endocraine and metabolic disorders
After reinforcing education to a client on how to correctly self-administer daily maintenance dose of 3 units of regular insulin and 4 units of NPH insulin, which client statement demonstrates that the education has been successful?
"After taking my insulin out of the refrigerator, I'll draw up the clear insulin first to the line for 3 units and then cloudy insulin until there's a total of 7 units in the syringe."
The nurse reinforces disease management instructions for a client newly diagnosed with type 1 diabetes. Which statement indicates to the nurse that the client has understood the information?
"Checking my blood sugar before meals and at bedtime will help me manage my blood sugar."
An older child has received diet instruction as part of the treatment plan for type 1 diabetes. Which statement by the older child indicates to the nurse the need for additional instruction?
"I can eat whatever I want as long as I cover the calories with sufficient insulin."
When reinforcing education with the parents about signs that indicate levothyroxine overdose, which comment by a parent indicates the need for further education?
"I shouldn't worry if my baby doesn't sleep very much."
An older adult client who has recently been diagnosed with hypothyroidism lives independently in an apartment in a community development designed for older adults. The client asks the nurse assigned to the complex for advice about managing this condition. What is the best response by the nurse?
"Increase fiber and fluids in your diet."
Which statement made by a parent of a child with short stature would indicate to the nurse the need for further education?
"Obtaining blood studies won't aid in proper diagnosis."
A client with type 1 diabetes must learn how to self-administer insulin. The physician has prescribed 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?
"Rotate injection sites within the same anatomic region, not among different regions."
A client with adrenal hypofunction has been asked to participate in a research study for a new medication. The client is unsure about participating in the study. What would be an appropriate response for the nurse to make to this client?
"You have the right to refuse to participate in the study."
A client with primary diabetes insipidus is prescribed desmopressin. Which instruction should the nurse provide before the client is discharged?
"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."
A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?
"You must avoid coughing, sneezing, and blowing your nose."
The nurse is monitoring a client receiving isophane insulin suspension. Which data obtained by the nurse would cause suspicion that the client is experiencing hypoglycemia? Select all that apply.
-diaphoresis -hunger confusion
A well 50-year-old client with a history of diabetes mellitus type 2 has gone to the immunization clinic at the local health department. The client reports no known allergies and no immunizations for the last 5 years. Which vaccine would the nurse administer to the client? Select all that apply.
-influenza vaccine -pneumococcal polyvalent vaccine
A client has a tumor of the posterior pituitary gland. The nurse assisting with the development of the plan of care should include which nursing interventions? (Select all that apply.)
-weigh the client daily -measure urine specific gravity -monitor intake and output
A client's glucose level is 365 mg/dL. The health care provider orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/mL. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place.
0.1 To find the correct administration amount, use the cross-product principle to set up the following equation: X/10 units = 1 mL/100 units Next, cross-multiply: 100 X x X units = 10 units X 1 mL. Then divide both sides of the equation by 100 units to solve for X: X = 0.1 mL.
A client is receiving isophane insulin suspension every morning. When would the nurse expect the client to possibly develop hypoglycemia?
4 to 12 hours
A female client who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?
Acromegaly
The nurse is teaching the client about risk factors for diabetes mellitus. Which risk factor for diabetes mellitus is nonmodifiable?
Advanced age
The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?
Antidiuretic hormone (ADH)
The nurse is collecting data on a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine. During the physical assessment, the nurse is most likely to detect which vital sign or symptom?
Blood pressure of 176/88 mm Hg
The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?
Calibrate the machine after installing a new battery.
The nurse is caring for a client with hypoparathyroidism. During data collection, the nurse taps the client's face 2 cm anterior to the earlobe. The nurse is attempting to elicit which of the following?
Chvostek's sign
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?
Coma, anxiety, confusion, headache, and cool, moist skin
Observation of a client reveals thin extremities, but an obese truncal area and a "buffalo hump" at the shoulder area with reports of weakness and disturbed sleep. The nurse interprets this data as indicating which disorder?
Cushing syndrome
A nurse observes a second nurse documenting a peripheral blood glucose level that the second nurse did not actually collect from a client with diabetes. What is the priority action by the nurse observing this situation?
Discuss the observation with the other nurse.
A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan?
Exercise and a weight reduction diet
A nurse is caring for a client with type 1diabetes who is talking but exhibits confusion, light-headedness, and blurred vision. What action should the nurse perform first?
Give 15 g of a fast-acting carbohydrate.
A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and her eyes feeling "gritty." Thyroid function tests reveal the following: a thyroid-stimulating hormone (TSH) level of 0.02 units/ml, a thyroxine level of 20 g/dl, and a triiodothyronine level of 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these findings, the nurse would suspect:
Graves' disease.
Which instructions should be included in the discharge teaching plan for a client after a thyroidectomy for Graves' disease?
Have regular follow-up care.
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?
Initiate fluid replacement therapy.
The nurse is caring for a client with diabetes insipidus (DI). What is the nurse's priority intervention?
Maintaining adequate hydration
A client with type 2 diabetes hasn't received insulin coverage for his afternoon blood glucose levels for 2 days. After further investigation, a nurse discovers that the afternoon blood glucose levels were phoned in from the laboratory but weren't documented in the client's medical record. What should the nurse do with this information?
Notify the physician and complete an incident report.
A nurse is caring for a postoperative thyroidectomy client at risk for hypocalcemia. What intervention should the nurse implement in this client's care?
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
A child is diagnosed with diabetes insipidus has developed a viral illness including congestion, nausea, and vomiting. What instructions should the nurse reinforce?
Obtain an alternate route for desmopressin acetate administration.
After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine, 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
Primary hypothyroidism
While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that the nurse forgot to administer insulin to client with diabetes mellitus. The nurse has made numerous errors in the past few weeks and is now afraid this job is in jeopardy. What is the best course of action?
Report the error, complete the proper paperwork, and meet with the unit manager.
The nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, T4, and calcitonin.
Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse obtains data from the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
Thyroid crisis
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneous (SC). She awakens in 5 minutes. Why should her husband offer a complex carbohydrate snack to her as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
Trousseau's sign.
A client with a history of type 1 diabetes mellitus recently had an amputation and is in the rehabilitation unit. When the nurse enters the room to administer the client's daily insulin, the client is diaphoretic, reports having a headache, and has slurred speech. What should the nurse do next?
Withhold the client's insulin, check the blood glucose level, bring a glass of orange juice, and report the findings to the charge nurse.
The nurse is assigned to care for the following clients. Which client should the nurse see first?
a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute
A client has been admitted after reporting acute abdominal pain in the mid-epigastric region, back tenderness, nausea, and vomiting. The nurse recognizes these findings to be associated with which condition?
acute pancreatitis
A nurse collects data on a client who is postoperative thyroid surgery. The client has a positive Chvostek's sign. Which laboratory finding supports the presence of this finding?
calcium 7.1 mg/dL (1.77 mmol/L)
The client is being evaluated for hypothyroidism. The nurse should stay alert for:
decreased body temperature and cold intolerance.
A client was recently admitted with a diagnosis of diabetes. The nurse observes that the client has acetone breath, a weak and rapid pulse, and Kussmaul respirations. The nurse recognizes that interventions should be provided for what condition?
diabetic ketoacidosis
The nurse is caring for a client with type I diabetes who does not adhere to an insulin regimen regularly. The nurse identifies that the client is at risk for which complication?
diabetic ketoacidosis
A nurse is caring for a client who is experiencing an acute Addisonian crisis. Which laboratory finding should the nurse expect?
elevated potassium level
A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client:
has type 2 diabetes.
The physician diagnoses type 1 diabetes in a client who has classic manifestations of the disease and a random blood glucose level of 350 mg/dl. In addition to dietary modifications, the physician prescribes insulin. Initially, most clients receive the least antigenic form of insulin. Therefore, the nurse expects the physician to prescribe:
human insulin.
A nurse reviews the laboratory data of a client. The data reveals increased blood and urine levels of triiodothyronine (T3) and thyroxine (T4). The nurse determines these values are associated with which condition?
hyperthyroidism
A client reports weight gain and fatigue. The nurse obtains data that reveal the following: blood pressure 120/74 mm Hg, pulse rate 52 beats/minute, respiratory rate 20 breaths/minute, and temperature 98° F. Laboratory results show low thyroxine (T4) and triiodothyronine (T3) levels. The nurse determines these symptoms are associated with which condition?
hypothyroidism
The nurse is caring for a client with hypothyroidism. For which medication will the nurse reinforce instructions?
levothyroxine
In caring for a client with insulin-dependent diabetes mellitus, the nurse identifies that the client may require which change to their daily routine during periods of infection?
more insulin
A client with diabetes mellitus has just been prescribed insulin. When teaching the client about hypoglycemia, the nurse should mention that this reaction may cause:
nervousness, diaphoresis, and confusion.
A nurse is evaluating a client for signs of hypoxemia. Which diagnostic procedure would the nurse expect to perform first to monitor the client's respiratory status?
pulse oximetry
A client is admitted with Graves' disease. Which laboratory test should the nurse expect to be ordered?
thyroid panel
A client with hyperthyroidism develops high fever, extreme tachycardia, and altered mental status. Which condition does the nurse suspect is developing?
thyroid storm
A client is receiving oral calcium supplements. Which additional vitamin would the nurse encourage the client to consume to enhance absorption of calcium from the gastrointestinal (GI) tract?
vitamin D