The patient with endocrine health problems

*Assessment of the diabetic client for common complications should include examination of the: 1. abdomen. 2. lymph glands. 3. pharynx. 4. eyes.

eyes Diabetic retinopathy, cataracts, and glaucoma are common complications in diabetics, necessitating eye assessment and examination. The feet should also be examined at each client encounter, monitoring for thickening, fissures, or breaks in the skin; ulcers; and thickened nails. Although assessments of the abdomen, pharynx, and lymph glands are included in a thorough examination, they are not pertinent to common diabetic complications.

Which goal is the priority for a client in addisonian crisis? 1. controlling hypertension 2. preventing irreversible shock 3. preventing infection 4. relieving anxiety

preventing irreversible shock Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. This results in loss of extracellular fluid and dangerously low blood volume. Glucocorticoids must be administered to reverse hypotension. Preventing infection is not an appropriate goal of care in this life-threatening situation. Relieving anxiety is appropriate when the client's condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially reassuring.

A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for: 1. tachycardia. 2. weight gain. 3. diarrhea. 4. nausea.

weight gain. Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intolerance, hair loss, constipation, and numbness and tingling in the fingers. Tachycardia is a sign of hyperthyroidism, not hypothyroidism. Diarrhea and nausea are not symptoms of hypothyroidism.

*To reduce the risk of developing type 2 diabetes mellitus, the nurse should instruct the client to: 1. stop smoking cigarettes. 2. obtain a high-cholesterol diet. 3. maintain weight in normal limits. 4. prevent hypertension.

maintain weight in normal limits. The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases complications of diabetes mellitus. A high-cholesterol diet does not necessarily predispose to diabetes mellitus, but it may contribute to obesity and hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for developing complications of diabetes mellitus.

*Which finding should the nurse report to the client's healthcare provider (HCP) for a client with unstable type 1 diabetes mellitus? Select all that apply. 1. systolic blood pressure, 145 mm Hg 2. diastolic blood pressure, 87 mm Hg 3. high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) 4. glycosylated hemoglobin (HbA1c ), 10.2% (0.1) 5. triglycerides, 425 mg/dL (23.6 mmol/L) 6. urine ketones, negative

1.systolic blood pressure, 145 mm Hg 2. diastolic blood pressure, 87 mm Hg 3. high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) 4. glycosylated hemoglobin (HbA1c), 10.2% (0.1) 5. triglycerides, 425 The client with unstable diabetes mellitus is at risk for many complications. Heart disease is the leading cause of mortality in clients with diabetes. The goal blood pressure for diabetics is <130/80 mm Hg. Therefore, the nurse would need to report any findings >130/80 mm Hg. The goal of HbA1c is <7% (0.07); thus, a level of 10.2% (0.1) must be reported. HDL <40 mg/dL (2.2 mmol/L) and triglycerides >150 mg/dL (8.3 mmol/L) are risk factors for heart disease. The nurse would need to report the client's HDL and triglyceride levels. The urine ketones are negative, but this is a late sign of complications when there is a profound insulin deficiency.

Vasopressin is administered to the client with diabetes insipidus because it: 1. decreases blood pressure. 2. increases tubular reabsorption of water. 3. increases release of insulin from the pancreas. 4. decreases glucose production within the liver.

increases tubular reabsorption of water. The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism nor is insulin production a factor in diabetes insipidus.

*The nurse is obtaining a health history from a client with diabetes mellitus who has been taking insulin for 20 years. Currently, the client reports having periods of hypoglycemia followed by periods of hyperglycemia. The nurse should specifically ask if the client is: 1. eating snacks between meals. 2. initiating the use of the insulin pump. 3. injecting insulin at a site of lipodystrophy. 4. adjusting insulin according to blood glucose levels.

injecting insulin at a site of lipodystrophy Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of repeated injections, which can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been receiving insulin for many years, this is the most likely cause of poor control. Eating snacks between meals causes hyperglycemia. Adjusting insulin according to blood glucose levels would not cause hypoglycemia but normal levels. Initiating an insulin pump would not, of itself, cause the periods of hyperglycemia.

One day following a subtotal thyroidectomy, a client begins to have tingling in the fingers and toes. The nurse should first: 1. encourage the client to flex and extend the fingers and toes. 2. notify the healthcare provider (HCP). 3. assess the client for thrombophlebitis. 4. ask the client to speak.

notify the healthcare provider (HCP). Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively. Late signs and symptoms of tetany include seizures, contraction of the glottis, and respiratory obstruction. The nurse should notify the HCP . Exercising the joints in the fingers and toes will not relieve the tetany. The client is not exhibiting signs of thrombophlebitis. There is no indication of nerve damage that would cause the client not to be able to speak.

*Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza? 1. obtaining adequate food intake 2. managing own health 3. relieving pain 4. increasing activity

obtaining adequate food intake The priority goal for the client with diabetes mellitus who is experiencing vomiting with influenza is to obtain adequate nutrition. The diabetic client should eat small, frequent meals of 50 g of carbohydrate or food equal to 200 cal. every 3 to 4 hours. If the client cannot eat the carbohydrates or take fluids, the healthcare provider (HCP) should be called, or the client should go to the emergency department. The diabetic client is in danger of complications with dehydration, electrolyte imbalance, and ketoacidosis. Increasing the client's health management skills is important to lifestyle behaviors, but it is not a priority during this acute illness of influenza. Pain relief may be a need for this client, but it is not the priority at this time; neither is increasing activity during the illness.

The nurse should assess a client with hypothyroidism for: 1. corneal abrasion due to inability to close the eyelids. 2. weight loss due to hypermetabolism. 3. fluid loss due to diarrhea. 4. decreased activity due to fatigue.

decreased activity due to fatigue. A major problem for the person with hypothyroidism is fatigue. Other signs and symptoms include lethargy, personality changes, generalized edema, impaired memory, slowed speech, cold intolerance, dry skin, muscle weakness, constipation, weight gain, and hair loss. Incomplete closure of the eyelids, hypermetabolism, and diarrhea are associated with hyperthyroidism.

The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. 1. Addison's disease will resolve over a few weeks, requiring no further treatment. 2. Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3. Fatigue, weakness, dizziness, and mood changes need to be reported to the healthcare provider (HCP). 4. A medical identification bracelet should be worn. 5. Family members need to be informed about the warning signals of adrenal crisis. 6. Dental work or surgery will require adjustment of daily medication.

Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. Fatigue, weakness, dizziness, and mood changes need to be reported to the healthcare provider (HCP). A medical identification bracelet should be worn. Family members need to be informed about the warning signals of adrenal crisis. Dental work or surgery will require adjustment of daily medication. Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn, and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.

A male client expresses concern about how a hypophysectomy will affect his sexual function. Which statement provides the most accurate information about the physiologic effects of hypophysectomy in a male? 1. Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. 2. Potency will be restored, but the client will remain infertile. 3. Fertility will be restored, but impotence and decreased libido will persist. 4. Exogenous hormones will be needed to restore erectile function after the adenoma is removed.

Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. The client's sexual problems are directly related to the excessive prolactin level. Removing the source of excessive hormone secretion should allow the client to return gradually to a normal physiologic pattern. Fertility will return, and erectile function and sexual desire will return to baseline as hormone levels return to normal.

*A client is prescribed exenatide. What should the nurse instruct the client to do? Select all that apply. 1. Review the one-time setup for each new pen. 2. Inject in the thigh, abdomen, or upper arm. 3. Administer the drug within 60 minutes before morning and evening meals. 4. Understand that there is a low incidence of hypoglycemia when exenatide is taken with insulin. 5. Take the dose of exenatide as soon as the client remembers a dose has been missed.

Review the one-time setup for each new pen. Inject in the thigh, abdomen, or upper arm. Administer the drug within 60 minutes before morning and evening meals. Client teaching includes reviewing proper use and storage of the exenatide dosage pen, particularly the onetime setup for each new pen. The nurse should instruct the client to inject the drug in the thigh, abdomen, or upper arm. The drug should be administered within 60 minutes of the morning and evening meals; the client should not inject the drug after a meal. The nurse should review steps for managing hypoglycemia, especially if the client also takes a sulfonylurea or insulin. If a dose is missed, the client should resume treatment as prescribed, with the next scheduled dose.

Cortisone acetate and fludrocortisone acetate are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy? 1. Take both drugs three times a day. 2. Take the entire dose of both drugs first thing in the morning. 3. Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. 4. Take half of each drug in the morning and the remaining half of each drug at bedtime.

Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. Fludrocortisone acetate can be administered once a day, but cortisone acetate administration should follow the body's natural diurnal pattern of secretion, in which greater amounts of cortisol are secreted during the daytime to meet the increased demand of the body. To mimic this pattern, baseline administration of cortisone acetate is typically 25 mg in the morning and 12.5 mg in the afternoon. Taking it three times a day would result in an excessive dose. Taking the drug only in the morning would not meet the needs of the body later in the day and evening.

A client with Cushing's disease tells the nurse that the healthcare provider (HCP) said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I am not imagining all these symptoms!" The nurse's response will be based on the fact that? 1. Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels. 2. A single random blood test cannot provide reliable information about endocrine levels. 3. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. 4. Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.

The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? 1. The importance of watching for signs of hyperglycemia 2. The need to adjust the steroid dose based on dietary intake and exercise 3. To notify the healthcare provider (HCP) when the blood pressure is suddenly high 4. How to decrease the dose of the corticosteroids when the client experiences stress

The importance of watching for signs of hyperglycemia Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. A serious adverse effect of corticosteroids is hyperglycemia. Clients do not adjust their steroid dose based on dietary intake and exercise; insulin is adjusted based on diet and exercise. Addisonian crisis can occur secondary to hypoadrenocorticism, resulting in a crisis situation of acute hypotension, not increased blood pressure. Addison's disease is a disease of inadequate adrenal hormone, and therefore, the client will have inadequate response to stress. If the client takes more medication than prescribed, there can be a potential increase in potassium depletion, fluid retention, and hyperglycemia. Taking less medication than was prescribed can trigger addisonian crisis state, which is a medical emergency manifested by signs of shock.

*The nurse is coaching a diabetic client using an empowerment approach. The nurse should initiate teaching by asking: 1. "How much does your family need to be involved in learning about your condition?" 2. "What is required for your family to manage your symptoms?" 3. "What activities are most important for you to be able to maintain control of your diabetes?" 4. "What do you know about your medications and condition?"

What activities are most important for you to be able to maintain control of your diabetes? Empowerment is an approach to clinical practice that emphasizes helping people discover and use their innate abilities to gain mastery over their own condition. Empowerment means that individuals with a health problem have the tools, such as knowledge, control, resources, and experience, to implement and evaluate their self-management practices. Involvement of others, such as asking the client about family involvement, implies that the others will provide the direct care needed rather than the client. Asking the client what the client needs to know implies that the nurse will be the one to provide the information. Telling the client what is required does not provide the client with options or lead to empowerment.

*A nurse is participating in a diabetes screening program. Who are at risk for developing type 2 diabetes? Select all that apply. 1. a 32-year-old female who gave birth to a 91⁄2-lb (4,300-g) infant. 2. a 44-year-old Native American (First Nations) who has a body mass index (BMI) of 32. 3. an 18-year-old immigrant from Mexico who jogs four times a week. 4. a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes. 5. a 12-year-old who is overweight.

a 32-year-old female who gave birth to a 91⁄2-lb (4,300-g) infant. a 44-year-old Native American (First Nations) who has a body mass index (BMI) of 32. a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes. a 12-year-old who is overweight. The risk factors for developing type 2 diabetes include giving birth to an infant weighing more than 9 lb (4,100 g); obesity (BMI over 30); ethnicity of Asian, African, Native American, or First Nations; age >45 years; hypertension; and family history in parents or siblings. Childhood obesity is also a risk factor for type 2 diabetes. Maintaining an ideal weight, eating a low-fat diet, and exercising regularly decrease the risk of type 2 diabetes.

A client diagnosed with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should: 1. collect a 24-hour urine specimen to measure serum cortisol levels. 2. administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. 3. draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels. 4. administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels.

administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning When Cushing's syndrome is suspected, a 24-hour urine collection for free cortisol is performed. Levels of 50 to 100 mcg/day (1,379 to 2,756 mmol/L) in adults indicate Cushing's syndrome. If these results are borderline, a high-dose dexamethasone suppression test is done. The dexamethasone is given at 2300 to suppress secretion of the corticotrophin-releasing hormone. A plasma cortisol sample is drawn at 0800. Normal cortisol level <5 mcg/dL (140 mmol/L) indicates normal adrenal response.

*An adult with type 2 diabetes mellitus has been NPO since 2200 in preparation for having a nephrectomy the next day. At 0600 on the day of surgery, the nurse reviews the client's medical record and laboratory results. Which finding should the nurse report to the healthcare provider (HCP)? 1. urine output of 350 mL in 8 hours 2. urine specific gravity of 1.015 3. potassium of 4.0 mEq (4 mmol/L) 4. blood glucose of 140 mg/dL (7.8 mmol/L)

blood glucose of 140 mg/dL (7.8 mmol/L) The client's blood glucose level is elevated, beyond levels accepted for fasting; normal blood glucose range is 70 to 120 mg/dL (3.9 to 6.7 mmol/L). The specific gravity is within normal range (1.001 to 1.030). Urine output should be 30 to 50 mL/h; thus, 350 mL is a normal urinary output over 8 hours. The potassium level is normal.

*A client with diabetes mellitus asks the nurse to recommend something to remove corns from the toes. The nurse should advise the client to: 1. apply a high-quality corn plaster to the area. 2. consult a healthcare provider (HCP) about removing the corns. 3. apply iodine to the corns before peeling them off. 4. soak the feet in borax solution to peel off the corns.

consult a healthcare provider (HCP) about removing the corns. A client with diabetes should be advised to consult an HCP or a podiatrist for corn removal because of the danger of traumatizing the foot tissue and potential development of ulcers. The diabetic client should never self-treat foot problems but should consult an HCP or a podiatrist.

A client with hyperthyroidism is hospitalized to have a thyroidectomy. The healthcare provider (HCP) has prescribed propranolol. In reviewing the client's history, the nurse notes that the client has asthma. The nurse should next: 1. take the client's pulse and withhold the propranolol if the pulse is <100 beats per minute. 2. count the client's respirations and withhold the propranolol if the respirations are <20 breaths per minute. 3. contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. 4. instruct the client to make position changes slowly.

contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. Propranolol hydrochloride is a nonselective beta-blocker of both cardiac and bronchial drenoreceptors, which competes with epinephrine and norepinephrine for available beta-receptor sites. Propranolol blocks cardiac effects of beta-adrenergic stimulation; as a result, it reduces heart rate; a hypertensive effect is associated with decreased cardiac output. A contraindication of propranolol is bronchial asthma; propranolol can cause bronchiolar constriction even in normal clients. The nurse takes the apical pulse and BP before administering propranolol. The medication is withheld if the heart rate is <60 beats per minute or the systolic BP is <90 mm Hg.

A 34-year-old female is diagnosed with hypothyroidism. What should the nurse assess the client for? Select all that apply. 1. rapid pulse 2. decreased energy and fatigue 3. weight gain of 10 lb (4.5 kg) 4. fine, thin hair with hair loss 5. constipation 6. menorrhagia

decreased energy and fatigue weight gain of 10 lb (4.5 kg) constipation menorrhagia Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone. Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse hair, constipation, and menorrhagia are common signs and symptoms of hypothyroidism.

*A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate action? 1. deep, rapid respirations with long expirations 2. shallow respirations alternating with long expirations 3. regular depth of respirations with frequent pauses 4. short expirations and inspirations

deep, rapid respirations with long expirations Deep, rapid respirations with long expirations are indicative of Kussmaul's respirations, which occur in metabolic acidosis. The respirations increase in rate and depth, and the breath has a "fruity" or acetone-like odor. This breathing pattern is the body's attempt to blow off carbon dioxide and acetone, thus compensating for the acidosis. The other breathing patterns listed are not related to ketoacidosis and would not compensate for the acidosis.

The client is receiving an IV infusion of 5% dextrose in normal saline running at 125 mL/h. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first: 1. discontinue the infusion. 2. apply a warm soak to the site. 3. stop the flow of solution temporarily. 4. irrigate the needle with normal saline.

discontinue the infusion. Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the IV line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the IV line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem nor does it address the client's needs for fluid replacement. Infiltrated IV sites should not be irrigated; doing so will only cause more swelling and pain.

*The nurse should caution the client with diabetes mellitus who is taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause: 1. hypokalemia. 2. hyperkalemia. 3. hypocalcemia. 4. disulfiram-like symptoms.

disulfiram-like symptoms. A client with diabetes who takes any first- or second-generation sulfonylurea should be advised to avoid alcohol intake. Sulfonylureas in combination with alcohol can cause serious disulfiram-like reactions, including flushing, angina, palpitations, and vertigo. Serious reactions, such as seizures and possibly death, may also occur. Hypokalemia, hyperkalemia, and hypocalcemia do not result from taking sulfonylureas in combination with alcohol.

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The nurse does this to monitor for signs of: 1. internal hemorrhage. 2. decreasing level of consciousness. 3. laryngeal nerve damage. 4. upper airway obstruction.

laryngeal nerve damage. Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the healthcare provider (HCP) immediately. Internal hemorrhage is detected by changes in vital signs. The client's level of consciousness can be partially assessed by asking her to speak, but that is not the primary reason for doing so in this situation. Upper airway obstruction is detected by color and respiratory rate and pattern.

Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, the nurse should recommend that the client: 1. increase the amount of potassium in the diet. 2. maintain a regular program of weight-bearing exercise. 3. limit dietary vitamin D intake. 4. perform isometric exercises.

maintain a regular program of weight-bearing exercise. Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.

Initial treatment for a cerebrospinal fluid (CSF) leak after transsphenoidal hypophysectomy would most likely involve: 1. repacking the nose with pressure dressings. 2. returning the client to surgery to close the leak. 3. maintaining bed rest with the head of the bed elevated to 30 degrees. 4. administering high-dose corticosteroid therapy.

maintaining bed rest with the head of the bed elevated to 30 degrees. If CSF leakage is suspected or confirmed, the client is treated initially with bed rest with the head of the bed elevated to decrease pressure on the graft site. Most leaks heal spontaneously, but occasionally, surgical repair of the site in the sella turcica is needed. Repacking the nose will not heal the leak at the graft site in the dura. The client will not be returned to surgery immediately because most leaks heal spontaneously. High-dose corticosteroid therapy is not effective in healing a CSF leak.

Which outcome is a priority for the client with Addison's disease? 1. maintenance of medication compliance 2. avoidance of normal activities with stress 3. adherence to a 2-g sodium diet 4. prevention of hypertensive episodes

maintenance of medication compliance Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the healthcare provider (HCP) to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease.

When discussing recent onset of feelings of sadness and depression in a client with hypothyroidism who has just started to take thyroid hormone replacement, the nurse should inform the client that these feelings are: 1. the effects of thyroid hormone replacement therapy and will diminish over time. 2. related to thyroid hormone replacement therapy and will not diminish over time. 3. a normal part of having a chronic illness. 4. most likely related to low thyroid hormone levels and will improve with treatment.

most likely related to low thyroid hormone levels and will improve with treatment. Hypothyroidism may contribute to sadness and depression. It is good practice for clients with newly diagnosed depression to be monitored for hypothyroidism by checking serum thyroid hormone and thyroid- stimulating hormone levels. This client needs to know that these feelings may be related to her low thyroid hormone levels and may improve with treatment. Replacement therapy does not cause depression. Depression may accompany chronic illness, but it is not "normal."

*The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can: 1. perform the procedure safely and correctly. 2. critique the nurse's performance of the procedure. 3. explain all steps of the procedure correctly. 4. obtain 100% correct answers on a posttest.

perform the procedure safely and correctly. The nurse should judge that learning has occurred from the evidence of a change in the client's behavior. A client who performs a procedure safely and correctly demonstrates that he or she has acquired a skill. Evaluation of this skill acquisition requires performance of that skill by the client with observation by the nurse. The client must also demonstrate cognitive understanding, as shown by the ability to critique the nurse's performance. Explaining the steps demonstrates acquisition of knowledge at the cognitive level only. A posttest does not indicate the degree to which the client has learned a psychomotor skill.

In the early postoperative period after a bilateral adrenalectomy, the client has an increased temperature. The nurse should assess the client specifically for signs of: 1. dehydration. 2. poor lung expansion. 3. wound infection. 4. urinary tract infection.

poor lung expansion. Poor lung expansion from bed rest, pain, and retained anesthesia is a common cause of slight postoperative temperature elevation. Nursing care includes turning the client and having the client cough and deep breathe every 1 to 2 hours or more frequently as prescribed. The client will have postoperative IV fluid replacement prescribed to prevent dehydration. Wound infections typically appear 4 to 7 days after surgery. Urinary tract infections would not be typical with this surgery.

A priority in the first 24 hours after a bilateral adrenalectomy is: 1. beginning oral nutrition. 2. promoting self-care activities. 3. preventing adrenal crisis. 4. ambulating in the hallway.

preventing adrenal crisis. The priority in the first 24 hours after adrenalectomy is to identify and prevent adrenal crisis. Monitoring of vital signs is the most important evaluation measure. Hypotension, tachycardia, orthostatic hypotension, and arrhythmias can be indicators of pending vascular collapse and hypovolemic shock that can occur with adrenal crisis. Beginning oral nutrition is important, but not necessarily in the first 24 hours after surgery, and it is not more important than preventing adrenal crisis. Promoting self-care activities is not as important as preventing adrenal crisis. Ambulating in the hallway is not a priority in the first 24 hours after adrenalectomy.

*Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of: 1. chronic obstructive pulmonary disease (COPD). 2. pancreatic cancer. 3. renal failure. 4. cerebrovascular accident.

renal failure Renal failure frequently results from the vascular changes associated with diabetes mellitus. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic nephropathy. Chronic obstructive pulmonary disease is not a complication of diabetes nor is it prevented by ACE inhibitors. Pancreatic cancer is neither prevented by ACE inhibitors nor considered a complication of diabetes. Cerebrovascular accident is not directly prevented by ACE inhibitors, although management of hypertension will decrease vascular disease.

A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. 1. hyperkalemia 2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection 6. hypotension

skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reabsorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. CNS adverse effects are euphoria, headache, insomnia, confusion, and psychosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress the cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the: 1. back of the mouth. 2. nose. 3. sinus channel below the right eye. 4. upper gingival mucosa in the space between the upper gums and lip.

upper gingival mucosa in the space between the upper gums and lip. With transsphenoidal hypophysectomy, the sella turcica is entered from below, through the sphenoid sinus. There is no external incision; the incision is made between the upper lip and gums.

The nurse should teach the client with Graves' disease to prevent corneal irritation from mild exophthalmos by: 1. massaging the eyes at regular intervals. 2. instilling an ophthalmic anesthetic as prescribed. 3. wearing dark-colored glasses. 4. covering both eyes with moistened gauze pads.

wearing dark-colored glasses Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures such as wearing sunglasses to protect the eyes from corneal irritation. Treatment of ophthalmopathy should be performed in consultation with an ophthalmologist. Massaging the eyes will not help to protect the cornea. An ophthalmic anesthetic is used to examine and possibly treat a painful eye, not protect the cornea. Covering the eyes with moist gauze pads is not a satisfactory nursing measure to protect the eyes of a client with exophthalmos because treatment is not focused on moisture to the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the retrobulbar connective tissues and extraocular muscle volume are expanded because of fluid retention. The pressure is also increased.

*The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time? 1. 1100, shortly before lunch 2. 1300, shortly after lunch 3. 1800, shortly after dinner 4. 0100, while sleeping

0100, while sleeping The client with diabetes mellitus who is taking NPH insulin in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. The client should eat a bedtime snack to help prevent hypoglycemia while sleeping.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? 1. Increase calories. 2. Restrict sodium. 3. Restrict potassium. 4. Reduce fat to 10%.

Restrict sodium A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of <20% of total calories is not recommended.

*When teaching the diabetic client about foot care, the nurse should instruct the client to: 1. avoid going barefoot. 2. buy shoes a half size larger. 3. cut toenails at angles. 4. use heating pads for sore feet.

avoid going barefoot. The client with diabetes is prone to serious foot injuries secondary to peripheral neuropathy and decreased circulation. The client should be taught to avoid going barefoot to prevent injury. Shoes that do not fit properly should not be worn because they will cause blisters that can become nonhealing, serious wounds for the diabetic client. Toenails should be cut straight across. A heating pad should not be used because of the risk of burns due to insensitivity to temperature.

*A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications? 1. regular insulin with breakfast; NPH after breakfast 2. both insulins 0.5 hours before breakfast 3. in two separate syringes with breakfast 4. NPH 1 hour before and regular 0.5 hours before breakfast

both insulins 0.5 hours before breakfast Regular and NPH insulins are scheduled together one-half hour before breakfast. They do not need to be given separately or in different syringes.

A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluids would be most appropriate? 1. milk and diet soda 2. water and eggnog 3. chicken broth and juice 4. coffee and milkshakes

chicken broth and juice Electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia, and hyperkalemia. Regular salted (not low-salt) chicken or beef broth and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium.

The nurse is receiving results of a blood glucose level from the laboratory over the telephone. The nurse should: 1. write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. 2. repeat the results to the caller from the laboratory, write the results on scrap paper, and then transfer the results to the medical record. 3. indicate to the caller that the nurse cannot receive results from lab tests over the telephone and ask the lab to bring the written results to the nurses' station. 4. request that the laboratory send the results by email to transfer to the client's medical record.

write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. To assure client safety, the nurse first writes the results on the chart, then reads them back to the caller, and waits for the caller to confirm that the nurse has understood the results. The nurse may receive results by telephone; and although electronic transfer to the client's medical record is appropriate, the nurse can also accept the telephone results if the laboratory has called the results to the nurses' station.

*The nurse is administering the initial dose of a rapid-acting insulin to a client with type 1 diabetes. The nurse should assess the client for hypoglycemia within: 1. 0.5 hours. 2. 1 hour. 3. 2 hours. 4. 3 hours.

3 hours Rapid-acting insulin has an onset in 15 minutes, peaks at 1 hour, and lasts for 3 to 4 hours. Rapid-acting insulin is administered right before or right after a meal. The nurse should assess the client for hypoglycemia 1 hour following administration of the drug.

*The client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which nutrients? 1. carbohydrates only 2. fats and carbohydrates only 3. protein and carbohydrates only 4. proteins, fats, and carbohydrates

proteins, fats, and carbohydrates Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client's diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins.

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. The expected outcome of using this drug is that it helps: 1. slow progression of exophthalmos. 2. reduce the vascularity of the thyroid gland. 3. decrease the body's ability to store thyroxine. 4. increase the body's ability to excrete thyroxine.

reduce the vascularity of the thyroid gland. SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of exophthalmos, and it does not decrease the body's ability to store thyroxine or increase the body's ability to excrete thyroxine.

*The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes? 1. aspirin 2. steroids 3. sulfonylureas 4. angiotensin-converting enzyme (ACE) inhibitors

steroids Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. The nurse should assess this client for: 1. anorexia. 2. tachycardia. 3. weight gain. 4. cold skin.

tachycardia Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism.

*The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? Record your answer using a whole number. units.

32 units. Clients commonly need to mix insulin, requiring careful mixing and calculation. The total dosage is 10 units plus 22 units, for a total of 32 units.

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. Teaching regarding the use of these medications is effective if the client will take: 1. the levothyroxine with breakfast and the other medications after breakfast. 2. the levothyroxine before breakfast and the other medications 4 hours later. 3. all medications together 1 hour after eating breakfast. 4. all medications before going to bed.

the levothyroxine before breakfast and the other medications 4 hours later. Levothyroxine must be given at the same time each day on an empty stomach, preferably 1⁄2 to 1 hour before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours.

Which indicates that the client with diabetes insipidus understands how to manage care? 1. The client will maintain normal fluid and electrolyte balance. 2. The client will select a diabetic diet correctly. 3. The client will state dietary restrictions. 4. The client will exhibit serum glucose level within normal range.

The client will maintain normal fluid and electrolyte balance. Because diabetes insipidus involves excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.

Glulisine insulin is prescribed to be administered to a client before each meal. To assist the day-shift nurse who is receiving the report, the night-shift nurse gives the morning dose of glulisine. When the day-shift nurse goes to the room of the client who requires glulisine, the nurse finds that the client is not in the room. The client's roommate tells the nurse that the client "went for a test." What should the nurse do next? 1. Bring a small glass of juice, and locate the client. 2. Call the client's healthcare provider (HCP). 3. Check the computerized care plan to determine what test was scheduled. 4. Send the nurse's assistant to the x-ray department to bring the client back to his room.

Check the computerized care plan to determine what test was scheduled. Glulisine is a rapid-acting insulin with an action onset of 15 minutes. The client could experience hypoglycemia with the insulin in the bloodstream and no breakfast. It is not necessary to call the client's HCP ; the nurse should determine what test was scheduled and then locate the client and provide either breakfast or 4 oz (120 mL) of fruit juice. To bring the client back to the room would be wasting valuable time needed to prevent or correct hypoglycemia.

As the nurse assists the postoperative client out of bed, the clientreports having gas pains in the abdomen. To reduce this discomfort, what should the nurse do? 1. Encourage the client to ambulate. 2. Insert a rectal tube. 3. Insert a nasogastric (NG) tube. 4. Encourage the client to drink carbonated liquids.

Encourage the client to ambulate. Decreased mobility is one of the most common causes of abdominal distention related to retained gas in the intestines. Peristalsis has been inhibited by general anesthesia, analgesics, and inactivity during the immediate postoperative period. Ambulation increases peristaltic activity and helps move gas. Walking can prevent the need for a rectal tube, which is a more invasive procedure. An NG tube is also a more invasive procedure and requires a prescription. It is not a preferred treatment for gas postoperatively. Walking should prevent the need for further interventions. Carbonated liquids can increase gas formation.

A young adult client who has been diagnosed with type 1 diabetes has an insulin drip to aid in lowering the serum blood glucose level of 600 mg/dL (33.3 mmol/L). The client is also receiving ciprofloxacin IV. The healthcare provider (HCP) prescribes discontinuation of the insulin drip. What should the nurse do next? 1. Discontinue the insulin drip, as prescribed. 2. Hang the next IV dose of antibiotic before discontinuing the insulin drip. 3. Inform the HCP that the client has not received any subcutaneous insulin yet. 4. Add glargine to the insulin drip before discontinuing it.

Inform the HCP that the client has not received any subcutaneous insulin yet. Because subcutaneous administration of insulin has a slower rate of absorption than IV insulin, there must be an adequate level of insulin in the bloodstream before discontinuing the insulin drip; otherwise, the glucose level will rise. Adding an IV antibiotic has no influence on the insulin drip; it should not be piggy-backed into the insulin drip. Glargine cannot be administered IV and should not be mixed with other insulins or solutions.

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? 1. The client will need steroid replacement for the rest of her life. 2. The client must decrease the dose of steroid medication carefully to prevent crisis. 3. The client will require steroids only until her body can manufacture sufficient quantities. 4. The client will need to take steroids whenever her life involves physical or emotional stress.

The client will need steroid replacement for the rest of her life. Bilateral adrenalectomy requires lifelong adrenal hormone replacement therapy. If unilateral surgery is performed, most clients gradually reestablish a normal secretion pattern. The client and family will require extensive teaching and support to maintain self-care management at home. Information on dosing, adverse effects, what to do if a dose is missed, and follow-up examinations is needed in the teaching plan. Although steroids are tapered when given for an intermittent or onetime problem, they are not discontinued when given to clients who have undergone bilateral adrenalectomy because the clients will not regain the ability to manufacture steroids. Steroids must be taken on a daily basis, not just during periods of physical or emotional stress.

The elderly client with type 2 diabetes has hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent: 1. ketone body formation. 2. a major vascular accident. 3. fluid volume depletion. 4. cerebral edema.

cerebral edema. HHS can be caused by acute illness, such as an infection like pneumonia or sepsis. In HHS, there is a residual amount of insulin that suppresses ketosis but cannot control hyperglycemia. This leads to severe dehydration and impaired renal function. Ketone bodies are usually absent in HHS, and they do not form as a result of too rapid correction of blood glucose. The nurse should assess the client for a major vascular accident in the elderly as an etiology for a hyperglycemic crisis. Volume depletion must be treated first in HHS. Cerebral edema is a risk with too rapid correction of blood glucose.

The nurse is reviewing the postoperative prescriptions (see chart) just written by a healthcare provider (HCP) for a client with type 1 diabetes who has returned to the surgery floor from the recovery room following surgery for a left hip replacement. The client has pain of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. *CHART* After obtaining the client's glucose level, the nurse should first: 1. administer the morphine. 2. contact the healthcare provider (HCP) to rewrite the insulin prescription. 3. administer oxygen per nasal cannula at 2 L/min. 4. take the vital signs.

contact the healthcare provider (HCP) to rewrite the insulin prescription. Insulin is on the list of error-prone medications, and the nurse should ask the HCP to rewrite the prescription to spell out the word "units" and to indicate the route by which the drug is to be administered. The nurse should contact the HCP immediately as the nurse is to administer the insulin now. The nurse can then also report the most current glucose level. While waiting for the insulin prescription to be rewritten, the nurse can administer the pain medication if needed, start the oxygen, and check the client's vital signs.

A client who is recovering from a bilateral adrenalectomy has a client-controlled analgesia (PCA) system with morphine sulfate. The nurse should: 1. observe the client at regular intervals for opioid addiction. 2. encourage the client to reduce analgesic use and tolerate the pain. 3. evaluate pain control at least every 2 hours. 4. increase the amount of morphine if the client does not administer the medication.

evaluate pain control at least every 2 hours. Pain control should be evaluated at least every 2 hours for the client with a PCA system. Addiction is not a common problem for the postoperative client. A client should not be encouraged to tolerate pain; in fact, other nursing actions besides PCA should be implemented to enhance the action of opioids. One of the purposes of PCA is for the client to determine frequency of administering the medication; the nurse should not interfere unless the client is not obtaining pain relief. The nurse should ensure that the client is instructed on the use of the PCA control button and that the button is always within reach.

After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. The expected outcome of these injections is: 1. balanced reproductive cycle. 2. restored sodium and potassium balance. 3. stimulated protein metabolism. 4. stabilized mood swings.

stimulated protein metabolism. Testosterone is an androgen hormone that is responsible for protein metabolism as well as maintenance of secondary sexual characteristics; therefore, it is needed by both males and females. Removal of both adrenal glands necessitates replacement of glucocorticoids and androgens. Testosterone does not balance the reproductive cycle, stabilize mood swings, or restore sodium and potassium balance.

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. The nurse should teach the client that: 1. the body changes are permanent and the client will not be the same as before this condition. 2. the body and mood will gradually return to normal. 3. the physical changes are permanent, but the mood swings will disappear. 4. the physical changes are temporary, but the mood swings are permanent.

the body and mood will gradually return to normal. As the body readjusts to normal cortisol levels, mood and physical changes will gradually return to a normal state. The body changes are not permanent, and the mood swings should level off.

The client's wife asks the nurse whether the IV infusion is meeting her husband's nutritional needs because he has vomited several times. The nurse's response should be based on the knowledge that 1 L of 5% dextrose in normal saline delivers: 1. 170 cal. 2. 250 cal. 3. 340 cal. 4. 500 cal.

170 cal. Each liter of 5% dextrose in normal saline contains 170 cal. The nurse should consult with the healthcare provider (HCP) and dietitian when a client is on IV therapy or is on nothing-by-mouth status for an extended period because further electrolyte supplementation or alimentation therapy may be needed.

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrochloride 2 mg to be administered subcutaneously every 4 hours PRN for pain. This drug is administered in relatively small doses primarily because it is: 1. less likely to cause dependency in small doses. 2. less irritating to subcutaneous tissues in small doses. 3. as potent as most other analgesics in larger doses. 4. excreted before accumulating in toxic amounts in the body.

as potent as most other analgesics in larger doses Hydromorphone hydrochloride is about five times more potent than morphine sulfate, from which it is prepared. Therefore, it is administered only in small doses. Hydromorphone hydrochloride can cause dependency in any dose; however, fear of dependency developing in the postoperative period is unwarranted. The dose is determined by the client's need for pain relief. Hydromorphone hydrochloride is not irritating to subcutaneous tissues. As with opioid analgesics, excretion depends on normal liver function.

The nurse is administering a saturated solution of potassium iodide (SSKI). The nurse should: 1. pour the solution over ice chips. 2. mix the solution with an antacid. 3. dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. 4. disguise the solution in a pureed fruit or vegetable.

dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. SSKI should be diluted well in milk, water, juice, or a carbonated beverage before administration to help disguise the strong, bitter taste. Also, this drug is irritating to the mucosa if taken undiluted. The client should sip the diluted preparation through a drinking straw to help prevent staining of the teeth. Pouring the solution over ice chips will not sufficiently dilute the SSKI or cover the taste. Antacids are not used to dilute or cover the taste of SSKI. Mixing in a puree would put the SSKI in contact with the teeth.

The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation when: 1. returning to work after a weekend. 2. going on vacation. 3. having oral surgery. 4. having a routine medical checkup.

having oral surgery. Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, a vacation, or a routine checkup usually will not alter glucocorticoid dosage needs.

*A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to: 1. increase the frequency of self-monitoring (blood glucose testing). 2. reduce food intake to diminish nausea. 3. discontinue that dose of insulin if unable to eat. 4. take half of the normal dose of insulin.

increase the frequency of self-monitoring (blood glucose testing). Colds and influenza present special challenges to the client with diabetes mellitus because the body's need for insulin increases during illness. Therefore, the client must take the prescribed insulin dose, increase the frequency of blood glucose testing, and maintain an adequate fluid intake to counteract the dehydrating effect of hyperglycemia. The nurse can encourage the client to drink clear fluids, juices, and electrolyte drinks. Not taking insulin when sick, or taking half the normal dose, may cause the client to develop ketoacidosis.

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery? 1. prednisone orally 2. fludrocortisones subcutaneously 3. spironolactone intramuscularly 4. methylprednisolone sodium succinate intravenously

methylprednisolone sodium succinate intravenously A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalectomy. Spironolactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisones is a mineral corticoid.

*The nurse should teach the diabetic client that which symptom is most indicative of hypoglycemia? 1. nervousness 2. anorexia 3. Kussmaul's respirations 4. bradycardia

nervousness The four most commonly reported signs and symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Other signs and symptoms include hunger, incoherent speech, tachycardia, and blurred vision. Anorexia and Kussmaul's respirations are clinical manifestations of hyperglycemia or ketoacidosis. Bradycardia is not associated with hypoglycemia; tachycardia is.

A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to: 1. begin total parenteral nutrition. 2. initiate defibrillation. 3. administer tube feedings. 4. perform a tracheotomy.

perform a tracheotomy. Equipment for an emergency tracheotomy should be kept in the room, in case tracheal edema and airway occlusion occur. Laryngeal nerve damage can result in vocal cord spasm and respiratory obstruction. A tracheostomy set, oxygen and suction equipment, and a suture removal set (for respiratory distress from hemorrhage) make up the emergency equipment that should be readily available. Total parenteral nutrition is not anticipated for the client undergoing thyroidectomy. Arrhythmias requiring defibrillation is not an expected possible treatment after thyroidectomy. Tube feedings are not anticipated emergency care.

*A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss? 1. hypotension 2. decreased serum potassium level 3. rapid, deep respirations 4. warm, dry skin

rapid, deep respirations Due to the rapid, deep respirations, the client is losing fluid from vaporization from the lungs and skin (insensible fluid loss). Normally, about 900 mL of fluid is lost per day through vaporization. Decreased serum potassium level has no effect on insensible fluid loss. Hypotension occurs due to polyuria and inadequate fluid intake. It may decrease the flow of blood to the skin, causing the skin to be warm and dry.

After treatment with radioactive iodine (RAI, 1-131) I, the nurse should teach the client to: 1. monitor for signs and symptoms of hyperthyroidism. 2. rest for 1 week to prevent complications of the medication. 3. take thyroxine replacement for the remainder of the client's life. 4. assess for hypertension and tachycardia resulting from altered thyroid activity.

take thyroxine replacement for the remainder of the client's life. The client needs to be educated about the need for lifelong thyroid hormone replacement. Permanent hypothyroidism is the major complication of radioactive iodine treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client needs to monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1 week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not hypothyroidism.

After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to: 1. remove all sources of stress from daily life. 2. use relaxation techniques such as music. 3. take antianxiety drugs daily. 4. avoid discussing stressful experiences.

use relaxation techniques such as music. Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress management. Removing all sources of stress from one's life is not possible. Antianxiety drugs are prescribed for temporary management during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion of stressful situations will not necessarily reduce stress.

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? 1. with a full glass of water 2. on an empty stomach 3. at bedtime to increase absorption 4. with meals or with an antacid

with meals or with an antacid Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid. Only instructing the client to take the medication with a full glass of water will not help prevent gastric complications from steroids. Steroids should never be taken on an empty stomach. Glucocorticoids should be taken in the morning, not at bedtime.

The nurse is evaluating a client with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which statement from the client indicates the drug is effective? 1. "I have excess energy throughout the day." 2. "I am able to sleep and rest at night." 3. "I have lost weight since taking this medication." 4. "I do perspire throughout the entire day."

"I am able to sleep and rest at night." PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormones and peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be able to sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy throughout the day, loss of weight, and perspiring through the day are symptoms of hyperthyroidism indicating the drug has not produced its outcome.

*A client with diabetes mellitus presents to the clinic for a regular 3- month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I am so clumsy. I am always cutting my finger cooking or burning myself on the iron." Which response by the nurse would be most appropriate? 1. "Wash all wounds in isopropyl alcohol." 2. "Keep all cuts clean and covered." 3. "Could you have your children do the cooking and ironing?" 4. "You really should be fine as long as you take your daily medication."

"Keep all cuts clean and covered." Proper and careful first aid treatment is important when a client with diabetes has a skin cut or laceration. The skin should be kept supple and as free of organisms as possible. Washing and bandaging the cut will accomplish this. Washing wounds with alcohol is too caustic and drying to the skin. Having the children help is an unrealistic suggestion and does not educate the client about proper care of wounds. Tight control of blood glucose levels through adherence to the medication regimen is vitally important; however, it does not mean that careful attention to cuts can be ignored.

*The client with type 2 insulin-requiring diabetes asks the nurse about having alcoholic beverages. Which is the best response by the nurse? 1. "You can have one or two drinks a day as long as you have something to eat with them." 2. "Alcohol is detoxified in the liver, so it is not a good idea for you to drink anything with alcohol." 3. "If you are going to have a drink, it is best to consume alcohol on an empty stomach." 4. "If you do have a drink, the blood glucose value may be elevated at bedtime, and you should skip having a snack."

"You can have one or two drinks a day as long as you have something to eat with them." A modest alcohol intake (1 to 2 drinks/day) may be incorporated into the nutrition plan for individuals who choose to drink. Alcohol is detoxified in the liver where glycogen reserves are stored and normally released in case of hypoglycemia. At the time alcohol is consumed, glucose values will likely rise because of the carbohydrate in the beer, wine, or mixed drinks; however, the later and more dangerous effect of alcohol is a hypoglycemic effect. Alcohol should be consumed with food; even if blood glucose values are elevated, the bedtime snack should not be skipped.

*The healthcare provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. The nurse should tell the client: 1. "You may increase the carbohydrates in your diet when using this insulin." 2. "You do not need to rotate injection sites with this insulin." 3. "You do not mix insulin detemir; the solution is clear." 4. "You may refill the detemir insulin pen."

"You do not mix insulin detemir; the solution is clear." Insulin detemir is used only if the solution appears clear and colorless with no visible particles. Insulin detemir is not diluted or mixed with any other insulin preparations. As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Continuous rotation of the injection site within a given area may help to reduce or prevent this reaction. The client should continue to follow the prescribed diet and monitor glucose levels when taking insulin detemir. Insulin detemir is available in a prefilled insulin pen. When the insulin pen is empty, it may not be refilled; instead, the pen is discarded.

Following a transsphenoidal hypophysectomy, the nurse should assess the client for: 1. cerebrospinal fluid (CSF) leak. 2. fluctuating blood glucose levels. 3. Cushing's syndrome. 4. cardiac arrhythmias.

cerebrospinal fluid (CSF) leak. A major focus of nursing care after transsphenoidal hypophysectomy is the prevention of and monitoring for a CSF leak. CSF leakage can occur if the patch or incision is disrupted. The nurse should monitor for signs of infection, including elevated temperature, increased white blood cell count, rhinorrhea, nuchal rigidity, and persistent headache. Hypoglycemia and adrenocortical insufficiency may occur. Monitoring for fluctuating blood glucose levels is not related specifically to transsphenoidal hypophysectomy. The client will be given IV fluids postoperatively to supply carbohydrates. Cushing's disease results from adrenocortical excess, not insufficiency. Monitoring for cardiac arrhythmias is important, but arrhythmias are not anticipated following a transsphenoidal hypophysectomy.

*Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply. 1. A major risk factor for complications is obesity and central abdominal obesity. 2. Supplemental insulin is mandatory for controlling the disease. 3. Exercise increases insulin resistance. 4. The primary nutritional source requiring monitoring in the diet is carbohydrates. 5. Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations.

A major risk factor for complications is obesity and central abdominal obesity. Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations. Being overweight and having a large waist-hip ratio (central abdominal obesity) increase insulin resistance, making control of diabetes more difficult. The American and Canadian Diabetes Associations recommend a yearly referral to an ophthalmologist and podiatrist. Exercise and weight management decrease insulin resistance. Insulin is not always needed for type 2 diabetes; diet, exercise, and oral medications are the first-line treatment. The client must monitor all nutritional sources for a balanced diet—fats, carbohydrates, and protein.

A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. The nurse should further assess the client for: 1. orthostatic hypotension. 2. muscle hypertrophy in the extremities. 3. bruised areas on the skin. 4. decreased body hair.

bruised areas on the skin. Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing's disease. Hyperpigmentation and bruising are caused by the hypersecretion of glucocorticoids. Fluid retention causes hypertension, not hypotension. Muscle wasting occurs in the extremities. Hair on the head thins, while body hair increases.

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? 1. sodium phosphate 2. calcium gluconate 3. echothiophate iodide 4. sodium bicarbonate

calcium gluconate The client with tetany is suffering from hypocalcemia, which is treated by administering an IV preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then necessary until normal parathyroid function returns. Sodium phosphate is a laxative. Echothiophate iodide is an eye preparation used as a miotic for an antiglaucoma effect. Sodium bicarbonate is a potent systemic antacid.

The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation? 1. completing the spring semester of school 2. gaining 4 lb (1.8 kg) 3. becoming engaged 4. having wisdom teeth extracted

having wisdom teeth extracted Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid need than physical stress.

The nurse should monitor the client with Cushing's disease for which finding? 1. postprandial hypoglycemia 2. hypokalemia 3. hyponatremia 4. decreased urine calcium level

hypokalemia Sodium retention is typically accompanied by potassium depletion. Hypertension, hypokalemia, edema, and heart failure may result from the hypersecretion of aldosterone. The client with Cushing's disease exhibits postprandial or persistent hyperglycemia. Clients with Cushing's disease have hypernatremia, not hyponatremia. Bone resorption of calcium increases the urine calcium level.

*The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia? 1. 59 mg/dL (3.3 mmol/L) 2. 75 mg/dL (4.2 mmol/L) 3. 108 mg/dL (6 mmol/L) 4. 119 mg/dL (6.6 mmol/L)

59 mg/dL (3.3 mmol/L) Although some individual variation exists, when the blood glucose level decreases to <70 mg/dL (3.9 mmol/L), the client experiences or is at risk for hypoglycemia. Hypoglycemia can occur in both type 1 and type 2 diabetes mellitus, although it is more common when the client is taking insulin. The nurse should instruct the client on the prevention, detection, and treatment of hypoglycemia.

*The client has been recently diagnosed with type 2 diabetes and is taking metformin two times per day, 1,000 mg before breakfast and 1,000 mg before supper. The client is experiencing diarrhea, nausea, vomiting, abdominal bloating, and anorexia on admission to the hospital. The admission prescriptions include metformin. What should the nurse do? Select all that apply. 1. Discontinue the metformin. 2. Administer glargine insulin rather than the metformin. 3. Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually subside over time. 4. Assess the client's renal function. 5. Monitor the client's glucose value prior to each meal.

Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually subside over time. Assess the client's renal function. Monitor the client's glucose value prior to each meal. The nurse may not discontinue a medication without a healthcare provider's (HCP's) prescription, and the nurse may not substitute one medication for another. Maximum doses may be better tolerated if given with meals. Before therapy begins, and at least annually thereafter, assess the client's renal function; if renal impairment is detected, a different antidiabetic agent may be indicated. To evaluate the effectiveness of therapy, the client's glucose value must be monitored regularly. The prescriber must be notified if the glucose value increases, despite therapy.

Adrenal function is affected by the drug ketoconazole, an antifungal agent used to treat severe fungal infections. How is this effect manifested? 1. Ketoconazole suppresses adrenal steroid secretion. 2. Ketoconazole destroys adrenocortical cells, resulting in a "medical" adrenalectomy. 3. Ketoconazole increases adrenocorticotropic hormone (ACTH)- induced corticosteroid serum levels. 4. Ketoconazole decreases duration of adrenal suppression when administered with corticosteroids.

Ketoconazole suppresses adrenal steroid secretion. Ketoconazole suppresses adrenal steroid secretion and may cause acute hypoadrenalism. The adverse effect should reverse when the drug is discontinued. Ketoconazole does not destroy adrenal cells; mitotane destroys the cells and may be used to obtain a medical adrenalectomy. Ketoconazole decreases, not increases, ACTH-induced serum corticosteroid levels. It increases the duration of adrenal suppression when given with steroids.

*A client is to receive glargine insulin in addition to a dose of aspart. When the nurse checks the blood glucose level at the bedside, it is >200 mg/dL (11.1 mmol/L). How should the nurse administer the insulins? 1. Put air into the glargine insulin vial and then air into the aspart insulin vial, and draw up the correct dose of aspart insulin first. 2. Roll the glargine insulin vial, and then roll the aspart insulin vial. Draw up the longer-acting glargine insulin first. 3. Shake both vials of insulin before drawing up each dose in separate insulin syringes. 4. Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe; then with a different insulin syringe, put air into the aspart vial, and draw up the correct dose.

Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe; then with a different insulin syringe, put air into the aspart vial, and draw up the correct dose. Glargine is a long-acting recombinant human insulin analog. Glargine should not be mixed with any other insulin product. Insulins should not be shaken; instead, if the insulin is cloudy, roll the vial or insulin pen between the palms of the hands.

*The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. The nurse should: 1. contact the manager of the Food and Nutrition Department. 2. request that the dietitian discuss the drug-food interaction between repaglinide and grapefruit juice with the client. 3. Substitute a half grapefruit in place of the grapefruit juice. 4. Remove the grapefruit juice from the client's tray and bring another juice of the client's preference.

Remove the grapefruit juice from the client's tray and bring another juice of the client's preference. There is a drug-food interaction between repaglinide and grapefruit juice that may inhibit metabolism of repaglinide; the fresh grapefruit also interacts with repaglinide. It is not necessary that the dietitian inform the client of the drug-food interaction first. To contact the manager of the Food and Nutrition Department is not an intervention that will bring about prompt removal of the juice.

*A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs? 1. arms 2. legs 3. abdomen 4. iliac crest

abdomen If the client engages in an activity or exercise that focuses on one area of the body, that area may cause inconsistent absorption of insulin. A good regimen for a jogger is to inject the abdomen for 1 week and then rotate to the buttock. A jogger may have inconsistent absorption in the legs or arms with strenuous running. The iliac crest is not an appropriate site due to a lack of loose skin and subcutaneous tissue in that area.

*The nurse is checking the laboratory results of an adult client with type 1 diabetes (see chart). What laboratory result indicates a problem that should be managed? 1. blood glucose (192 mg/dL) 2. total cholesterol (250 mg/dL) 3. hemoglobin (12.3 mg/dL) 4. low-density lipoprotein (LDL) cholesterol (125 mg/dL)

blood glucose (192 mg/dL) The normal range for blood glucose is 70 to 100 mg/dL; the elevated blood glucose level indicates hyperglycemia. The hemoglobin is normal. The client's cholesterol and LDL levels are both normal. The nurse should determine if there are standing orders for the hyperglycemia or notify the healthcare provider (HCP)

*An adult client with type 2 diabetes is taking metformin 1,000 mg two times every day. After the nurse provides instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says: 1. "If I know I will be having alcohol, I must not take metformin; I could develop lactic acidosis." 2. "If my healthcare provider approves, I may drink alcohol with my metformin." 3. "Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain, and a rapid heartbeat." 4. "If I feel bloated, I should call my healthcare provider."

"If I know I will be having alcohol, I must not take metformin; I could develop lactic acidosis." Lactic acidosis is a rare but serious adverse effect of metformin when combined with alcohol use; half the cases are fatal. Ideally, one should stop metformin for 2 days before and 2 days after drinking alcohol. Signs and symptoms of lactic acidosis are weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or light- headedness, and bradycardia or cardiac arrhythmias. Bloating is not an adverse effect of metformin.

A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily." Which response by the nurse would give the client the most accurate explanation of this behavior? 1. "Your behavior is caused by temporary confusion brought on by your illness." 2. "Your behavior is caused by the excess thyroid hormone in your system." 3. "Your behavior is caused by your worrying about the seriousness of your illness." 4. "Your behavior is caused by the stress of trying to manage a career and cope with illness."

"Your behavior is caused by the excess thyroid hormone in your system." A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid hormones in the body. This symptom decreases as the client responds to therapy. Thyrotoxicosis does not cause confusion. The client may be worried about her illness, and stress may influence her mood; however, irritability is a common symptom ofthyrotoxicosis, and the client should be informed of that fact rather than blamed.

*Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. The nurse should: 1. tell the client to lie down for 30 minutes. 2. have the client drink a glass of milk or orange juice. 3. contact the client's healthcare provider (HCP) to decrease the insulin dose. 4. administer the next dose of insulin.

have the client drink a glass of milk or orange juice. Hypoglycemia is a blood glucose level below 70 mg/dL. The signs and symptoms of hypoglycemia include confusion, irritability, diaphoresis, tremors, hunger, weakness, and visual disturbances. Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death. With effective treatment, hypoglycemia can usually be quickly reversed. If the client has manifestations of hypoglycemia and monitoring equipment is not available, hypoglycemia is assumed, and treatment is initiated. Hypoglycemia is treated by ingesting 10 to 15 g of simple (fast- acting) carbohydrate, such as 4 to 8 ounces of fruit juice or regular (nondiet) soft drink or 8 ounces of low-fat milk. The nurse can tell the client to eat the regularly scheduled meal or a snack that has protein, such as cheese or peanut butter, to prevent hypoglycemia from recurring. Without treating the possible hypoglycemia, the blood glucose level will go down even lower and the client may lose consciousness, develop seizures, or go into a coma. Contacting the HCP would delay treating the possible hypoglycemia. Decreasing the insulin dose or increasing the meal plan may prevent episodes of hypoglycemia in the future. Administering insulin would cause the blood sugar to go even lower.

The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? 1. acromegaly 2. Cushing's disease 3. diabetes mellitus 4. hypopituitarism

hypopituitarism Most clients who undergo adenoma removal experience a gradual return of normal pituitary secretion and do not experience complications. However, hypopituitarism can cause growth hormone, gonadotropin, thyroid-stimulating hormone, and adrenocorticotropic hormone deficits. The client should be taught to monitor for change in mental status, energy level, muscle strength, and cognitive function. In adults, changes in sexual function, impotence, or decreased libido should be reported. Acromegaly and Cushing's disease are conditions of hypersecretion. Diabetes mellitus is related to the function of the pancreas and is not directly related to the function of the pituitary.

When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from: 1. insufficient secretion of growth hormone (GH). 2. dysfunction of the hypothalamic pituitary. 3. idiopathic atrophy of the adrenal gland. 4. oversecretion of the adrenal medulla.

idiopathic atrophy of the adrenal gland. Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands. The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insufficiency are autoimmune destruction (70%) and tuberculosis (20%). Insufficient secretion of GH causes dwarfism or growth delay. Hyposecretion of glucocorticoids, aldosterone, and androgens occurs with Addison's disease. Pituitary dysfunction can cause Addison's disease, but this is not a primary disease process. Oversecretion of the adrenal medulla causes pheochromocytoma.

The nurse should teach the client with Addison's disease that the bronze-colored skin is thought to be caused by: 1. hypersensitivity to sun exposure. 2. increased serum bilirubin level. 3. adverse effects of the glucocorticoid therapy. 4. increased secretion of adrenocorticotropic hormone (ACTH).

increased secretion of adrenocorticotropic hormone (ACTH). Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison's disease and is caused by melanocyte-stimulating hormone produced in response to increased ACTH secretion. The hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to the sun. Additionally, areas that may not be exposed to the sun, such as the nipples, genitalia, tongue, and knuckles, become bronze colored. Treatment of Addison's disease usually reverses the hyperpigmentation. Bilirubin level is not related to the pathophysiology of Addison's disease. Hyperpigmentation is not related to the effects of the glucocorticoid therapy.

The nurse should assess a client with Addison's disease for: 1. weight gain. 2. hunger. 3. lethargy. 4. muscle spasms.

lethargy Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and depression as early symptoms. Other early signs and symptoms include mood changes, emotional lability, irritability, weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles become weak, not spastic, because of adrenocortical insufficiency.

When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about which changes in the menstrual cycle? 1. dysmenorrhea 2. metrorrhagia 3. oligomenorrhea 4. menorrhagia

oligomenorrhea A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the absence of menstruation (amenorrhea) may result from the hormonal imbalances of thyrotoxicosis. Oligomenorrhea in women and decreased libido and impotence in men are common features of thyrotoxicosis. Dysmenorrhea is painful menstruation. Metrorrhagia, blood loss between menstrual periods, is a symptom of hypothyroidism. Menorrhagia, excessive bleeding during menstrual periods, is a symptom of hypothyroidism.

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately report: 1. sore throat. 2. painful, excessive menstruation. 3. constipation. 4. increased urine output.

sore throat. The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the healthcare provider (HCP) signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and increased urine output are not associated with PTU therapy.

Because of steroid excess after a bilateral adrenalectomy, the nurse should assess the client for: 1. postoperative confusion. 2. delayed wound healing. 3. emboli. 4. malnutrition.

delayed wound healing. Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy. Nutritional status should be regained postoperatively.

To provide oral hygiene for a client recovering from transsphenoidal hypophysectomy, the nurse should instruct the client to: 1. rinse the mouth with saline. 2. perform frequent toothbrushing. 3. clean the teeth with an electric toothbrush. 4. floss the teeth thoroughly.

rinse the mouth with saline. After transsphenoidal surgery, the client must be careful not to disturb the suture line while healing occurs. Frequent oral care should be provided with rinses of saline, and the teeth may be gently cleaned with oral swabs. Frequent or vigorous toothbrushing or flossing is contraindicated because it may disturb or cause tension on the suture line.

A client with type 1 diabetes is admitted to the emergency department with dehydration following the flu. The client has a blood glucose level of 325 mg/dL (18 mmol/L) and a serum potassium level of 3.5 mEq (3.5 mmol/L). The healthcare provider (HCP) has prescribed 1,000 mL 5% dextrose in water to be infused every 8 hours. Prior to implementing the HCP's prescriptions, the nurse should contact the HCP, explain the situation, provide background information, report the current assessment of the client, and: 1. suggest adding potassium to the fluids. 2. request an increase in the volume of intravenous fluids. 3. verify the prescription for 5% dextrose in water. 4. determine if the client should be placed in isolation.

verify the prescription for 5% dextrose in water. The client needs fluid volume replacement due to the dehydration. However, the nurse should verify the prescription for IV dextrose with the HCP due to the risk of hyperglycemia that dextrose would present when administered to a client with diabetes. The potassium level is within normal limits. The client does not have restrictions on oral fluids, and the nurse can encourage the client to drink fluids. The client does not need to be placed in isolation at this time.

*A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat: 1. within 10 to 15 minutes after the injection. 2. 1 hour after the injection. 3. at any time because timing of meals with lispro injections is unnecessary. 4. 2 hours before the injection.

within 10 to 15 minutes after the injection. Insulin lispro begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of lispro is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.

Which is an expected finding in a client with adrenal crisis (addisonian crisis)? 1. fluid retention 2. pain 3. peripheral edema 4. hunger

pain Adrenal hormone deficiency can cause profound physiologic changes. The client may experience severe pain (headache, abdominal pain, back pain, or pain in the extremities). Inhibited gluconeogenesis commonly produces hypoglycemia, and impaired sodium retention causes decreased, not increased, fluid volume. Edema would not be expected. Gastrointestinal disturbances, including nausea and vomiting, are expected findings in Addison's disease, not hunger.

To minimize the risk of postoperative respiratory complications after a hypophysectomy, the nurse should instruct the client how to: 1. limit use of pain medications. 2. turn in bed. 3. take deep breaths. 4. clear the throat and cough.

take deep breaths. Deep breathing is the best choice for helping prevent atelectasis. The client should be placed in the semi-Fowler's position (or as prescribed) and taught deep breathing, sighing, mouth breathing, and how to avoid coughing. The client should receive sufficient medication to control postoperative pain. Frequent position changes help loosen lung secretions, but deep breathing is most important in preventing atelectasis. Coughing is contraindicated because it increases intracranial pressure and can cause cerebrospinal fluid to leak from the point at which the sella turcica was entered.

After pituitary surgery, the nurse should assess the client for: 1. urine specific gravity <1.010. 2. urine output between 1 and 2 L/day. 3. blood glucose level higher than 300 mg/dL (16.7 mmol/L). 4. urine negative for glucose and ketones.

urine specific gravity <1.010. Pituitary diabetes insipidus is a potential complication after pituitary surgery because of possible interference with the production of antidiuretic hormone (ADH). One major manifestation of diabetes insipidus is polyuria because lack of ADH results in insufficient water reabsorption by the kidneys. The polyuria leads to a decreased urine specific gravity (between 1.001 and 1.010). The client may drink and excrete 5 to 40 L of fluid daily. Diabetes insipidus does not affect metabolism. A blood glucose level higher than 300 mg/dL (16.7 mmol/L) is associated with impaired glucose metabolism or diabetes mellitus. Urine negative for sugar and ketones is normal.

*When evaluating teaching a client how to administer insulin, which action indicates that additional teaching is necessary? 1. Client draws up the regular insulin first and then the NPH. 2. Client rotates sites from legs to arms. 3. Client identifies that the syringe is U-100. 4. Client waits 30 minutes to eat breakfast after injecting rapid-acting insulin.

Client waits 30 minutes to eat breakfast after injecting rapid-acting insulin. The nurse instructs the client to not wait any longer than 5 to 15 minutes to eat after injecting rapid-acting insulin, which has an onset action of 5 minutes and a duration of 1 hour. The client is using proper technique for mixing the insulins, rotating sites, and using the U-100 syringe.

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep-breathing exercises after surgery by telling the client to: 1. "Sit in an upright position, and take a deep breath." 2. "Hold your abdomen firmly with a pillow, and take several deep breaths." 3. "Tighten your stomach muscles as you inhale, and breathe normally." 4. "Raise your shoulders to expand your chest."

"Hold your abdomen firmly with a pillow, and take several deep breaths." Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client's ability to deep breathe effectively. Deep breathing should be done hourly by the client after surgery. Sitting upright ignores the need to splint the incision to prevent pain. Tightening the stomach muscles is not an effective strategy for promoting deep breathing. Raising the shoulders is not a feature of deep-breathing exercises.

The client with Addison's disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? 1. "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." 2. "My need for glucocorticoids will stabilize, and I will be able to take a predetermined dose once a day." 3. "Glucocorticoids are cumulative, so I will take a dose every third day." 4. "I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids."

"Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, addisonian crisis could result. Two-thirds of the daily dose should be taken at about 0800 and the remainder at about 1600. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 0400 and 0600 and lowest levels in the evening.

*Which indicates a potential complication of diabetes mellitus? 1. inflamed, painful joints 2. blood pressure of 160/100 mm Hg 3. stooped appearance 4. hemoglobin of 9 g/dL (90 g/L)

blood pressure of 160/100 mm Hg The client with diabetes mellitus is especially prone to hypertension due to atherosclerotic changes, which leads to problems of the microvascular and macrovascular systems. This can result in complications in the heart, brain, and kidneys. Heart disease and stroke are twice as common among people with diabetes mellitus as among people without the disease. Painful, inflamed joints accompany rheumatoid arthritis. A stooped appearance accompanies osteoporosis with narrowing of the vertebral column. A low hemoglobin concentration accompanies anemia, especially iron deficiency anemia and anemia of chronic disease.

*A client with diabetes begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day." What would be the best response by the nurse? 1. "If you do not give yourself your insulin shots, you will be at greater risk for complications." 2. "We can teach a family member to give the shots so you will not have to do it." 3. "I can arrange to have a home care nurse give you the shots every day." 4. "What is it about giving yourself the insulin shots that bothers you?"

"What is it about giving yourself the insulin shots that bothers you?" The best response is to allow the client to verbalize fears about performing self-injection. Tactics that increase fear such as threatening the client about complications are not effective in changing behavior. If possible, the client needs to be responsible for self-care, including giving self-injections. A nurse for home care visits is not justified if the client is capable of self-administration.

Which indicator is best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? 1. skin turgor 2. temperature 3. thirst 4. daily weight

daily weight Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable.