Endocrine and Metabolic Disorders
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? sulfonylureas aspirin steroids angiotensin-converting enzyme (ACE) inhibitors
steroids Explanation: 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.
A nurse explains to a client that the nurse will administer the client's first insulin dose in the client's abdomen. How does absorption at the abdominal site compare with absorption at other sites? Insulin is absorbed unpredictably at all injection sites. Insulin is absorbed more slowly at abdominal injection sites than at other sites. Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Explanation: Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.
A client with diabetes mellitus is admitted with hypoglycemia. Which information should the nurse include in the client teaching? Select all that apply. "Hypoglycemia can result from excessive alcohol consumption." "Symptoms of hypoglycemia include shakiness, confusion, and headache." "Strenuous activity may result in hypoglycemia." "Hypoglycemia is a relatively harmless situation." "Symptoms of hypoglycemia include thirst and excessive urinary output." "Skipping meals can cause hypoglycemia."
"Hypoglycemia can result from excessive alcohol consumption." "Skipping meals can cause hypoglycemia." "Strenuous activity may result in hypoglycemia." "Symptoms of hypoglycemia include shakiness, confusion, and headache." Explanation: Alcohol consumption, missed meals, and strenuous activity may lead to hypoglycemia. Symptoms of hypoglycemia include shakiness, confusion, headache, sweating, and tingling sensations around the mouth. Thirst and excessive urination are symptoms of hyperglycemia. Hypoglycemia can become a life-threatening disorder involving seizures and death to brain cells; the client shouldn't be told that the condition is relatively harmless.
The nurse teaches a client with diabetes mellitus about proper foot care. Which statement indicates the client understands the teaching? "I'll schedule an appointment with my healthcare provider if my feet start to ache." "I'll thoroughly rub lotion on all areas of my feet, including between my toes." "I'll wear cotton socks with well-fitting shoes." "I'll soak my feet in warm water to soften rough skin."
"I'll wear cotton socks with well-fitting shoes." Explanation: The client demonstrates an understanding of proper foot care when stating they'll wear cotton socks with well-fitting shoes; cotton socks wick moisture away from the skin, helping to prevent fungal infections, and well-fitting shoes help avoid pressure areas. Aching isn't a common sign of foot problems; however, a tingling sensation in the feet indicates neurovascular changes. Clients with diabetes should not soak feet unless specifically directed by a healthcare provider as softening the skin may make it more prone to injury. Although lotions are acceptable, the client should not apply it between the toes, as this could promote a fungal infection.
A client diagnosed with thyroid cancer signed a living will that states the client doesn't want ventilatory support if the condition deteriorates. As the client's condition worsens, the client states, "I changed my mind. I want everything done for me." Which response by the nurse is best? "What exactly do you mean by wanting 'everything' done for you?" "I'll ask your physician to revoke your do-not-resuscitate order." "Do you understand that you'll be placed on a ventilator?" "Maybe you should talk with your family."
"What exactly do you mean by wanting 'everything' done for you?" Explanation: Asking the client what they mean is the best response. The nurse should clarify the client's request and get as much information as possible before notifying the physician of the client's wishes. Asking the physician to revoke the client's do-not-resuscitate (DNR) order makes an assumption about the client's wishes without obtaining clarification of their statement. The client might want aggressive treatment without reversing the DNR order. Asking the client if they understand that they'll be placed on a ventilator places the client on the defensive. Telling the client to talk with family is an inappropriate response; the client has the right to change their treatment plan without input from their family.
A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. What should the nurse do next? Assess for gastrointestinal (GI) bleeding. Increase protein in the diet. Withhold the lactulose. Monitor serum bilirubin levels.
Assess for gastrointestinal (GI) bleeding. Explanation: Clients with cirrhosis can develop hepatic encephalopathy caused by increased ammonia levels. Asterixis, a flapping tremor, is a characteristic symptom of increased ammonia levels. Bacterial action on increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed in the diet increase protein in the intestine and can elevate ammonia levels. Lactulose is given to reduce ammonia formation in the intestine and should not be held since neurologic symptoms are worsening. Bilirubin is associated with jaundice.
A client with type 1 diabetes mellitus asks the nurse to recommend something to remove corns from the toes. What should the nurse advise the client to do? Consult a health care provider (HCP) about removing the corns. Apply high-quality corn plaster to the area. Apply iodine to the corns before peeling them off. Soak the feet in borax solution to peel off the corns.
Consult a health care provider (HCP) about removing the corns. Explanation: 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 the potential for the development of ulcers. A client with diabetes should never self-treat foot problems but should consult an HCP or a podiatrist.
The nurse is developing a teaching plan with a client who had a bilateral adrenalectomy. What information should the nurse include in the plan? The client must decrease the dose of steroid medication carefully to prevent a crisis. The client will need to take steroids whenever their life involves physical or emotional stress. The client will need steroid replacement for the rest of their life. The client will require steroids only until their body can manufacture sufficient quantities.
The client will need steroid replacement for the rest of their life. Explanation: 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 one-time 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
Propylthiouracil (PTU) is prescribed for a client with Graves disease. Which symptom should the nurse teach the client to report? excessive menstruation constipation sore throat increased urine output
sore throat Explanation: 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 health care provider 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.
Parathyroid hormone (PTH) has which effects on the kidney? stimulation of phosphate reabsorption and calcium excretion increased absorption of vitamin E and excretion of vitamin D stimulation of calcium reabsorption and phosphate excretion increased absorption of vitamin D and excretion of vitamin E
stimulation of calcium reabsorption and phosphate excretion Explanation: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.
A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. What should the nurse tell the client? "It's ok to take ginseng if you take it with a carbohydrate." "There are no therapeutic benefits of ginseng." "You can take the ginseng to help improve your memory." "Taking ginseng will increase the risk of hypoglycemia."
"Taking ginseng will increase the risk of hypoglycemia." Explanation: Taking ginseng when on insulin is not encouraged because ginseng increases the risk of hypoglycemia. Ginseng can be therapeutic in certain situations but is potentially harmful to clients taking insulin. Taking ginseng with a carbohydrate will not offset the long acting effect of the ginseng.
A nurse is providing dietary instructions to a client with diabetes. What is most important for the nurse to include in teaching for prevention of hypoglycemia? Drink orange juice if lightheadedness occurs. Avoid delaying or skipping meals. Increase protein intake in the morning. Reduce carbohydrate intake when drinking alcohol.
Avoid delaying or skipping meals. Explanation: Hypoglycemia is an important complication in the treatment of diabetes. The risk of hypoglycemia increases as nutritional intake decreases, so it is most important to teach the client to avoid delaying or skipping meals. Carbohydrate intake has the greatest influence on blood glucose levels, so increasing protein in the morning will not prevent hypoglycemic episodes. Drinking alcohol inhibits the release of glucose from the liver; therefore it would be important to increase carbohydrate intake when drinking alcohol. Lightheadedness is a manifestation of hypoglycemia, and drinking orange juice would be the means to treat the hypoglycemia, not prevent it.
A client is informed by his healthcare provider that a tumor has been found. When the nurse sees the client later, the client states that no one knows what is wrong with him. The nurse determines that the client is experiencing which of the following? Needs teaching reinforced May not understand medical terminology Has a hearing deficit Could be in denial
Could be in denial Explanation: The natural response to a new diagnosis is denial. The question does not suggest any of the other options.
The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose? Prevention of hemorrhage. Stimulation of peristalsis of the bowel. Reduced serum ammonia levels. Reduced peripheral edema and ascites.
Reduced serum ammonia levels. Explanation: Lactulose is used to treat hepatic encephalopathy by reducing serum ammonia levels. It is not used to stimulate bowel peristalsis, even though diarrhea can be a side effect of the drug. Lactulose does not have any effect on edema, ascites, or hemorrhage.
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? Humidifier Tracheostomy set Cardiac monitor Indwelling urinary catheter kit
Tracheostomy set Explanation: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.
A client with diabetes is explaining to the nurse about doing foot care at home. Which statement indicates the client needs further instruction on how to care for the feet properly? "I inspect my feet once a week for cuts and redness." "I shouldn't go barefoot, even in my home." "I'm not allowed to use a heating pad on my feet." "It's important to dry my feet carefully after my bath."
"I inspect my feet once a week for cuts and redness." Explanation: Clients with diabetes should be taught to visually inspect their feet on a daily basis. All other answer choices represent an accurate understanding of diabetic foot care.
Which statement indicates that a client with the medical diagnosis of hypoparathyroidism understands diet instructions? "A spinach salad with cucumbers and tomatoes is a good meal." "For breakfast, I can have scrambled eggs." "I can have yogurt with fruit as a snack." "I will eat green beans, fish, and white bread for a meal."
"I will eat green beans, fish, and white bread for a meal." Explanation: Green beans, fish, and white bread are good choices because of the high calcium and low phosphorus content. Yogurt contains high levels of phosphorus. Egg yolks are restricted, and spinach contains oxalates that form insoluble calcium substances.
A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide? "You won't need to monitor your fluid intake and output after you start taking desmopressin." "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." "Administer desmopressin while the suspension is cold."
"You may not be able to use desmopressin nasally if you have nasal discharge or blockage." Explanation: The nurse should advise the client that desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and get adequate fluid replacement.
A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number. units
5 Explanation: To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 units ÷ 100 ml = 0.5 units/ml). Next, multiply the units per milliliter by the rate of milliliters per hour (0.5 units × 10 ml/hr = 5 units).
The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. Maintain intake and output records. Compare ABG findings with previous results. Document presenting signs and symptoms. Suction the client's airway. Administer I.V. bicarbonate.
Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms. Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The result is retention of sodium bicarbonate and increased base bicarbonate. Nursing management includes documenting all presenting signs and symptoms to provide accurate baseline data, monitoring laboratory values, comparing ABG findings with previous results (if any), maintaining accurate intake and output records to monitor fluid status, and implementing prescribed medical therapy.
A nurse should perform which intervention for a client with Cushing's syndrome? Explain that the client's physical changes are a result of excessive corticosteroids. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather. Suggest a high-carbohydrate, low-protein diet. Offer clothing or bedding that's cool and comfortable.
Explain that the client's physical changes are a result of excessive corticosteroids. Explanation: The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: multinodular goiter. thyroiditis. Graves' disease. Hashimoto's thyroiditis.
Graves' disease. Explanation: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A client with diabetes is found unconscious after the morning dose of insulin. What would be a priority nursing intervention at this time? Give fruit juice or milk as soon as the client is able to take fluids orally. Withhold glucose in any form until the ketoacidosis is corrected. Contact the healthcare provider to report the client's status. Initiate treatment for hypoglycemia as a result of insulin.
Initiate treatment for hypoglycemia as a result of insulin. Explanation: During treatment for diabetes, the client may develop hypoglycemia. Careful observation for this complication should be made by the nurse, and the nurse would begin treatment for hypoglycemia immediately to prevent it from progressing. The client would not be able to take fluids while unconscious. Withholding glucose will contribute to worsening hypoglycemia. The healthcare provider should be contacted after the client has stabilized
A client with type 1 diabetes mellitus is scheduled to have surgery. The client has been nothing-by-mouth since midnight. In the morning, the nurse notices that the client's daily insulin has not been prescribed. Which should the nurse do first? Inform the Post Anesthesia Care Unit staff to obtain the insulin prescription. Give the client's usual morning dose of insulin. Obtain the client's blood glucose level at the bedside. Contact the health care provider for further prescriptions regarding insulin dosage.
Obtain the client's blood glucose level at the bedside. Explanation: The nurse should first obtain the blood glucose level and then contact the health care provider to clarify whether the client's usual insulin dose should be given before surgery; having the blood glucose level is objective information that the health care provider may need to know before making a final decision as to the insulin dosage. The nurse should not assume that the usual insulin dose is to be given. It is not appropriate for the nurse to defer decision-making on this issue until after the surgery.
The client with Cushing disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? Restrict sodium. Reduce fat to 10%. Increase calories. Restrict potassium.
Restrict sodium. Explanation: 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, a fat intake of less than 20% of total calories is not recommended.
A staff member says she is really busy and asks the charge nurse to double-check a dose of insulin which she has drawn up. The nurse holds up a bottle of Lente insulin, but the charge nurse notices a bottle of Lantus insulin on the medication cart. This nurse has made multiple medication errors and the charge nurse is concerned that she isn't safe. What should the charge nurse do? State that she can't check the dose unless she sees the nurse draw it up. Ask the nurse which bottle of insulin she used to draw up the client's dose. Ask to see the original order, then determine if the dose is correct. Tell the nurse that she'd like to start at the beginning to be on the safe side.
Tell the nurse that she'd like to start at the beginning to be on the safe side. Explanation: The charge nurse should observe the process from the beginning and determine whether the nurse is following the five rights of drug administration. Only then should she cosign that the dose is correct. Saying that she can't check the dose unless she sees the nurse draw it up, asking the nurse which bottle of insulin she used, and asking to see the original order provide too much opportunity for error.
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect a blood pressure of 176/88 mm Hg. bradycardia. a blood glucose level of 130 mg/dl (7.2 mmol/L). a blood pressure of 130/70 mm Hg.
a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
A client is diagnosed with diabetic ketoacidosis. Which finding would the nurse anticipate? potassium 4.5 mEq/L platelets 309 fasting blood glucose 70 mg/dL (3.89 mmol/L) arterial pH 7.33
arterial pH 7.33 Explanation: In diabetic ketoacidosis, the client is acidic with a pH below 7.35. The potassium level is typically low. The client is hyperglycemic. Potassium level may be high or low depending upon renal function and potassium replacement. Also, blood glucose will be elevated. Platelet count should be within normal limits.
A client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply. review of the procedure for thyroid radiation therapy high-protein, high-calorie diet use of stool softeners high-fiber, low-calorie diet plan for a thyroidectomy thyroid hormone replacements
both insulins 0.5 hours before breakfast Explanation: 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 nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor? starting the timer on the machine while gathering supplies smearing the drop of blood onto the reagent pad ungloving the hands when removing the test strip calibrating the machine after installing a new battery
calibrating the machine after installing a new battery Explanation: To obtain accurate readings, the nurse should calibrate the machine whenever a new battery is installed. To adhere to standard precautions and prevent contact with blood, the nurse's hands should remain gloved throughout blood glucose testing. The nurse should drop the blood — not smear it — onto the reagent pad because smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the timer before the blood sample is collected.
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? confusion and seizures tetany and increased blood urea nitrogen (BUN) levels sunken eyeballs and spasticity flaccidity and thirst
confusion and seizures Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Test your blood glucose every 4 hours." "Don't take your insulin or oral antidiabetic agent if you don't eat." "Follow your regular meal plan, even if you're nauseous."
high-fiber, low-calorie diet use of stool softeners thyroid hormone replacements Explanation: The treatment for hypothyroidism includes a high-fiber, low-calorie diet, because weight gain and constipation are two symptoms of the disorder. Stool softeners are prescribed to prevent constipation, and thyroid hormone replacements are needed to supplement the under-functioning thyroid gland. A high-protein, high-calorie diet is commonly used for clients with hyperthyroidism, along with a thyroidectomy or irradiation of the thyroid gland.
Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? hypokalemia and hypoglycemia hypocalcemia and hyperkalemia hyperkalemia and hyperglycemia hypernatremia and hypercalcemia
hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.
Which results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? decreased edema, stable temperature, and decreased respiratory rate elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels increased energy, weight loss, and a higher temperature and pulse rate improved appetite, weight gain, and sleeping fewer hours
increased energy, weight loss, and a higher temperature and pulse rate Explanation: The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.
For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? cool, clammy skin jugular vein distention decreased serum sodium level increased urine osmolarity
increased urine osmolarity Explanation: In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.
What important considerations would the nurse make when teaching and caring for a client newly diagnosed with diabetes mellitus? having the client work closely with a peer who has diabetes to learn about the condition and control involving the client in the development of the teaching plan and encouraging questions and active participation allowing the client to develop the teaching plan and assess readiness to learn about different aspects of the disease informing the client about complications that could occur if the client is noncompliant
involving the client in the development of the teaching plan and encouraging questions and active participation Explanation: Actively involving the client in the teaching usually results in better understanding and compliance with the plan of care.
The nurse is caring for a client in a diabetic coma. The nurse is aware that this is caused by an excess of which substance in the blood? ketones from rapid fat breakdown, causing acidosis sodium bicarbonate, causing alkalosis glucose from rapid carbohydrate metabolism, causing drowsiness nitrogen from protein catabolism, causing ammonia intoxication
ketones from rapid fat breakdown, causing acidosis Explanation: Ketones are released when fat is broken down for energy. In diabetic coma, the client is admitted with dehydration and ketoacidosis. The other choices do not define diabetic coma.
The nurse is caring for a client with multiple organ failure who is in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? kidneys and liver pancreas and heart heart and lungs lungs and kidneys
lungs and kidneys Explanation: The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.
Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will: maintain normal fluid and electrolyte balance. select a diabetic diet correctly. state dietary restrictions. exhibit serum glucose level within normal range.
maintain normal fluid and electrolyte balance. Explanation: Because diabetes insipidus involves the 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 the treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and magnesium. sodium. potassium. phosphorus.
phosphorus. Explanation: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?
potassium chloride Explanation: Since addisonian crisis results in hyperkalemia, administering potassium chloride is contraindicated. Therefore, the nurse should question the order for potassium chloride, making this the correct choice for this question. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of acute gastritis. profound neuromuscular irritability. severe hypotension. excessive thirst.
profound neuromuscular irritability. Explanation: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.
A client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases? serum bicarbonate of 28 mEq/L pH 7.30 serum bicarbonate of 21 mEq/L pH 7.26
serum bicarbonate of 28 mEq/L Explanation: Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.
The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100 mg intravenously at a rate of 10 mL/hour for a client in acute adrenal crisis. The nurse understands that this treatment is common in clients with which disease process? Addison's disease hypoparathyroidism Cushing's syndrome hyperthyroidism
Addison's disease Explanation: Intravenous hydrocortisone for clients in acute adrenal crisis is the proper treatment for individuals with Addison's disease. Cushing's syndrome is associated with excessive amounts of glucocorticoids. Hyperthyroidism and hypoparathyroidism are not treated with hydrocortisone.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? blood urea nitrogen (BUN) level of 12 mg/dl (0.7 mmol/L) serum sodium level of 134 mEq/L (134 mmol/L) blood glucose level of 90 mg/dl (4.9 mmol/L) serum potassium level of 5.8 mEq/L (5.8 mmol/L)
serum potassium level of 5.8 mEq/L (5.8 mmol/L) Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
A nurse in a diabetes clinic receives phone calls from four clients with type 1 diabetes. The nurse returns the call of the client reporting what symptoms as highest priority? "My blood sugar was 55 mg/dL (3 mmol/L) , so I didn't take my insulin." "I'm nauseated this morning and can keep only fluids down." "I'm thirsty all the time, and I'm urinating a lot." "I noticed that my urine has a foul odor, and I have a fever."
"I noticed that my urine has a foul odor, and I have a fever." Explanation: Urination can be increased with diabetes, but the urine should not have a foul odor. Diabetics are more at risk for urinary tract infections. The client with foul-smelling urine could have an active urinary tract infection and should be the priority for the nurse because a urinary tract infection in a diabetic client may quickly progress to sepsis. Classic signs and symptoms of diabetes mellitus are polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive appetite). These signs could indicate that a client is experiencing hyperglycemia, but they don't suggest an emergent problem. Nausea and vomiting reflect a GI disorder, which is a concern for a client with type 1 diabetes. This client is taking oral fluids and should be called to reinforce the sick day plan of care. Again, though, this client is not emergent. The client with hypoglycemia performed the correct action by holding insulin. The client requires follow-up to ensure that the blood sugar has normalized, but this is not emergent.
Which factor, if described by the parents, indicates understanding the underlying problem of the disease? reaction to the formation of antibodies against streptococcus an abnormality in the body's mucus-secreting glands formation of fibrous cysts in various body organs failure of the pancreatic ducts to develop properly
an abnormality in the body's mucus-secreting glands Explanation: CF is characterized by a dysfunction in the body's mucus-producing exocrine glands. The mucus secretions are thick and sticky rather than thin and slippery. The mucus obstructs the bronchi, bronchioles, and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine, resulting in poor digestion and poor absorption of various food nutrients. Fibrous cysts do not form in various organs. CF is an autosomal recessive inherited disorder and does not involve any reaction to the formation of antibodies against streptococcus.
The nurse is assessing a client with an A-V fistula. Which finding should the nurse report to the healthcare provider? fistula covered with long-sleeve clothing skin discoloration distal to the fistula pulse palpated over the fistula site a murmur auscultated over the fistula
skin discoloration distal to the fistula Explanation: The nurse's priority is to ensure adequate circulation to the arm with the fistula. Discoloration may indicate poor circulation at the fistula site. A bruit (murmur) and vibration (thrill) should be assessed. Wearing long sleeves would be appropriate as long as they were not tight.
The client with type 1 diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." What is the best response by the nurse? "Eliminating carbohydrates from your diet is a good first step toward getting off of insulin." "It is correct that you do not need to count carbohydrates from fruits and vegetables." "A person with diabetes should monitor their eating of proteins, fats, and carbohydrates." "All we ask you to do is have your blood sugar in range."
"A person with diabetes should monitor their eating of proteins, fats, and carbohydrates." Explanation: 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. Limiting carbohydrate intake is just part of a comprehensive diabetic diet plan. A client with type 1 diabetes will need lifelong insulin therapy. Carbohydrates from fruit and vegetable sources will still need to be factored into carbohydrate intake. Telling a client "all we ask you to do" is a value-judgement and is not therapeutic communication.
