Saunders Comprehensive NCLEX-PN: Ch 43 Endocrine Disorders***

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 warrant primary health care provider notification?

-"I am urinating a lot." The classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia.

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?

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

When the nurse is reinforcing instructions to a client who has newly been diagnosed with type-1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?

-"I will notify my primary health care provider if my 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 PCHP if the level is greater than 250 mg/dL (13.9 mol/L). Insulin should never be stopped. In fact, insulin may need to be increased during time of illness. Doses should not be adjusted without the PCHP's advice.

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates need for further teaching?

-"Need to buy a special dietetic foods." It is important to emphasize to the client and family that they are not eating a diabetic, but rather following a balanced meal plan. Adherence to nutrition principle is important component of diabetic management, and an individualized meal plan should be developed for the client.

The nurse is assisting with preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?

-Apply moisturizing lotion to dry feet, but not between the toes. The client should be instructed not to soak feet and to avoid hot water to prevent burns. The client may cut 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 his or her vision is poor. The client should be instructed to wash the feet daily with mild soap.

A 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?

-Maintain a patent airway 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 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 nurse to emphasize ?

-Monitor blood glucose level frequently. Client education after DKA should emphasize the need 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 ketoses indicates that DKA has already occurred. the client should eat well-balanced meals with snacks, as prescribed.

A nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarse and a weak voice. Which nursing action is appropriate?

-Reassure the client that this is usually a temporary condition. Weakness and horseless of the voice can result due to trauma to the laryngeal nerve.

A nurse reinforces teaching with a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?

-Shakiness Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly 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 systemically 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 change to another site. This prevents dramatic changes in daily insulin absorption.

The nurse is caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed. The nurse determines that this medication has been prescribed for which reason?

-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.