Endocrine Passpoint

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. How should the nurse respond to the client? a. "You can take ginseng if you take it with a carbohydrate" b. "Taking ginseng will increase the risk of hypoglycemia." c. "There are no therapeutic benefits of ginseng." d. "You can take the ginseng to help improve your memory."

ANS: b. "Taking ginseng will increase the risk of hypoglycemia." Rationale: 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.

What is the most common cause of hyperaldosteronism? a. A pituitary adenoma b. Excessive sodium intake c. An adrenal adenoma d. Deficient potassium intake

ANS: c. An adrenal adenoma Rationale: An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.

Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use? a. Demonstrating correct technique b. Providing documentation of previous certification c. Documenting a normal blood glucose level d. Verbalizing an understanding of blood glucose meter use

ANS: a. Demonstrating correct technique Rationale: The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use.

The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? a. acromegaly b. hypopituitarism c. Cushing's disease d. diabetes mellitus

ANS: b. hypopituitarism Rationale: Hypopituitarism can cause growth hormone, gonadotropin, TSH, and adrenocorticotropic hormone deficits. Client should be taught to monitor for changes in mental status, energy level, muscle strength, and cognitive function. In adults changes in sexual function should be reported.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

ANS: Using sterile technique during the dressing change Rationale: The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in:

ANS: serum glucose level. Rationale: Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns? a. "I'll stay here with you while the technician draws your blood." b. "When your thyroid levels are stable, we won't have to draw your blood as often." c. "It's only a little stick. It'll be over before you know it." d. "The physician has ordered this test so you can get better sooner."

ANS: a. "I'll stay here with you while the technician draws your blood." Rationale: The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear.

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client? Select all that apply. a. Frequent, high-volume urination b. Excessive hunger c. Excessive thirst d. Edema e. Insomnia f. Weight gain

ANS: a. Frequent, high-volume urination b. Excessive hunger c. Excessive thirst Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose that the cells are using for energy, the client has weight loss, not weight gain. Clients usually do not present with insomnia, however, clients can report fatigue. Fluid retention and edema are not associated with diabetes mellitus.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? a. Elevating the head of the client's bed to 90 degrees b. Restricting sodium intake to 1 gm/day c. Administering vasopressin as ordered d. Restricting fluids to 800 ml/day

ANS: d. Restricting fluids to 800 ml/day. Rationale: Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion, thus worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.

When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to: a. take glipizide immediately after meals. b. take glipizide as indicated by blood glucose values. c. take glipizide four times a day at evenly spaced intervals. d. take glipizide 30 minutes before breakfast.

ANS: d. take glipizide 30 minutes before breakfast. Rationale: Glipizide is most effective when taken 30 minutes before breakfast. The duration of action is 10 to 24 hours. If the drug needs to be taken more than once a day, the dosage may be divided and taken twice a day before meals. It is not as effective to take the drug after meals. Although blood glucose levels will be monitored, the values do not dictate when the drug should be taken.

The unlicensed assistive personnel (UAP) records a capillary blood glucose of 253 mg/dL (14.04 mmol/L) and the nurse administered insulin for coverage to the client. The UAP reports to the nurse that the blood glucose was incorrect. What actions should the nurse take? Select all that apply. a. Complete an incident report. b. Reprimand the UAP for the incorrect blood glucose. c. Obtain a current blood glucose level. d. Observe the client for hypoglycemia. e. Report the incident to the healthcare provider.

ANS: a. Complete an incident report. c. Obtain a current blood glucose level. d. Observe the client for hypoglycemia. e. Report the incident to the healthcare provider. Rationale: The nurse should obtain a current blood glucose level to ascertain whether the blood glucose level is higher or lower than the amount stated, and this will guide the nurse in correcting the error. Observe for hypoglycemia because the nurse administered insulin to the client and the client's blood glucose may drop drastically. Report the incident to the healthcare provider so an order can be given, and complete an incident report recounting the incident. Reprimanding the UAP for the incorrect blood glucose will not correct the incident.

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

ANS: a. increased secretion of adrenocorticotropic hormone (ACTH). Rationale: 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.

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

ANS: b. "Hold your abdomen firmly with a pillow, and take several deep breaths." Rationale: 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.

An obese client, age 65, is diagnosed with type 2 diabetes. When educating this client about his diagnosis, the nurse knows that the client will need more education when he says which of the following? Select all that apply. a. "My doctor says that if I keep my weight down I probably won't have to go on insulin." b. "I guess I will need to stop meeting my friends at the coffee shop." c. "If I follow my diet and exercise, I won't have diabetes any more." d. "If I don't keep my sugar under control, I could go into kidney failure." e. "I can never eat a hot fudge sundae again."

ANS: b. "I guess I will need to stop meeting my friends at the coffee shop." c. "If I follow my diet and exercise, I won't have diabetes any more." e. "I can never eat a hot fudge sundae again." Rationale: Patients with type 2 diabetes who follow a diet and exercise program will likely be able to achieve normal blood sugar levels, but cannot consider themselves "cured" of diabetes. Renal failure is a possible complication of uncontrolled diabetes. A person with well controlled diabetes can modify their diet to include occasional treats like ice cream if they select sugar free versions. Meeting friends for coffee is fine as long as the client does not include high sugar items along with the beverage. Type 2 diabetes can often be controlled with oral hypoglycemics.

A client diagnosed with thyroid cancer signed a living will that states he doesn't want ventilatory support if his condition deteriorates. As his condition worsens, the client states, "I changed my mind. I want everything done for me." Which response by the nurse is best? a. "I'll ask your physician to revoke your do-not-resuscitate order." b. "What exactly do you mean by wanting 'everything' done for you?" c. "Maybe you should talk with your family." d. "Do you understand that you'll be placed on a ventilator?"

ANS: b. "What exactly do you mean by wanting 'everything' done for you?" Rationale: Asking the client what he means is the best response. The nurse should clarify the client's request and get as much information as she can 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 his statement. The client might want aggressive treatment without reversing the DNR order. Asking the client if he understands that he'll be placed on a ventilator places him on the defensive. Telling the client to talk with his family is an inappropriate response; the client has the right to change his treatment plan without input from his family.

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test? a. The amount of dexamethasone in the system b. Cortisol levels before and after the system is challenged with a synthetic steroid c. Changes in certain body chemicals, which are altered in depression d. Cortisol levels after the system is challenged

ANS: b. Cortisol levels before and after the system is challenged with a synthetic steroid Rationale: The dexamethasone suppression test measures cortisol levels before and after the system is challenged with a synthetic steroid. The dexamethasone suppression test does not measure dexamethasone or body chemicals altered in depression. Dexamethasone is used to challenge the cortisol level.

Which of the following results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? a. Decreased edema, stable temperature, and decreased respiratory rate b. Increased energy, weight loss, and a higher temperature and pulse rate c. Elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels d. Improved appetite, weight gain, and sleeping fewer hours

ANS: b. Increased energy, weight loss, and a higher temperature and pulse rate Rationale: 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.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? a. Fasting blood glucose test b. Serum glycosylated hemoglobin (Hb A1c) c. Urine ketones d. 6-hour glucose tolerance test

ANS: b. Serum glycosylated hemoglobin (Hb A1c) Rationale: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolbutamide. Which laboratory test is the most important for confirming this disorder? a. Arterial blood gas (ABG) values b. Serum osmolarity c. Serum potassium level d. Serum sodium level

ANS: b. Serum osmolarity Rationale: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

The nurse should teach the client with hepatitis A to: a. intensify routine exercise and increase strength. b. increase carbohydrates and protein in the diet. c. limit caloric intake and reduce weight. d. avoid contact with others and sleep in a separate room.

ANS: b. increase carbohydrates and protein in the diet. Rationale: Low-fat, high-protein, high-carbohydrate diet is encouraged for a client with hepatitis to promote liver rejuvenation. Nutrition intake is important because clients may be anorexic and experience weight loss. Activity should be modified and adequate rest obtained to promote recovery. Social isolation should be avoided, and education on preventing transmission should be provided; the client does not need to sleep in a separate room.

An elderly client who is receiving steroids has secondary diabetes and chronic kidney disease (CKD) and takes insulin. The client has had episodes of hypoglycemia. The nurse should: a. restrict ambulation so there will be less of a chance for hypoglycemia. b. keep an 240 ml bottle of orange juice at the bedside to use when the client becomes hypoglycemic. c. contact the dietitian to request that one additional serving of protein be added to each meal. d. continue to monitor the client's blood glucose values.

ANS: b. keep an 240 ml bottle of orange juice at the bedside to use when the client becomes hypoglycemic. Rationale: The nurse should continue to monitor glucose in the blood to prevent the client from continuing to experience hypoglycemia. One of the risk factors for hypoglycemia is decreased insulin clearance as with impaired kidney function and/or renal failure. Another risk factor for hypoglycemia is increased glucose utilization when there is too much activity or exercise without enough food. Protein is digested slower than carbohydrate, but with chronic kidney disease (CKD) it is more difficult for the kidneys to rid the body of metabolic waste products.

A client with a history of Addison's disease is experiencing weakness and headache. The vital signs are blood pressure of 100/60 and heart rate of 80. Laboratory values are Na 130, potassium 4.8, and blood glucose 70. Which of the following would the nurse expect to administer? a. IV total parenteral nutrition and insulin coverage b. IV 5% dextrose and dopamine c. IV normal saline and glucocorticoids d. IV lactated Ringer's solution and packed cells

ANS: c. IV normal saline and glucocorticoids Rationale: The client with Addison's is expected to have hypotension and inadequate corticosteroids. There is no evidence that the client would be anemic. Although the blood pressure may be a little below normal, there is no indication for an inotropic drug such as dopamine to increase perfusion. There is no indication that the client would be weak and hypoglcemic.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? a. Insulin is absorbed more slowly at abdominal injection sites than at other sites. b. Insulin is absorbed rapidly regardless of the injection site. c. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. d. Insulin is absorbed unpredictably at all injection sites.

ANS: c. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Rationale: 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 nurse is assigned to a client who is using an insulin pump. She has never cared for a client with an insulin pump and isn't sure what to do. What should the nurse do first? a. Accept the client and do her best until the shift ends. b. Inform the charge nurse that she doesn't feel comfortable with this assignment. c. Request information about nursing responsibilities in caring for a client with a pump. d. Refuse to accept the assignment until she's received training about pump management.

ANS: c. Request information about nursing responsibilities in caring for a client with a pump. Rationale: Taking the initiative to gain new information relevant to client care as well as expressing a desire to support the unit's needs is an appropriate and professional nursing response. Refusing the assignment is inappropriate because the nurse isn't taking any initiative to learn about the pump. Refusing to care for the client until she receives training is inappropriate; the nurse should gather information and evaluate the client before refusing to care for him. Accepting the assignment doesn't address the issue of lack of knowledge and may put the nurse or the client in jeopardy.

After surgery for bilateral adrenalectomy, the client is kept on bed rest for several days. Which exercise will be most effective for preparing a client for ambulation after a period of bed rest? a. alternately abducting and adducting the legs b. alternately stretching the Achilles tendons c. alternately flexing and relaxing the quadriceps femoris muscles d. alternately flexing and extending the knees

ANS: c. alternately flexing and relaxing the quadriceps femoris muscles Rationale: Alternately flexing and relaxing the quadriceps femoris muscles helps prepare the client for ambulation. This exercise helps maintain the strength in the quadriceps, which is the major muscle group used when walking. The other exercises listed do not increase a client's readiness for walking.

Lab Results: Test: Results: Blood Glucose 192 Total Cholesterol 250 Hemoglobin 12.3 LDL 125 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? a. total cholesterol b. hemoglobin c. blood glucose d. low-density lipoprotein (LDL) cholesterol

ANS: c. blood glucose Rationale: 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 health care provider (HCP).

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? a. Hypotonic saline b. Insulin c. Hydrocortisone d. Potassium

ANS: c. hydrocortisone Rationale: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

Several hours into a shift, a nurse on a very busy medical-surgical unit privately asks the charge nurse to change her assignment. She is frustrated because she has had to devote so much time and energy to helping a newly licensed nurse provide discharge teaching for clients with diabetes mellitus. The charge nurse should: a. try to provide the staff member with a float nurse. b. insist that the nurse follow through with the assignment. c. offer to assist with the discharge teaching needs. d. reassign the new graduate to another staff member.

ANS: c. offer to assist with the discharge teaching needs. Rationale: Staff members need to know the charge nurse is a supportive leader who respects their honesty and stands behind them. By offering to help with discharge teaching, the charge nurse is actively engaging with her staff at a time of need. Changing all the assignments on this extremely busy floor would be counterproductive. Insisting that the staff member follow through with her assignment disrespects her request and genuine need. Providing a float nurse could help, but there are no guarantees a float nurse is available.

Which instruction about levothyroxine administration should a nurse teach a client? a. "Take the drug in the evening." b. "Take the drug whenever convenient." c, "Take the drug with meals." d. "Take the drug on an empty stomach."

ANS: d. "Take the drug on an empty stomach." Rationale: The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release).

During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should: a. Hand the physician calcium gluconate for I.V. use. b. Hand the physician calcium chloride for I.V. use. c. Hand the physician the kind of calcium available on the unit. d. Check with the physician for his complete order.

ANS: d. Check with the physician for his complete order. Rationale: The nurse should first check with the physician for the complete order of calcium because calcium chloride has a concentration of 13.6 mEq (3.4 mmol/l) of calcium per gram and calcium gluconate has 4.65 mEq (1.2 mmol/l) of calcium per gram. The nurse can always offer the doctor the type of calcium available after the conversion in calcium has been made; otherwise, the error could be fatal.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Disturbed body image related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

ANS: d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess Rationale: In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. a. Polyuria b. Polydipsia c. Aphasia d. Numbness e. Muscle twitching and spasms f. Tingling

ANS: d. Numbness e. Muscle twitching and spasms f. Tingling Rationale: When the parathyroid gland is removed, the body may not produce enough parathyroid hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral numbness, tingling, and muscle spasms. Aphasia is not a symptom of calcium depletion. Polyuria and polydipsia are symptoms of diabetes mellitus.

A client is diagnosed with diabetes mellitus. The physician orders 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes her hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use? a. Inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; inject 35 units air into NPH vial and withdraw 35 units NPH. b. Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial; withdraw 35 units NPH; withdraw 15 units regular insulin. c. Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. d. Inject 15 units air into regular insulin vial; inject 35 units air into NPH vial, withdraw 35 units NPH; withdraw 15 units regular insulin

ANS: c. Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. Rationale: To avoid creating a vacuum, the nurse must inject exactly the same amount of air into a multidose vial to replace the amount of medication to be withdrawn. She should follow these steps: (1) Inject air into the vial from which the second insulin dose will be withdrawn (isophane insulin). (2) Inject air into the vial from which insulin will be withdrawn first (regular insulin). (3) With the needle inserted into the regular insulin vial, withdraw the correct amount. (4) With 15 units of regular insulin in the syringe, carefully withdraw 35 units of NPH, for a total of 50 units in the syringe. Options 2 and 4 are incorrect because regular insulin must be withdrawn first. Option 3 is incorrect because the nurse must not insert air into a multiple-dose vial with a syringe containing medication.

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: a. acute gastritis. b. profound neuromuscular irritability. c. excessive thirst. d. severe hypotension.

ANS: b. profound neuromuscular irritability. Rationale: 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.

The school nurse in a middle school (ages 12-15) is reinforcing client goals on a newly placed insulin pump. Which are included? Select all that apply.

ANS: -having fewer injections of insulin -continuing to eat a snack before physical activity -self-adjusting basal rate upon activity/illness Rationale: Reinforcement of medical goals and standards of care are common responsibilities of the school nurse. For the middle school student who has a new insulin pump, the teaching commonly relates to blood sugar monitoring, type of insulin, and side effects of treatment. The blood sugar will be monitored via the pump and insulin will be administered accordingly: thus, no further glucometer checks or insulin injections will regularly be needed. The insulin pump delivers one type of insulin, a rapid acting insulin. Once the client is comfortable with the pump, regulation of the basal rate being infused can be adjusted upon activity and illness.

A client's fasting blood sugar (FBS) is 63 mg/dL (3.5 mmol/L) at 0700. The client is alert and oriented. What should the nurse do first?

ANS: Give 15 g of carbohydrate and recheck the blood glucose in 15 minutes. Rationale: According to American Diabetes Association (Canadian Diabetes Association) guidelines for treating hypoglycemia, the conscious adult client should be given 15 g of carbohydrate with a follow-up blood glucose level in 15 minutes. The other options do not follow these guidelines.

The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose?

ANS: Reduced serum ammonia levels. Rationale: 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.

Parathyroid hormone (PTH) has which effects on the kidney?

ANS: Stimulation of calcium reabsorption and phosphate excretion Rationale: 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 nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do?

ANS: Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Rationale: Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client to ask her physician about the medication dosage might cause her to alter her dosage on her own, and also is putting the client off instead of addressing her concerns. Telling the client that she looks fine discounts the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.

A nurse is assessing a client with hyperparathyroidism. Which finding should the nurse report immediately to the physician?

ANS: Client reports flank pain Rationale:The client with hyperparathyroidism has elevated calcium levels, which promotes the formation of kidney stones. Flank pain may be indicative of kidney stones. Anorexia is common with this condition and is not cause for immediate intervention. Urinary output and blood pressure are normal.

A client with diabetes mellitus has a foot ulcer. The physician orders bed rest, a wet-to-damp dressing change every shift, and blood glucose monitoring before meals and at bedtime. Why are wet-to-damp dressings used for this client? a. They prevent the entrance of microorganisms and minimize wound discomfort. b. They contain exudate and provide a moist wound environment. c. They protect the wound from mechanical trauma and promote healing. d. They debride the wound and promote healing by secondary intention.

ANS: d. They debride the wound and promote healing by secondary intention. Rationale: For this client, wet-to-damp dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Dry, sterile dressings protect the wound from mechanical trauma and promote healing. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort.

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? a. The kidneys react rapidly to compensate for imbalances in the body. b. The kidneys regulate the bicarbonate level in the intracellular fluid. c. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. d. The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.

ANS: c. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. Rationale: The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. The kidneys cannot compensate for the metabolic acidosis created by renal failure. Renal compensation for imbalances is relatively slow (a matter of hours or days).

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? a. Serum creatinine level of 0.4 mg/dl b. Serum sodium level of 124 mEq/L c. Serum blood urea nitrogen (BUN) level of 8.6 mg/dl d. Hematocrit of 52%

ANS: b. Serum sodium level of 124 mEq/L Rationale: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses 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?

ANS: Thyroid crisis Rationale: Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

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? a. Pancreas and heart b. Heart and lungs c. Lungs and kidneys d. Kidneys and liver

ANS: c. Lungs and kidneys Rationale: 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.

A nurse should expect to administer which medication to a client with gout? a. Calcium gluconate b. Aspirin c. Furosemide d. Colchicine

ANS: d. colchicine Rationale: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, a diuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it doesn't treat gout.

A client's glucose level is 365 mg/dL (365 mmol/dL). The physician 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.

ANS: 0.1 Rationale: 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 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 nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a. Decreased cardiac output b. Risk for infection c. Imbalanced nutrition: Less than body requirements d. Impaired physical mobility

ANS: a. Decreased cardiac output Rationale: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.

Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Jugular vein distention b. Weight loss c. Tetanic contractions d. Polyuria

ANS: a. Jugular vein distention Rationale: SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by jugular vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

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:

ANS: most likely related to low thyroid hormone levels and will improve with treatment. Rationale: 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."