adrenal cortex

What is the most common cause of hyperaldosteronism? excessive sodium intake a pituitary adenoma deficient potassium intake an adrenal adenoma

an adrenal adenoma

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

compensated respiratory alkalosis

A client is going to receive an insulin pump prior to discharge and the nurse has done extensive teaching. Which statement indicates that the client has a good understanding about the pump? "I am able to use various types of insulin with the pump and can change the insulin infusion based on activity level." "I will need to monitor blood glucose levels multiple times a day while on the insulin pump." "Insulin bolus is not needed prior to a meal because a steady dose of insulin is received through the infusion pump." "There is a decrease in flexibility with the pump because a needle rests under the skin of the client."

"I will need to monitor blood glucose levels multiple times a day while on the insulin pump."

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

hydrocortisone

A client has had an hypophysectomy. What signs of a potential complication should the nurse teach the client to report? acromegaly Cushing's disease diabetes mellitus hypopituitarism

hypopituitarism

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 5% dextrose and normal saline solution lactated Ringer's solution half-normal saline solution 10% dextrose in water

lactated Ringer's solution

A client has been diagnosed with Addison's disease. The nurse should plan with the client to manage which effect of the disease? weight gain. hunger. lethargy. muscle spasms.

lethargy.

A client with diabetes and peripheral neuropathy is being discharged from the hospital. What instruction should the nurse provide to decrease the risk for skin breakdown? Select all that apply. It is acceptable to use a hot water bottle to keep feet warm. Always wear socks and, preferably, shoes to protect the feet. Check the feet daily to look for any injuries. Nail clippers can be used with toenails to prevent injury. Use lotion on feet to keep skin from becoming dry and cracked.

Always wear socks and, preferably, shoes to protect the feet. Check the feet daily to look for any injuries. Use lotion on feet to keep skin from becoming dry and cracked.

A nurse is assigned to a client who is using an insulin pump. The nurse has never cared for a client with an insulin pump and isn't sure what to do. What should the nurse do first? Inform the charge nurse that the nurse doesn't feel comfortable with this assignment. Refuse to accept the assignment until the nurse has received training about pump management. Request information about nursing responsibilities in caring for a client with a pump. Accept the client and do the best possible until the shift ends.

Request information about nursing responsibilities in caring for a client with a pump.

A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching? Select all that apply. Use scissors to trim toenails. Wear cotton socks. Apply foot powder after bathing. Go barefoot only when you know your home environment. See a podiatrist regularly to have your feet checked. Wear loose-fitting shoes.

Wear cotton socks. See a podiatrist regularly to have your feet checked. Apply foot powder after bathing.

A client with diabetes has been diagnosed with hypertension, and the health care provider has prescribed atenolol, a beta-blocker. When teaching the client about the drug, what should the nurse tell the client about how it may interact with the client's diabetes? Atenolol may cause: a decrease in the hypoglycemic effects of insulin. an increase in the hypoglycemic effects of insulin. an increase in the incidence of ketoacidosis. a decrease in the incidence of ketoacidosis.

an increase in the hypoglycemic effects of insulin.

Which goal is the priority for a client in Addisonian crisis? controlling hypertension preventing irreversible shock preventing infection relieving anxiety

preventing irreversible shock

A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of severe hypotension. excessive thirst. profound neuromuscular irritability. acute gastritis.

profound neuromuscular irritability.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl (26.1 mmol/L). Which finding is most likely to accompany this blood glucose level? cool, moist skin rapid, thready pulse arm and leg trembling slow, shallow respirations

rapid, thready pulse

A 24-year-old client with diabetes mellitus sustains a large laceration that requires suturing. Which statement indicates that the client understands wound healing? "My scar will fade within 4 months." "If I don't get an infection, the scar may fade in 1 to 3 years." "This procedure won't leave a scar." "It's so hard to predict when this scar will disappear."

"It's so hard to predict when this scar will disappear."

The client who has been hospitalized with pancreatitis does not drink alcohol because of religious convictions. The client becomes upset when the health care provider (HCP) persists in asking about alcohol intake. What should the nurse tell the client about the reason for these questions? "There is a strong link between alcohol use and acute pancreatitis." "Alcohol intake can interfere with the tests used to diagnose pancreatitis." "Alcoholism is a major health problem, and all clients are questioned about alcohol intake." "The health care provider must obtain the pertinent facts, regardless of religious beliefs."

"There is a strong link between alcohol use and acute pancreatitis."

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. The client is being converted to continuous subcutaneous insulin therapy. While teaching continuous subcutaneous insulin therapy, the nurse should tell the client that the regimen includes the use of: intermediate- and long-acting insulins. short- and long-acting insulins. rapid-acting insulin only. short- and intermediate-acting insulins.

rapid-acting insulin only.

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrochloride 2 mg to be administered subcutaneously every 4 hours as needed for pain. Why should the nurse administer hydromorphone in small doses? A small dose is: less likely to cause dependency. less irritating to subcutaneous tissues in small doses. as potent as morphine in larger doses. excreted before accumulating in toxic amounts in the body.

as potent as morphine in larger doses.

A client receives 12 units of intermediate- or long-acting insulin and 6 units of fast-acting insulin each morning. Place the following actions in chronological order of how the nurse would demonstrate how to mix insulins. Use all options. Wipe off the vials with an alcohol swab. Inject 6 units of air into the fast-acting insulin vial. Inject 12 units of air into the intermediate- or long-acting insulin vial. Withdraw 6 units of fast-acting insulin. Withdraw 12 units of intermediate- or long-acting insulin .

Wipe off the vials with an alcohol swab. Inject 12 units of air into the intermediate- or long-acting insulin vial. Inject 6 units of air into the fast-acting insulin vial. Withdraw 6 units of fast-acting insulin. Withdraw 12 units of intermediate- or long-acting insulin .

A client with diabetes and peripheral neuropathy is being discharged from the hospital. What instruction should the nurse provide to decrease the risk for skin breakdown? Select all that apply. It is acceptable to use a hot water bottle to keep feet warm. Always wear socks and, preferably, shoes to protect the feet. Check the feet daily to look for any injuries. Nail clippers can be used with toenails to prevent injury. Use lotion on feet to keep skin from becoming dry and cracked.

Always wear socks and, preferably, shoes to protect the feet. Check the feet daily to look for any injuries. Use lotion on feet to keep skin from becoming dry and cracked. Explanation:

The adrenal cortex is responsible for producing which substances? glucocorticoids and androgens catecholamines and epinephrine mineralocorticoids and catecholamines norepinephrine and epinephrine

glucocorticoids and androgens

The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel? administering hepatitis C vaccine to all health care personnel decreasing contact with blood and blood-contaminated fluids wearing gloves when emptying the bedpan wearing a gown and mask when providing direct care

decreasing contact with blood and blood-contaminated fluids

A client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply. high-protein, high-calorie diet high-fiber, low-calorie diet plan for a thyroidectomy use of stool softeners thyroid hormone replacements review of the procedure for thyroid radiation therapy

high-fiber, low-calorie diet use of stool softeners thyroid hormone replacements

A client receiving thyroid replacement therapy develops influenza and forgets to take the prescribed thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing what life-threatening complication? systolic hypertension thyroid storm myxedema coma cerebrovascular accident

myxedema coma

Which of the following arterial blood gas (ABG) results would the nurse anticipate for a client with a 3-day history of vomiting? pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28