Evolve: Endo

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A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient?

A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. In addition to these changes, the nurse further assesses this client for:

A client who is 60 pounds more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept should the nurse include in teaching about diabetes when discussing strategies to lose weight?

A client with diabetes asks how exercise will affect insulin and dietary needs. The nurse should respond, "Exercise:

A client with type 1 diabetes self-administers NPH insulin (Novolin N) every morning at 8:00 AM. The nurse concludes that the client understands the action of this insulin when the client says, "I should be alert for signs of hypoglycemia between:

The nurse identifies that the dietary teaching provided for a client with diabetes is understood when the client states, "My diet:

Can be planned around a wide variety of commonly used foods."

A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?

A female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. The nurse should base a response on the understanding that:

A nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify?

A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiological changes that are associated with a long history of diabetes?

A nurse is caring for a client who is admitted to the hospital with the diagnosis of primary hyperparathyroidism. Which action should be included in this client's plan of care?

A nurse is caring for a newly admitted client with a diagnosis of Graves disease. In preparing a teaching plan, the nurse anticipates which diet will be prescribed for this client?

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis?

A nurse is providing postoperative care for a client one hour after the client had an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse should monitor the client for which complication?

Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit:

What should the nurse do when collecting a 24-hour urine specimen?

During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? (Select all that apply.)

1,2

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? (Select all that apply.)

1,2,5

A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility two days after surgery when preparing the client to eat dinner? 1 Checking the client's serum glucose level 2 Assisting the client out of bed into a chair 3 Placing the client in the high-Fowler position 4 Ensuring the client's residual limb is elevated

1 Checking the client's serum glucose level

A nurse is caring for an alert client who has diabetes and is receiving an 1800-calorie American Diabetic Association diet. The client's blood glucose level is 60 mg/dL. The health care provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. The nurse should:

A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis?

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. The nurse evaluates that the teaching was effective when the client says, "I should:

An obese client must self-administer insulin at home. The nurse should teach the client to use what technique?

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." On the basis of this statement, the nurse's best action is to:

Which is the best advice the nurse can give regarding foot care to a client diagnosed with diabetes?

A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will:

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon?

A client's parathyroid glands are removed. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery?

A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. Which is the best indication that a client with type 1 diabetes is successfully managing the disease?

Postoperatively a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing?

A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription?

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra pill should be taken before exercise. The best response by the nurse is:

Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get the atomic cocktail?" The nurse explains that the medication is being prescribed because it decreases the:

Production of thyroid hormones. Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones

A nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify?

Retention of sodium and water

A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. The primary cause of the client's ascites is a decrease in:

Plasma protein to maintain adequate capillary-tissue circulation -Malnutrition and liver damage lead to a reduced serum albumin level and failure of the capillary fluid shift mechanism, resulting in ascites.

A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? (Select all that apply.)

Polyuria and Polydipsia

A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client?

Presence of infection

A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client?

Kussmaul respirations Kussmaul respirations occur in diabetic coma as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis). HHNS affects people with type 2 diabetes who still have some insulin production; the insulin prevents the breakdown of fats into ketones.

The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit:

Lability of mood

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response?

Less thyroid tissue is available to supply thyroid hormone after surgery.

Which health problem should the nurse consider is most likely to precipitate acute hypoglycemia in a client?

Liver disease; Clients with liver disease have a decreased ability to metabolize carbohydrates because of a decreased ability to form glycogen and to form glucose from glycogen. Cushing's syndrome causes hyperglycemia.

A client with type 2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (Glucophage) and an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do?

Monitor blood glucose levels more frequently.

When assessing a client with Graves disease, the nurse expects to identify:

Weight loss, exophthalmos, and restlessness

A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention that the nurse should expect the health care provider to prescribe for this client?

NPH insulin (Novolin N)

A client who had a subtotal thyroidectomy returns to the unit from the postanesthesia care unit. What is the priority nursing action at this time?

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?

-Administer intravenous (IV) steroids.

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? (Select all that apply.)

1,3

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?

Hypernatremia

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. Which plan reported by the client supports the nurse's conclusion that the teaching was effective?

"Avoid using a sleeping mask at night.

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. The nurse's most appropriate response is:

"Choose the foods you normally do and follow your food plan wherever you are."

A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary?

"The fingertip is preferred for glucose monitoring if hyperglycemia is suspected."

A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse's best response to this question?

"There is no difference between readings."

A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not get along. It seems as though my spouse doesn't care about my diabetes." The nurse's most appropriate response is:

"You are unhappy. I wonder—have you tried to talk to your spouse?"

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for:

A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" What is the nurse's best reply?

-"I don't know if you do; let's talk about it." The nurse has demonstrated recognition of the verbalized concern and a willingness to listen. The client did not state cancer as the diagnosis; this response puts the client on the defensive.

A client in thyroid storm tells the nurse, "I know I'm going to die. I'm very sick." What is the nurse's best response?

-"You must feel very sick and frightened."

On the first day after a thyroidectomy, a client tolerates a full-liquid/fluid diet. When the diet is progressed to a soft diet the next day, the client complains of a sore throat when swallowing. How should the nurse respond?

-Administer prescribed analgesics before meals

The major nursing concern when caring for a client with the diagnosis of hyperthyroidism is:

-Arranging for sufficient rest periods Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism . With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite.

What should the nurse do when collecting a 24-hour urine specimen?

-Check to verify if a preservative is needed. Depending on the purpose of the collection, a preservative to prevent breakdown of the specimen may be necessary. Weighing the client is not necessary.

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes:

-Complications are not present at the time of diagnosis.

-Despite steroid therapy, the ability to cope with stress will be decreased

A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to:

-Improve the cellular uptake of glucose Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise.

-Hypocalcemia The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood. Hypokalemia is characterized by generalized weakness, a decrease in reflexes, shallow respirations, and cardiac dysrhythmias. Thyrotoxic crisis is characterized by tachycardia, hyperpyrexia, and an exacerbation of hyperthyroid symptoms. Hypovolemic shock is characterized by a weak, thready pulse and hypotension.

A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations?

-Increased intracranial pressure

A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor?

-Low blood sugar

-Measure the blood glucose level between 2 AM and 4 AM.

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease?

-Mineralocorticoids

A client's parathyroid glands are removed. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery?

-Muscle spasms Removal of the parathyroids causes hypocalcemia and associated neuromuscular irritability. Constipation is a sign of hypercalcemia. Hypoactive reflexes are signs of hypercalcemia. Increased specific gravity is a sign of fluid volume deficit.

-Obesity leads to insulin resistance

The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication?

-Observe for signs of infection PTU may lower the white blood cell count, making the client prone to infection. Propylthiouracil does not cause hypocalcemia.

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis?

-Receives long-term steroid therapy Increased levels of steroids will accelerate bone demineralization.

A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider?

-Reduced insulin production Oral hypoglycemics may be helpful when some functioning of the beta cells exists, as in type 2 diabetes. Rapid-acting regular insulin is needed to reverse ketoacidosis. Obesity does not offer enough information to determine the status of beta cell function. Clients with type 1 diabetes have no functioning beta cells; the necessary treatment is insulin, not an oral hypoglycemic.

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing?

-Somogyi effect The Somogyi effect is a response to hypoglycemia induced by too much insulin; the body responds to the hypoglycemia by counterregulatory hormones stimulating lipolysis, gluconeogenesis, and glycogenolysis, resulting in rebound hyperglycemia. The Dawn phenomenon is hyperglycemia that is present on awakening in the morning because of the release of counterregulatory hormones in the predawn hours; it is thought that growth hormone or cortisol is related to this phenomenon. Diabetic ketoacidosis (diabetic coma) is a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. Hyperosmolar nonketotic syndrome occurs in clients with type 2 diabetes. It is a condition in which the client produces enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that:

-There may not be enough thyroid tissue to supply adequate thyroid hormone

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

-Urine negative for ketones and hyperglycemia In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia.

A client has a glycosylated hemoglobin measurement of 6%. What should the nurse conclude about this client when planning a teaching plan based on the results of this laboratory test?

A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment? 1 Dry 2 Moist 3 Flushed 4 Smooth

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client? 1 Administer intravenous (IV) steroids. 2 Provide a high protein diet. 3 Collect a 24-hour urine specimen. 4 Withhold all medications for 48 hours.

1 Administer intravenous (IV) steroids. Steroid therapy usually is instituted preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample, not high, protein and potassium; however, it must be low in calories, carbohydrates, and sodium to promote weight loss and reduce fluid retention. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

When assessing a client with Graves disease (hyperthyroidism) the nurse expects to identify a history of: 1 Diaphoresis 2 Menorrhagia 3 Dry, brittle hair 4 Sensitivity to cold

1 Diaphoresis Increased basal metabolic rate, increased circulation, and vasodilation result in warm, moist skin. Menorrhagia, dry, brittle hair, and sensitivity to cold are associated with hypothyroidism.

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis? 1 Receives long-term steroid therapy 2 Has a history of hypoparathyroidism 3 Engages in strenuous physical activity 4 Consumes high doses of the hormone estrogen

1 Receives long-term steroid therapy Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization.

A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide:

1 Stimulates the pancreas to produce insulin

A client has a thyroidectomy for cancer of the thyroid. To evaluate for nerve injury that may be the result of surgery-related trauma, the nurse assesses the client's ability to: 1 Speak 2 Swallow 3 Purse the lips 4 Turn the head

1 Speak The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return.

A female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. The nurse should base a response on the understanding that:

1 As long as medication is continued, ovulation will occur

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response? 1 The tumor must be removed to prevent heart and kidney damage. 2 Surgery will prevent the tumor from metastasizing to other organs. 3 Radiation therapy can be just as effective as surgery if the tumor is small. 4 Chemotherapy is as reliable as surgery for the treatment of adenomas of this type in some people

1 The tumor must be removed to prevent heart and kidney damage.

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)

1 Emotional lability 2 Dyspnea on exertion 5 Hyperactive deep tendon reflexes

A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include that will decrease the risk of complications? (Select all that apply.) 1 Examining the feet daily 2 Wearing well-fitting shoes 3 Performing regular exercise 4 Powdering the feet after showering 5 Visiting the health care provider weekly 6 Testing bathwater with the toes before bathing

1 Examining the feet daily 2 Wearing well-fitting shoes 3 Performing regular exercise

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? (Select all that apply.)

1 Irritability 4 Heart palpitations

A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What signs of common complications of diabetes might the nurse expect to identify when assessing this client? (Select all that apply.)

1 Leg ulcers 2 Loss of visual acuity 3 Thick, yellow toenails 5 Decreased sensation in the feet

A client has a hypoglycemic reaction to insulin. Which client responses should the nurse document as clinical manifestations of hypoglycemia? (Select all that apply.)

1,2,5

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)

1,2, 5

A nurse is caring for a client newly admitted with a diagnosis of pheochromocytoma. Which clinical findings does the nurse expect when assessing this client? (Select all that apply.)

1,2,3

After assessing a client, a nurse concludes that the client may be experiencing hyperglycemia. Which clinical findings commonly associated with hyperglycemia support the nurse's conclusion? (Select all that apply.)

1,2,3

1,2,3,5

While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? (Select all that apply.)

1,2,4

Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? (Select all that apply.)

1,2,5,

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? (Select all that apply.)

1,3

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? (Select all that apply.)

1,3,4

A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? (Select all that apply.)

1,3,6

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? (Select all that apply.)

1,4

The nurse is assessing a client with hyperthyroidism. For which signs and symptoms should the nurse assess the client? (Select all that apply.)

1,4,5

A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? (Select all that apply.)

1. Cool Skin 3. Constipation 4. Periorbital edema 5. Decreased appetite

A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated?

Hypotension

1. Dry skin 2. Lethargy 5. Sensitivity to cold

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)

1. Emotional lability 2. Dyspnea on exertion 5. Hyperactive deep tendon reflexes

A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? (Select all that apply.)

1. Excessive Thirst 3. Dry Mucous Membrane 6. Decreased urine specific gravity

A nurse is caring for a client recently diagnosed with type 1 diabetes. For what signs and symptoms of an insulin reaction should the nurse assess this client? (Select all that apply.)

1. Headache 2. Diaphoresis 3. Nervousness

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? (Select all that apply.)

1. Hirsutism 3. Buffalo hump

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? (Select all that apply.)

1. Lability of mood 2. Slow wound healing

1. Palpitations 2. Tachycardia Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Thickened skin, An apathetic attitude, and Menstrual disturbances are associated with hypothyroidism and myxedema.

A nurse mixes a short-acting and an intermediate-acting insulin in the same syringe to administer to a client with diabetes. List the actions in the order the nurse should perform them.

1. Put air into the intermediate-acting insulin 2. Put air into the short-acting insulin vial 3. Withdraw the prescribed amount of short-acting insulin. 4. Withdraw the prescribed amount of intermediate acting insulin. 5. Don a pair of clean gloves

A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement?

1. Regulated food intake is basic to control.

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiological finding should be the nurse's focus when collecting additional data about this client?

1. Starvation

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? (Select all that apply.)

1. Thirst 4. Fruity breath odor 5. Excessive urination

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? (Select all that apply.)

1. Tremors 4. Heat intolerance

1. Use tinted glasses. 3. Elevate the head of the bed 45 degrees. 4. Tape eyelids shut at night if they do not close.

A nurse is preparing to administer insulin to a client with diabetes. In which order should the nurse perform the actions associated with insulin administration?

1. Wash hands with soup and water 2. Rotate the vial of insulin between the palms of the hands. 3. Wipe the top of the insulin vial with an alcohol swab 4. Instill air into the vial of insulin equal to the desired dose 5. Withdraw the correct amount of insulin from the inverted vial

12 PM and 8 PM." NPH insulin's onset of action is 1.5 to 4 hours, peak action is 4 to 12 hours, and duration of action is 18 to 24 hours; if hypoglycemia occurs, it will happen most likely between 12 PM and 8 PM.

A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" What is the nurse's best reply?

A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include:

A client newly diagnosed with type 1 diabetes receives information about insulin. The client states, "I hate shots. Why can't I take the insulin in pill form?" What is the nurse's best response? 1 "Your diabetic condition is too serious for oral insulin." 2 "Insulin is poorly absorbed and its action is erratic when taken by mouth." 3 "Insulin by mouth causes a high incidence of allergic and adverse reactions." 4 "Once your diabetes is controlled, your physician might consider oral insulin."

2 "Insulin is poorly absorbed and its action is erratic when taken by mouth."

Daily Humulin R insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 am. When should the nurse monitor the client for a potential insulin reaction? 1 At breakfast 2 Before lunch 3 Before dinner 4 In the early afternoon

2 Before lunch Regular insulin is short acting, and it peaks in two to four hours, which in this case will be at or before lunch. Breakfast is too soon; regular insulin peaks in two to four hours. Before dinner is too late; regular insulin peaks in two to four hours. The early afternoon is too late; regular insulin peaks in two to four hours.

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations? 1 Potassium iodide 2 Calcium gluconate 3 Magnesium sulfate 4 Potassium chloride

2 Calcium gluconate; The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. The nurse notifies the health care provider about the client becoming upset. What is the primary reason the nurse chose to notify the health care provider? 1 With this type of emotion, the dosage of steroids may have to be reduced 2 Despite steroid therapy, the ability to cope with stress will be decreased 3 Mild sedation is needed to assist the client with coping with the loss 4 Feelings of exhaustion with lethargy will occur as a result of stress

2 Despite steroid therapy, the ability to cope with stress will be decreased

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? 1 Urine output 2 Glucose level 3 Serum potassium 4 Immune response

2 Glucose level As a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels. Increased mineralocorticoids will decrease urine output. Sodium is retained by the kidneys, but potassium is excreted. The immune response is suppressed.

2 Hypocalcemia The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood.

A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include: 1 Low protein diet 2 Parenteral steroids 3 Preoperative 24-hour urine specimen 4 Withholding all medications 48 hours before surgery

2 Parenteral steroids; Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

While a nurse is teaching a client with diabetes about food choices, the client states, "I do not like broccoli." The nurse suggests that a food that can be substituted for the broccoli is:

3 Green beans

A nurse evaluates that a client with diabetes understands the teaching about the treatment of hypoglycemia when the client says, "If I become hypoglycemic I initially should eat: 1 Fruit juice and a lollipop. 2 Sugar and a slice of bread. 3 Chocolate candy and a banana. 4 Peanut butter crackers and a glass of milk.

2 Sugar and a slice of bread. The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); t

A client with type 1 diabetes self-administers Novolin N insulin every morning at 8 AM. The nurse evaluates that the client understands the action of the insulin when the client says, "I should be alert for signs of hypoglycemia between:

2 pm and 8 pm."

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin reaction should the nurse particularly be observant? (Select all that apply.)

2,3

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? (Select all that apply.) 1 Dry skin 2 Weight loss 3 Tachycardia 4 Restlessness 5 Constipation 6 Exophthalmos

2,3,4,6

A client is receiving dexamethasone (Decadron) for adrenocortical insufficiency. To monitor for a negative side effect of the medication, the nurse should:

The health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. The goal of treatment is that the client will have glucose levels within the range of:

2. 70 to 105 mg/dL of blood

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin reaction should the nurse particularly be observant? (Select all that apply.)

2. Headache 3. Diaphoresis Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Lethargy is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

A nurse is caring for a male client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? (Select all that apply.)

2. Obese trunk 4. Sleep Disturbance 5. Thin arms and legs

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

2. Tachycardia 5. Exopthalmos

A client is admitted with a head injury. The nurse identifies that the client's urinary retention catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause?

A client is scheduled to have a thyroidectomy for cancer of the thyroid. Preoperative instructions for the postoperative period include teaching the client to:

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that:

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the:

A nurse is caring for a client after a thyroidectomy. Because of concerns about potential nerve injury associated with this type of surgery, the nurse should assess for which functional ability?

Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematological studies?

For which client response should the nurse monitor when assessing for complications of hyperparathyroidism?

Four hours after surgery the blood glucose level of a client who has type 1 diabetes is elevated. The nurse can expect to:

When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of:

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? 1 Glargine (Lantus) 2 NPH insulin (Novolin N) 3 Insulin aspart (NovoLog) 4 Insulin detemir (Levemir

3 Insulin aspart (NovoLog) Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of one to two hours; for diabetic acidosis the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis the individual needs rapid-acting insulin.

A nurse is caring for a client after radioactive iodine is administered for Graves disease. What information about the client's condition after this therapy should the nurse consider when providing care? 1 Not radioactive and can be handled as any other individual 2 Highly radioactive and should be isolated as much as possible 3 Mildly radioactive but should be treated with routine safety precautions 4 Not radioactive but may still transmit some dangerous radiations and must be treated with precautions

3 Mildly radioactive but should be treated with routine safety precautions; An individual treated for a thyroid problem by intake of radioactive iodine (131I) becomes mildly radioactive, particularly in the region of the thyroid gland, which preferentially absorbs the iodine. Such clients should be treated with routine safety precautions for 48 hours (e.g., avoid prolonged contact or near-contact with others, flush toilet twice after using because radioactive iodine is excreted via the urine, and thoroughly wash hands after toileting). Because radioactive iodine is internalized, the client becomes the source of radioactivity. The amount of radioactive iodine used is not enough to cause high radioactivity.

Four hours after surgery the blood glucose level of a client who has type 1 diabetes is elevated. The nurse can expect to:

3 Give supplemental doses of regular insulin

A health care provider writes prescriptions addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client? 1 Decrease in eosinophils 2 Increase in lymphoid tissue 3 Restoration of electrolyte balance 4 Improvement of carbohydrate metabolism

3 Restoration of electrolyte balance

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse advise the client? 1 Skip the oral hypoglycemic pill, drink plenty of fluids, and rest. 2 Avoid food, drink clear liquids, take the daily medication, and stay in bed. 3 Take the oral medication, drink fluids, and monitor capillary glucose levels. 4 Delay taking the medication until tolerating food, and call the office the next day.

3 Take the oral medication, drink fluids, and monitor capillary glucose levels.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis . Which clinical findings related to this event should the nurse document in the client's clinical record? (Select all that apply.)

3 Acetone breath 5 Decreased arterial carbon dioxide level

A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T3 ) and thyroxine (T4 )? (Select all that apply.)

3 Weight gain 4 Cold intolerance

A client with type 1 diabetes mellitus has a finger stick glucose level of 258 mg/dL at bedtime. A prescription for sliding scale regular insulin (Novolin R) exists. What should the nurse do? 1 Call the health care provider. 2 Encourage the intake of fluids. 3 Administer the insulin as prescribed. 4 Give the client a half cup of orange juice.

3 Administer the insulin as prescribed.

A nurse is caring for a client with type 1 diabetes, and the health care provider prescribes one tube of glucose gel. What is the primary reason for the administration of glucose gel to this client?

3 Insulin-induced hypoglycemia

A nurse is collecting information about a client who has type 1 diabetes and is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? (Select all that apply.)

3. Excessive emotional stress 4. Running a fever with the flu

The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include? (Select all that apply.)

3. It can improve A1c levels 5. Clients can exercise without eating more carbohydrates

A client is taught how to recognize indications of a hypoglycemic reaction. Which signs and symptoms identified by the client indicate to the nurse that the teaching was effective? (Select all that apply.)

3. Weakness 4. Nervousness 6. Increased perspiration

A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. The nurse explains that:

A client had a thyroidectomy. The nurse monitors for thyrotoxic crisis, which is evidenced by:

A client is scheduled for a bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids?

A client who has type 1 diabetes is admitted to the hospital for major surgery. Before surgery the client's insulin requirements are elevated but well controlled. Postoperatively, the nurse anticipates that the client's insulin requirements will:

A client who was diagnosed recently with type 1 diabetes states, "I feel bad. I don't think I even want to go home. My spouse doesn't care about my diabetes." What is the most appropriate nursing response?

Which statement made by a 28-year-old client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 1 "I will need to have my eyes and vision examined once a year." 2 "I will need to check my blood sugar at home to evaluate my response to my treatment plan." 3 "I can improve metabolic and cardiac risk factors of this disease if I follow a low-calorie diet and lose weight." 4 "Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication to control my blood sugar."

4 "Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication to control my blood sugar."

The nurse is providing immediate postoperative care to a client who had a thyroidectomy. The nurse should monitor the client for which clinical manifestation? 1 Urinary retention 2 Signs of restlessness 3 Decreased blood pressure 4 Signs of respiratory obstruction

4 Signs of respiratory obstruction

The major nursing concern when caring for a client with the diagnosis of hyperthyroidism is: 1 Monitoring for hypoglycemia 2 Protecting visitors and staff from radiation exposure 3 Providing foods to increase appetite 4 Arranging for sufficient rest periods

4 Arranging for sufficient rest periods Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism . With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite.

A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor? 1 Ketonuria 2 Weight loss 3 Ketoacidosis 4 Low blood sugar

4 Low blood sugar Oral hypoglycemic agents decrease serum glucose levels that may precipitate hypoglycemia. Ketonuria occurs with insulin-dependent diabetes. Weight gain usually is noted in adult-onset diabetes. Ketoacidosis occurs with insulin-dependent diabetes.

A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states, "I will: 1 Cut my toenails before bathing." 2 Soak my feet daily for one hour." 3 Examine my feet using a mirror at least once a week." 4 Break in my new shoes over the course of several weeks."

4 Break in my new shoes over the course of several weeks." A slower, longer period of time to break in new, stiff shoes will help prevent blisters and skin breakdown. The toenails should be cut by a podiatrist; they usually are cut after a foot bath when the nails are softer. Soaking the feet daily for one hour will cause maceration of the skin and should be avoided. Examining the feet using a mirror at least once a week is too long a period of time; the client should examine the feet daily for signs of trauma.

A nurse is caring for a client who just returned from the postanesthesia care unit after having a thyroidectomy. Which action has priority during the first 24 hours after surgery when the nurse is concerned about thyroid storm? 1 Performing range-of-motion exercises 2 Humidifying the room air continuously 3 Assessing for hoarseness every two hours 4 Checking vital signs every two hours after they stabilize

4 Checking vital signs every two hours after they stabilize Checking vital signs helps detect complications such as thyrotoxic crisis, hemorrhage, and respiratory obstruction that may occur early in the postoperative period.

A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis? 1 Elevated serum calcium 2 Sudden drop in pulse rate 3 Hypothermia and dry skin 4 Rapid heartbeat and tremors

4 Rapid heartbeat and tremors

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. The nurse evaluates that the teaching was effective when the client says, "I should: 1 Massage my feet and legs with oil or lotion." 2 Apply heat intermittently to my feet and legs." 3 Eat foods high in protein and carbohydrate kilocalories." 4 Control my blood glucose with diet, exercise, and medication."

4 Control my blood glucose with diet, exercise, and medication."

A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. For what response should the nurse instruct the client to monitor in addition to nervousness and hunger? 1 Thirst 2 Nausea 3 Anorexia 4 Sweating

4 Sweating

After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client? 1 Serum osmolarity increases 2 Urine concentration decreases 3 Glomerular filtration decreases 4 Tubular reabsorption of water increases

4 Tubular reabsorption of water increases

A client's laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations should the nurse assess this client? (Select all that apply.)

4 Cardiac dysrhythmias 5 Hypoactive bowel sounds

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?

4 Hypernatremia

4,5

A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? (Select all that apply.)

4. Nervousness 5. Increased appetite

On the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports having a sore throat when swallowing. What should the nurse do first?

Administer analgesics as prescribed before meals. Analgesics as prescribed will reduce soreness during meals. Reordering the full-fluid diet is not within the legal role of the nurse. Soreness is to be expected;

A client had a thyroidectomy. The nurse monitors for thyrotoxic crisis, which is evidenced by:

An increased temperature and pulse rate

Ask the client to ingest one tube of glucose gel

For which client response should the nurse monitor when assessing for complications of hyperparathyroidism?

Bone pain

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis?

Breakdown of fat stores for energy; In the absence of insulin , which facilitates the transport of glucose into cells, the body breaks down proteins and fats to supply energy; ketones, a by-product of fat metabolism, accumulate, causing metabolic acidosis (pH below 7.35)

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which should the nurse expect the health care provider to prescribe?

Calcium

Calcium gluconate

A client's problem with ineffective control of type 1 diabetes is pinpointed as a sudden decrease in blood glucose level followed by rebound hyperglycemia. What should the nurse do when this event occurs?

Collaborate with the health care provider to alter the insulin prescription

A health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the antithyroid medication, the client calls the nurse and complains of feeling tired and looking pale. What should the nurse do?

Correct 2 Schedule the client for an appointment

A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription?

Drugs to increase the blood pressure

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, "I should call my health care provider if I develop:

Dry hair and an intolerance to cold."

The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). The nurse includes measures to increase arterial blood flow to the extremities, including:

Exercises that promote muscular activity

Fatigue

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?

Glucose level

A client has a glycosylated hemoglobin measurement of 6%. What should the nurse conclude about this client when planning a teaching plan based on the results of this laboratory test?

Has followed the treatment plan as prescribed; The expected range of glycosylated hemoglobin (HbA1c ) is 4.4% to 6.4%. A value of 6% is within the expected range. Glycosylated hemoglobin measures the average blood glucose level for the 90- to 120-day period before the blood sample is collected; thus, it is a reliable way to measure adherence to a therapy plan of insulin, diet, and exercise

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?

Hyperplasia of the adrenal cortex

At 4:30 PM, a client who is receiving human insulin (Humulin N) every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing?

Hypoglycemia

A nurse is caring for a client who was admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder?

Hypoglycemia and hypotension

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse expects that manifestations of excessive levels of antidiuretic hormone are:

Hyponatremia and decreased urine output

A client is diagnosed as having type 2 diabetes. A priority teaching goal is, "The client will be able to:

Identify pending hypoglycemia or hyperglycemia. Knowledge of the signs and treatment for hypoglycemia or hyperglycemia is critical to client health and well-being and essential for survival.

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?

Increased serum lipids; With diabetic ketoacidosis serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy.

A client with diabetes asks how exercise will affect insulin and dietary needs. The nurse should respond, "Exercise:

Increases the need for carbohydrates and decreases the need for insulin."

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug:

Interferes with the synthesis of thyroid hormone

An obese client must self-administer insulin at home. The nurse should teach the client to use what technique?

Spread the tissue and inject at a 90-degree angle

A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis?

Rapid heartbeat and tremors; Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe?

Regular insulin (Novolin R) Regular insulin is rapid-acting and should be used for diabetic coma

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, the nurse should teach the client to:

Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone

The nurse is counseling a client with type 1 diabetes about the client's favorite foods that are lowest in carbohydrates (CHO). The nurse determines that this concept is understood when the client chooses eight ounces of:

Skim milk Skim milk contains about 12 grams of CHO per cup. There are about 30 grams CHO in 1 cup of apple juice. There are about 16 grams CHO in 1 cup of nonfat yogurt. There are about 25 grams CHO in 1 cup of orange juice

A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide:

Stimulates the pancreas to produce insulin

A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease?

Stress response; Because of diminished glucocorticoid production, there is a decreased response to stress, reducing the ability to fight an infectious process.

A client is scheduled to have a thyroidectomy for cancer of the thyroid. Preoperative instructions for the postoperative period include teaching the client to:

Support the head with the hands when changing position

Supports a better response to stress Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus, it enables the body to adapt to stress.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." On the basis of this statement, the nurse's best action is to:

Test for Chvostek's and Trousseau's signs and notify the health care provider of the complaints. These symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy. Physical assessment and notification of the health care provider are the priorities.

A nurse is caring for a client who just had a thyroidectomy. For which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?

Tetany; Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death.

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response?

The tumor must be removed to prevent heart and kidney damage.

The tumor must be removed to prevent heart and kidney damage. Renal and cardiac complications will occur if hypertension caused by the tumor is not arrested. Aldosteronomas are benign tumors; metastasis is not possible.

A nurse is preparing to administer insulin to a client with diabetes. In which order should the nurse perform the actions associated with insulin administration? 1. Wipe the top of the insulin vial with an alcohol swab 2. Wash hands with soap and water 3. Rotate the vial of insulin between the palms of the hands 4. Withdraw the correct amount of insulin from the inverted vial 5. Instill air into the vial of insulin equal to the desired dose

Washing the hands prevents cross contamination. Rotating the insulin vial distributes the drug evenly throughout the vial. Wiping the seal on the insulin vial prevents contamination of the needle and the fluid. Instilling air into the vial increases the pressure in the closed space so that the correct amount of fluid finally can be withdrawn.

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? (Select all that apply.)

Wear shoes when out of bed; and Dry between the toes after bathing

Which is the best advice the nurse can give regarding foot care to a client diagnosed with diabetes?

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