T3U1 Endocrine Exam
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.
Correct Response: Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes Explanation: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.
Which of the following in a client's history is essential for the nurse to document and communicate about before the client undergoes a thyroid test? Select all that apply.
Correct Response: Intravenous pyelogram Allergy to seafood Gallbladder series Explanation: The nurse documents an allergy to iodine, a component of contrast dyes, or seafood, and informs the physician. He or she also reports whether the client has had a diagnostic test that used iodine (e.g., intravenous pyelography, gallbladder series) within the past 3 months. This information is essential before initiating a thyroid test.
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose?
Correct response: Goiter Explanation: A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of goiter include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.
A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs?
Correct response: Insulin pump Explanation: The insulin pump most closely mimics regular pancreas function and increases meal and exercise flexibility. The use of the pump would meet the client's needs of not wanting to self-administer several injections of insulin every day. With one injection per day, there is difficulty controlling fasting blood glucose if the type of insulin does not last. The client could also develop afternoon hypoglycemia if the single dose is increased in order to control the morning fasting glucose level. Two injections per day might meet the client's needs of minimal self-injections; however, for this regimen, there needs to be a fixed schedule of meals and exercise and it is difficult to adjust the dose if premixed insulin is used. Self-administering insulin before each meal will not meet the client's needs since this requires more injections than any other regimen.
Which statement is correct regarding glargine insulin?
Correct response: It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.
A 30-year-old client arrives at the community clinic complaining of difficulty sleeping. Which hormone should the nurse explain is responsible for regulating the sleep-wake cycle?
Correct response: Melatonin Explanation: Melatonin is thought to participate in the maintenance of the sleep-wake cycle. In sunlight, sympathetic nerve fibers release norepinephrine, which inhibits the secretion of melatonin and results in wakefulness. In darkness, the lack of norepinephrine stimulates the secretion of melatonin, resulting in sleepiness. Erythropoietin, gastrin, and somatostatin hormones are not responsible for the client's condition. Erythropoietin is a hormone that stimulates peripheral stem cells in the bone marrow to produce red blood cells. Gastrin is a hormone that is released after eating, which causes the stomach to produce more acid. Somatostatin is a pancreatic hormone that controls the rate of nutrient absorption into the blood stream.
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?
Correct response: NPH Explanation: Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.
A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin?
Correct response: Observe the client drawing up and administering the insulin. Explanation: Nurses should assess the client's ability to perform diabetes-related self-care as soon as possible during the hospitalization or office visit to determine whether the client requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the client performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the client about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.
The nurse is evaluating a client's neck for thyroid enlargement. Which action by the nurse is appropriate during the evaluation?
Correct response: Palpate the thyroid gland gently. Explanation: The nurse should inspect the neck for thyroid enlargement and gently palpate the thyroid gland. Repeated palpation of the thyroid in case of thyroid hyperactivity can result in a sudden release of a large amount of thyroid hormones, which may have serious implications. Pigment changes in the neck and excessive oiliness of the skin are not related to assessment for thyroid enlargement.
Nursing care for a client in addisonian crisis should include which intervention?
Correct response: Placing the client in a private room Explanation: The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client?
Correct response: Propylthiouracil Explanation: Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.
A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?
Correct response: Sodium level of 150 mEq/L Explanation: Diabetes insipidus (DI) is a rare disorder that occurs due to injury to the hypothalamus or pituitary gland with a deficiency of ADH (vasopressin) that results in excretion of large volumes of dilute urine and extreme thirst. Without the action of ADH on the distal nephron of the kidney, an enormous daily output (greater than 250 mL per hour) of very dilute urine with a specific gravity of 1.001 to 1.005 occurs. The urine contains no abnormal substances such as glucose or albumin. Due to the intense thirst, the client tends to drink 2 to 20 L of fluid daily and craves cold water. In adults, the onset of DI may be insidious or abrupt. The disease cannot be controlled by limiting fluid intake because the high-volume loss of urine continues even without fluid replacement. Attempts to restrict fluids cause the client to experience an insatiable craving for fluid and to develop hypernatremia and severe dehydration. DI does not affect the glucose, potassium, or phosphate levels.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: `
Correct response: T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Correct response: Tetany Explanation: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy?
Correct response: The presence of a tingling sensation Explanation: Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.
Which diagnostic test is done to determine suspected pituitary tumor?
Correct response: computed tomography scan Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
While preparing a client with mild cognitive impairment for upcoming diagnostics, the nurse includes the client's family during the information-gathering portion of the assessment. The nurse takes this action in order to:
Correct response: confirm the medications the client is using. Explanation: When preparing an client with cognitive impairment for a diagnostic test, it may be necessary to consult family members or the caregiver to confirm the drugs that the client is taking or has taken within the last several months because side effects or interactions may contribute to changes in endocrine function.
A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate?
Correct response: "Diet, exercise, and weight loss can eliminate the need for medication." Explanation: Dieting, exercise, and weight loss can control and/or delay the need for medication to treat type 2 diabetes mellitus in some clients. Because the client is controlling blood sugars, changing the diet is not indicated. Controlling blood glucose levels will prevent multisystem complications and should be the mainstay of treatment for diabetes mellitus. Although clarification is appropriate, stating the client misunderstood can close the line of communication between client and nurse.
During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function?
Correct response: "Do you experience fatigue even if you have slept a long time?" Explanation: With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.
A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications?
Correct response: "Do you feel any muscle twitches or spasms?" Explanation: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.
A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it?
Correct response: "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." Explanation: The client stating that he'll remain hydrated and pay attention to his eating, drinking, and voiding needs indicates understanding of HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of non-diet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral antidiabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?
Correct response: "I may stop taking this medication when I feel better." Explanation: The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?
Correct response: "I will increase my fluid and calcium intake." Explanation: The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with his physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.
A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what?
Correct response: "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." Explanation: The nurse must explain the "sick day rules" again to the client who plans to stop taking insulin when sick. The nurse should emphasize that the client should take insulin agents as usual and test the blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring clients may need supplemental doses of regular insulin every 3 to 4 hours. The client should report elevated glucose levels (greater than 300 mg/dL or 16.6 mmol/L, or as otherwise instructed) or urine ketones to the health care provider. If the client is not able to eat normally, the client should be instructed to substitute with soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the client should have an intake of liquids every 30 to 60 minutes to prevent dehydration.
A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response?
Correct response: "If treated successfully, the major physical changes will disappear with time." Explanation: If treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationships with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.
A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor?
Correct response: "It regulates the function of other endocrine glands." Explanation: The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.
A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?
Correct response: "Rotate injection sites within the same anatomic region, not among different regions." Explanation: The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.
A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?
Correct response: "You'll need less insulin when you exercise or reduce your food intake." Explanation: The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications decrease insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase insulin requirements.
A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective?
Correct response: 1/2 cup fruit juice or regular soft drink Explanation: In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
Correct response: 10 to 15 g of a simple carbohydrate. Explanation: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station?
Correct response: A 24-year-old client with unstable hyperthyroidism with sinus tachycardia Explanation: The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station. The client who had a CABG is most likely to develop an arrhythmia on his third postoperative day. The unstable client with diabetes mellitus could experience hypoglycemia or hyperglycemia and requires frequent monitoring of blood glucose levels. The elderly male is confused and agitated. The nurse should assign these three clients to beds as close to the nurses' station as possible.
A client has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the health care provider prescribe for this client?
Correct response: A biguanide Explanation: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
The nurse is assessing mental and emotional status in a client about to begin therapy for an endocrine disorder. Which of the following would the nurse test to assess the client's mental and emotional status?
Correct response: Ability to respond to questions Explanation: The client's ability to process information and respond to questions can help the nurse evaluate mental and emotional status.
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?
Correct response: Acromegaly Explanation: Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.
What should the nurse teach a client on corticosteroid therapy in order to reduce the client's risk of adrenal insufficiency?
Correct response: Always have enough medication on hand to avoid running out. Explanation: The client and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The client should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms.
Which would be included in the teaching plan for a client diagnosed with diabetes mellitus?
Correct response: An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. Explanation: Diabetic retinopathy is the leading cause of blindness among people between 20 and 74 years of age in the United States; it occurs in both type 1 and type 2 diabetes. When blood glucose is well controlled, the potential for complications of diabetes is reduced. Several types of foods contain sugar, including cereals, sauces, salad dressings, fruits, and fruit juices. It is not feasible, nor advisable, to remove all sources of sugar from the diet. If the diabetes had been well controlled without insulin before the period of acute stress causing the need for insulin, the client may be able to resume previous methods for control of diabetes when the stress is resolved.
A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client?
Correct response: Avoid hot-water bottles and heating pads. Explanation: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided.Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the client should gently, not vigorously, pat feet dry to avoid injury.
A nurse is caring for a client newly diagnosed with type 1 diabetes. The nurse is educating the client about self-administration of insulin in the home setting. The nurse should teach the client to do what action?
Correct response: Avoid using the same injection site more than once in 2 to 3 weeks. Explanation: To prevent lipodystrophy, the client should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90 degree angle. Cleansing the injection site with alcohol is optional.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Correct response: Calcium gluconate Explanation: Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?
Correct response: Calcium gluconate Explanation: Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Correct response: Desmopressin (DDAVP) Explanation: DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration. Other medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.
An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true?
Correct response: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Explanation: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.
Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin?
Correct response: Do not mix with other insulins. Explanation: Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
A nurse should perform which intervention for a client with Cushing's syndrome?
Correct response: Explain that the client's physical changes are a result of excessive corticosteroids. Explanation: The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis?
Correct response: Fluid deprivation test Explanation: The fluid deprivation test involves withholding water for 4 to 18 hours and periodically checking urine and plasma osmolarity. A client with diabetes insipidus will have an increased serum osmolarity of less than 300 mOsm/kg. Urine osmolarity won't increase. The capillary blood glucose test rapidly measures glucose level in whole blood. The serum ketone test is used to diagnose diabetic ketoacidosis. The urine glucose test monitors glucose levels in urine; however, diabetes insipidus doesn't affect urine glucose levels, so this test isn't appropriate.
The student nurse is labeling a diagram of the endocrine system. What organ would the student nurse not include in the diagram because it is not a major organ of the endocrine system?
Correct response: Gallbladder Explanation: The gallbladder is not part of the endocrine system and does not secrete hormones. All other options are organs of the endocrine system.
The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level?
Correct response: Glucagon Explanation: Glucagon, a hormone released by alpha islet cells, raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Insulin is released to lower the blood sugar levels. Cortisone and estrogen are not released from the pancreas.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect:
Correct response: Graves' disease. Explanation: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A student with diabetes reports feeling nervous and hungry. The school nurse assesses the student and finds the child has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer?
Correct response: Half of a cup of juice, followed by cheese and crackers Explanation: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. Initial treatment should be followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and the additional sugar may result in a sharp rise in blood sugar that will last for several hours.
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client?
Correct response: Hydrochlorothiazide Explanation: The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
Correct response: Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client?
Correct response: Hypoglycemia Explanation: The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.
The physiology instructor is talking with the class of nursing students. What would the instructor explain to the students is the connecting link between the nervous system and the endocrine system?
Correct response: Hypothalamus Explanation: The main connecting link between the nervous system and the endocrine system is the hypothalamus, which responds to nervous system stimulation by producing hormones.
A client is scheduled to have a test to determine thyroid function. What should the nurse ask the client prior to scheduling the testing?
Correct response: If the client has had a diagnostic test that used iodine within the last 3 months Explanation: The client should ask whether the client has had a diagnostic test that used iodine within the past 3 months. This information is essential before initiating a thyroid test. The nurse is not responsible for eliciting information regarding ability to pay. Fluid intake and taking birth control pills do not correlate with the thyroid tests and have no relevance.
A diabetic client maintains glucose control with the use of long-acting and short-acting insulin. Which nursing instruction would be considered a priority teaching issue for this client?
Correct response: If using Lantus or Levemir, give in separate syringe. Explanation: Long-acting insulin (Lantus and Levemir) cannot be mixed with other insulin in the same syringe. Blood glucose levels should be monitored prior to giving insulin and anytime symptoms present. The thighs are the preferred site for slower absorption of nighttime insulin dose.
A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level?
Correct response: Insulin Explanation: Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
Correct response: Levothyroxine (Synthroid) Explanation: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.
Which type of insulin acts most quickly?
Correct response: Lispro Explanation: The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.
Which intervention is the most critical for a client with myxedema coma?
Correct response: Maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
After reviewing the action of hormones, a group of students demonstrate understanding when they identify that the secretion of testosterone stimulates which of the following?
Correct response: Male secondary sex characteristics Explanation: Testosterone is responsible for stimulating the development of secondary sex characteristics. Gastrin stimulates stomach acid production. Secretin and cholecystokinin stimulate bile and pancreatic juice secretion. Thyroid hormone stimulates basal metabolism.
A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
Correct response: Metformin Explanation: Metformin is a biguanide and, along with the thiazolidinediones (rosiglitazone and pioglitazone), are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide, which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones?
Correct response: Methimazole Explanation: Propylthiouracil (PTU) and methimazole are commonly used. They both act by blocking the synthesis of hormones. The other choices suppress the release of the thyroid hormones, except for propranolol which is a beta-adrenergic blocking agent.
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
Correct response: Milk Explanation: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?
Correct response: Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Explanation: Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland?
Correct response: Oxytocin Explanation: The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction?
Correct response: Parathyroid gland Explanation: The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level. The thyroid, thymus, and adrenal gland do not secrete calcium.
Which of the following glands is considered the master gland?
Correct response: Pituitary Explanation: Commonly referred to as the master gland, the pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands. The thyroid, parathyroid, and adrenal glands are not considered the master gland.
The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels?
Correct response: Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. A positive Trousseau's sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski's sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.
A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address?
Correct response: Recognition of hypoglycemia and hyperglycemia Explanation: It is imperative that newly diagnosed clients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the client's immediate "survival skills" following a new diagnosis.
What is the only insulin that can be given intravenously?
Correct response: Regular Explanation: Insulins other than regular are in suspensions that could be harmful if administered IV.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Correct response: Restricting fluids Explanation: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan?
Correct response: Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns Explanation: The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.
A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?
Correct response: Serum glucose level of 52 mg/dl Explanation: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action?
Correct response: Slowly taper down the dose of prednisone, as prescribed. Explanation: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no over-the-counter (OTC) substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin?
Correct response: Sulfonylureas Explanation: A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
Correct response: Tachycardia Explanation: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus?
Correct response: The client has not eaten but continues to take insulin or oral antidiabetic medications. Explanation: Hypoglycemia occurs when a client with diabetes is not eating and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the client has not been compliant with the prescribed treatment regimen. If the client has eaten and has not taken or received insulin, diabetic ketoacidosis is more likely to develop.
A client is diagnosed with diabetes mellitus. The client reports visiting the gym regularly and is a vegetarian. Which of the following factors is important to consider when the nurse assesses the client?
Correct response: The client's consumption of carbohydrates Explanation: While assessing a client, it is important to ask about consumption of carbohydrates due to the client's high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not the priority when assessing a client with high blood sugar.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?
Correct response: The functioning of endocrine glands Explanation: Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic?
Correct response: The need for lifelong steroid replacement Explanation: Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the client and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
Hormones are chemicals produced in the body to perform specific functions. What is a characteristic of a hormone?
Correct response: They travel through the blood to specific receptor sites throughout the body Explanation: Hormones are chemicals that are produced in the body and meet specific criteria. Hormones are produced in very small amounts and are secreted directly into the blood stream. They do travel through the blood to specific receptor sites throughout the body and are immediately broken down.
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?
Correct response: This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.
The nurse is caring for a client with an immunodeficiency disorder. Lab results show that the client does not have an adequate number of T lymphocytes needed to improve immune function. Which gland should be investigated for dysfunction?
Correct response: Thymus Explanation: The thymus gland is located in the upper part of the chest above or near the heart. It secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. The parathyroid, thyroid, and adrenal gland do not develop T lymphocyte production.
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Correct response: Tracheostomy set Explanation: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.
A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes?
Correct response: Type 1 diabetes Explanation: Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.
A client is having problems with parathyroid hormone. What vitamin would the nurse suspect as potentially contributing to the client's problem?
Correct response: Vitamin D Explanation: Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
A patient with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which of the following suggestions should the nurse give the patient to cope with the condition?
Correct response: Wear clothing that covers the neck. Explanation: The nurse may suggest that the patient wear clothing that covers the neck, making the scar almost invisible. Application of medicines, skin graft, and cosmetic surgery are not the appropriate suggestions.
A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?
Correct response: Weight loss, nervousness, and tachycardia Explanation: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.
A nurse is performing an examination and notes that the client exhibits signs of exophthalmos. What has the nurse observed?
Correct response: abnormal bulging or protrusion of the eyes Explanation: When there is an increase in the volume of the tissue behind the eyes, the eyes will appear to bulge out of the face. Exophthalmos is a bulging of the eye anteriorly out of the orbit.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:
Correct response: decreased body temperature and cold intolerance. Explanation: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:
Correct response: deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:
Correct response: has type 2 diabetes. Explanation: Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain.
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences:
Correct response: heat intolerance and systolic hypertension. Explanation: An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs because of the increased metabolic rate. Diastolic blood pressure decreases because of decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite — not anorexia.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms?
Correct response: hyperpituitarism Explanation: Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes?
Correct response: increased thirst, hunger, and urination Explanation: The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms.
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition?
Correct response: ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:
Correct response: myxedema coma. Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
Which organ is both an exocrine and an endocrine gland?
Correct response: pancreas Explanation: The pancreas lies behind the stomach, with the head of the gland close to the duodenum. It is both an exocrine and an endocrine gland.
A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called:
Correct response: polyphagia. Explanation: While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.
A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:
Correct response: wash and inspect the feet daily. Explanation: A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot.
