NCLEX 10000 ENDOCRINE AND METABOLIC
A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily." Which response by the nurse would give the client the most accurate explanation of this behavior?
"Your behavior is caused by the excess thyroid hormone in your system."
The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? Record your answer using a whole number.
32
On a medical-surgical floor, a nurse is caring for a cluster of clients with diabetes mellitus. Which client should the nurse assess first?
A 55-year-old complaining of chest pressure
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:
Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."
Which indicates that the client with diabetes insipidus understands how to manage care?
The client will maintain normal fluid and electrolyte balance.
A client is admitted with advanced hepatic failure, including symptoms of fatigue and confusion. These symptoms are likely due to which of the following?
The liver is not breaking down the ammonia, and it acts as a neurotoxin on the brain.
A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes?
To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications"
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:
a blood pressure of 176/88 mm Hg.
Assessment of the diabetic client for common complications should include examination of the:
eyes
Levothyroxine 0.2 mg orally has been prescribed for a client diagnosed with hypothyroidism. The nurse has available 0.05-mg tablets. How many tablets should the nurse prepare to give the client?
four tab
A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to:
increase the frequency of self-monitoring (blood glucose testing).
A priority in the first 24 hours after a bilateral adrenalectomy is
preventing adrenal crisis
A priority in the first 24 hours after a bilateral adrenalectomy is:
preventing adrenal crisis.
Clients with diabetes mellitus require frequent vision assessment. The nurse should instruct the client about which vision problem most likely to be associated with diabetes mellitus?
retinopathy
Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect?
with each meal and snack
The nurse is evaluating a client with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which statement from the client indicates the drug is effective?
"I am able to sleep and rest at night."
A nurse working in a community clinic is discussing lifestyle modifications with a client. The client has been advised to lose weight because of a BMI greater than 25. Which of the following statements by the nurse would be most therapeutic in helping the client?
"I can offer you some information outlining a variety of ways to lose weight."
A client with diabetes is explaining to the nurse how he cares for the feet at home. Which statement indicates the client needs further instruction on how to care for the feet properly?
"I inspect my feet once a week for cuts and redness."
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?
"I may stop taking this medication when I feel better."
The nurse is assessing a client with hepatitis A and notices that the aspartate transaminase (AST) and alanine transaminase (ALT) lab values have increased. Which statement by the client indicates the need for further instruction by the nurse?
"I take acetaminophen for arthritis pain."
When educating the client with type 1 diabetes, the nurse knows that the client needs more education when he or she says:
"I will be able to switch to insulin pills when my sugar is under control."
A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse?
"I will increase fiber and fluids in my diet."
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?
"I will increase my fluid and calcium intake."
A nurse is teaching a client about how to recognize when treatment for hypothyroidism is effective. Which of the following statements from the client would indicate that the nurse's teaching has been effective?
"I will start feeling more energetic."
A client recently diagnosed with hyperparathyroidism demands to see what the physician has written about him in the chart. What is the nurse's best response?
"I'll get the chart and set up a time for you to review it with your physician."
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?
"I'll stay here with you while the technician draws your blood."
Which statement indicates that a client with diabetes mellitus understands proper foot care?
"I'll wear cotton socks with well-fitting shoes.
A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is:
"I'm going to give your son some insulin. Then I'll be happy to talk with you."
A client with diabetes is explaining to the nurse how to care for the feet at home. Which statement indicates that the client understands proper foot care?
"It is important to dry my feet carefully after my bath.
A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating:
"It tells us about your sugar control for the last 3 months."
A client with diabetes mellitus comes to the clinic for a regular 3-month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I am so clumsy. I am always cutting my finger cooking or burning myself on the iron." Which response by the nurse would be most appropriate?
"Keep all cuts clean and covered."
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?
"Maintain a moderate exercise program."
The client newly diagnosed with type 1 diabetes mellitus eats a lot of pasta products, such as macaroni and spaghetti, and asks if they can be included in the diet. The nurse should tell the client:
"Pasta can be a part of your diet. It is included in the bread and cereal exchange."
A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?
"Rotate injection sites within the same anatomic region, not among different regions."
The laboratory comes to draw an Hgb AIc. The client asks the nurse what this test represents. Which statement would be correct?
"This test reflects the average blood glucose over a period of approximately 2-3 months.
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?
"What exactly do you mean by wanting 'everything' done for you?"
A client with diabetes begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day." What would be the best response by the nurse?
"What is it about giving yourself the insulin shots that bothers you?"
The health care provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. The nurse should tell the client:
"You do not mix insulin detemir; the solution is clear." Explanation:
A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents?
"Your child will need less blood work as his glucose levels stabilize."
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.
0.1
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer:
15 to 20 g of a fast-acting carbohydrate such as orange juice.
A nurse is about to administer a client's morning dose of insulin. The client's order is for 5 units of regular insulin and 10 units of NPH (neutral protamine Hagedorn) insulin given as a basal dose. The client also is to receive an amount prescribed from the medium-dose sliding scale (shown image) based on morning blood glucose levels. The nurse performs a bedside blood glucose measurement and the result is 264 mg/dL (264 mmol/L). How many total units of insulin would the nurse administer to the client? Record your answer using a whole number.
21
A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.
5
The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia?
59 mg/dL (3.3 mmol/L)
Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?
70% NPH insulin and 30% regular insulin
The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. Which of the following would be expected findings?
Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet
Which health promotion activity should the nurse to suggest that the client with cirrhosis add to the daily routine at home?
Abstain from drinking alcohol.
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?
Acromegaly
The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for Hydrocortisone 100 mg intravenously at a rate of 10 cc/hour for a client in acute adrenal crisis. The nurse is most correct to understand that this treatment is common in clients with which disease process?
Addison's disease
Priority nursing care for a client in addisonian crisis should include which intervention(s)? Select all that apply.
Administer IV hydrocortisone sodium succinate as ordered Administer IV dextrose and insulin as ordered to decrease serum potassium level Administer IV glucose and glucagon as proscribed, and monitor blood glucose levels
A nurse obtained a client's fasting blood sugar (FBS) at 0700, which was 144 mg/dL (8 mmol/L). The client has an order for regular insulin 8 units every morning. What should the nurse do next?
Administer the insulin as ordered.
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?
Administering 1 ampule of 50% dextrose solution, per physician's order
Which instruction about insulin administration should a nurse give to a client?
Always follow the same order when drawing the different insulins into the syringe."
What is the most common cause of hyperaldosteronism?
An adrenal adenoma
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse
A client is diagnosed with diabetic ketoacidosis. Which of the following findings would the nurse anticipate?
Arterial pH 7.33
A nurse is caring for a client with advanced cirrhosis. Upon assessment, the nurse notes pallor with a distended and firm abdomen. What is the most likely cause?
Ascites increasing significantly due to hypoalbuminemia
The nurse develops a teaching plan for the client about how to prevent the transmission of hepatitis A. Which discharge instruction is appropriate for the client?
Ask family members to wash their hands frequently.
A nurse records a client's finger stick blood glucose level and gives 2 units of regular insulin as ordered. At the next scheduled blood glucose assessment, the nurse realizes that he/she previously tested and administered the insulin to the wrong client. What is the nurse's priority action related to this incident?
Assess both clients and call the appropriate physicians to notify them of the errors.
A client's 1200 blood glucose was inaccurately documented as 310 mg/dL (17.2 mmol/L) instead of 130 mg/dL (7.2 mmol/L). This error was not noticed until 1300. The nurse administered the sliding scale insulin for a blood glucose of 310 mg/dL (17.2 mmol/L). What should the nurse do first?
Assess for hypoglycemia.
The nurse is caring for a client with type 2 diabetes who has been admitted with hyperglycemia. What is the most important consideration when developing a teaching plan for this client?
Assess what the client already knows, then identify learning needs.
The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
Bicarbonate
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl (61.05 mmol/L)
A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?
Calibrating the machine after installing a new battery
On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 0600 glucose level is 300 mg/dL (16.7 mmol/L). What should the nurse do?
Call the health care provider (HCP) for specific prescriptions based on the glucose level.
A nurse is teaching a client about insulin infusion pump use. What intervention(s) should the nurse include to prevent infection at the injection site? Select all that apply.
Change the needle every 3 days. Use sterile techniques when changing the needle . Cleanse the skin at the insertion site for 15 seconds using alcohol.
During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should:
Check with the physician for his complete order.
A nurse should expect to administer which medication to a client with gout?
Colchicine
A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms?
Coma, anxiety, confusion, headache, and cool, moist skin
Upon shift report, the nurse learns the following laboratory values: pH, 7.44; PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance is the client most likely experiencing?
Compensated respiratory alkalosis
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?
Cortisol levels before and after the system is challenged with a synthetic steroid
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. The nurse knows that this may be the result of what complication of the surgery?
Damage to the parathyroid glands
The nurse is conducting an assessment of an elderly client who is blind. Which of the following would the nurse expect to be present in the medical history?
Diabetes mellitus
A nurse observes a second nurse documenting a peripheral blood glucose level that the second nurse did not actually collect from a client with diabetes. What is the priority action by the nurse observing this situation?
Discuss the observation with the other nurse.
A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, a problem that was accompanied by a random blood glucose reading of 31.9 mmol/L (575 mg/dL), vomiting, and shortness of breath. This client has experienced which of the following phenomena?
Exacerbation
A nurse should perform which intervention for a client with Cushing's syndrome?
Explain that the client's physical changes are a result of excessive corticosteroids.
A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?
Glucagon
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose?
Goiter
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?
Have regular follow-up care.
A nurse hears a staff member giving incorrect information to the family of a client newly diagnosed with diabetes mellitus who is being discharged to home. The nurse wants to make sure the family has the proper information before the client is discharged. What should she do?
Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity.
A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply.
High-fiber, low-calorie diet Use of stool softeners Thyroid hormone replacements
The client, a 56 year old woman, has just undergone a left adrenalectomy for pheochromocytoma. Which postoperative complication should be the nurse's priority concern?
Hypertension
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?
Hypocalcemia
The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for:
Hypoglycemia.
Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?
Hypokalemia and hypoglycemia
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
Which of the following results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism?
Increased energy, weight loss, and a higher temperature and pulse rate
A client with diabetes is found unconscious after the morning dose of insulin. What would be a priority nursing intervention at this time?
Initiating treatment for hypoglycemia as a result of insulin
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?
Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
What important considerations would the nurse make when teaching and caring for a newly diagnosed client with diabetes mellitus?
Involving the client in the development of the teaching plan and encouraging questions and active participation
A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test?
It determines the average blood glucose level in the previous 2-3 months.
A client with diabetes mellitus comes to the clinic for a regular 3-month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I am so clumsy. I am always cutting my finger cooking or burning myself on the iron." Which response by the nurse would be most appropriate?
Keep all cuts clean and covered."
The nurse is caring for a client in a diabetic coma. The nurse is aware that this is caused by an excess of which substance in the blood?
Ketones from rapid fat breakdown, causing acidosis
The nurse is teaching a client who is taking insulin about the signs of diabetic ketoacidosis, which include:
Kussmaul's respirations.
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
Levothyroxine
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?
Lungs and kidneys
Which intervention is the most critical for a client with myxedema coma? :
Maintaining a patent airway
The nurse is caring for a client following a motor vehicle incident with head trauma suspected of diabetes insipidus. Which nursing intervention is appropriate?
Measure and record urinary output.
During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?
Metabolic acidosis
A 75-year-old client who complains of a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for what acid-base imbalance?
Metabolic alkalosis
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
Metabolic alkalosis
A client is receiving dopamine hydrochloride for treatment of shock. What action should the nurse take?
Monitor blood pressure continuously.
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?
Nervousness, diaphoresis, and confusion
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.
Numbness Tingling Muscle twitching and spasms
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
A client with type I diabetes mellitus is scheduled to have surgery. The client has been nothing-by-mouth (NPO) since midnight. In the morning, the nurse notices the client's daily insulin has not been prescribed. Which action should the nurse do first?
Obtain the client's blood glucose at the bedside.
A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus?
Obtaining, reporting, and documenting fingerstick glucose levels
Nursing care for a client in Addisonian crisis should include which intervention?
Placing the client in a private room
A child with type 1 diabetes is admitted to the emergency department with hot and dry skin, rapid and deep respirations, and a fruity odor to her breath. Which task, when performed by a new-graduate registered nurse (RN), requires the RN preceptor to intervene?
Providing encouragement to the child to drink some orange juice.
Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement?
Rapid weight gain.
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl (26.1 mmol/L). Which finding is most likely to accompany this blood glucose level?
Rapid, thready pulse
While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that she forgot to administer insulin to client with diabetes mellitus. She's made numerous errors in the past few weeks and is now afraid her job is in jeopardy. What is her best course of action?
Report the error, complete the proper paperwork, and meet with the unit manager.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
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?
Restricting fluids to 800 ml/day
A client with type 1 diabetes takes 15 units of insulin isophane before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when she discovers the client takes which over-the-counter preparations?
Salicylate-containing preparations
A client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases?
Serum bicarbonate of 28 mEq/L
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?
Serum osmolarity
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias?
Serum potassium level
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
Sweating, tremors, and tachycardia
A nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, thyroxine (T4), and calcitonin.
A nurse is caring for a client who is being discharged after a thyroidectomy. Which discharge instructions would be appropriate for this client? Select all that apply.
Take thyroid replacement medication as ordered. Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin, and report these changes to the physician.
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?
Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?
They increase the need for insulin.
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?
Thyroid crisis
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set
A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:
Trousseau's sign.
A client newly diagnosed with type 1 diabetes asks the nurse, "Why do I have to take two shots of insulin? One shot is not enough?" The nurse should tell the client:
Two shots will give you better control and decrease complications."
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?
Weight reduction through diet and exercise
A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?
You may not be able to use desmopressin nasally if you have nasal discharge or blockage."
During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
You must avoid hyperextending your neck after surgery."
A coworker asks another nurse if a client received their pathology report. The coworker is not directly involved in the care of the client. How should the nurse respond? Select all that apply.
You need to review the hospital policy related to client privacy." "I can't give you that information." "Client information can only be shared with those who are involved in the care."
A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily." Which response by the nurse would give the client the most accurate explanation of this behavior?
Your behavior is caused by the excess thyroid hormone in your system."
The nurse should review the glucose level of which clients who are going to surgery today? Select all that apply.
a client with diabetes mellitus controlled by diet a client with a high stress response to surgery a client receiving corticosteroids for the past 3 months
For a client with hyperthyroidism, treatment is most likely to include:
a thyroid hormone antagonist.
A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs?
abdomen
A client with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should:
administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning.
Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease?
an abnormality in the body's mucus-secreting glands
A client with diabetes has been diagnosed with hypertension, and the health care provider (HCP) has prescribed atenolol, a beta-blocker. When performing discharge teaching, it is important for the nurse to emphasize that the addition of atenolol can cause:
an increase in the hypoglycemic effects of insulin.
A client is admitted to the medical unit with complaints of extreme fatigue and chest pain. An electrocardiogram has ruled out any cardiac involvement and laboratory work indicates that the client is experiencing severe hypothyroidism. As the nurse interviews him, the client states that he has been feeling very sad and depressed about the changes in his body and wonders if there's any reason to go on. The nurse should:
ask if the client has thought about wanting to harm himself.
After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide:
at breakfast.
When teaching the diabetic client about foot care, the nurse should instruct the client to:
avoid going barefoot.
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?
blood glu
Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy?
calcium gluconate
An elderly client with type 2 diabetes had hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent:
cerebral edema.
A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluids would be most appropriate?
chicken broth and juice
A client with diabetes mellitus asks the nurse to recommend something to remove corns from his toes. The nurse should advise the client to:
consult a health care provider (HCP) about removing the corns.
Which indicator is the best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement?
daily weight
The nurse should assess the client with hypothyroidism for:
decreased activity due to fatigue.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for
decreased body temperature and cold intolerance.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:
decreased body temperature and cold intolerance.
A 34-year-old female is diagnosed with hypothyroidism. What should the nurse assess the client for? Select all that apply.
decreased energy and fatigue weight gain of 10 lb (4.5 kg) constipation menorrhagia
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:
deposits of adipose tissue in the trunk and dorsocervical area.
The nurse caring for a client with diabetes realizes that the client has a higher risk of developing cataracts and should also assess the client for indications of:
diabetic retinopathy.
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of:
fresh fruits
Using a sliding-scale schedule, the nurse is preparing to administer an evening dose of regular insulin to a client who is receiving total parenteral nutrition (TPN). The nurse should base the dosage on the:
glucometer reading of the client's glucose level obtained immediately before administering the insulin.
The nurse who is caring for a client with type 1 diabetes mellitus should use which report to determine how well the insulin, diet, and exercise are balanced?
glycosylated hemoglobin leve
A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:
glycosylated hemoglobin level.
Before supper, an adult client who has type-2 diabetes and requires insulin tells the nurse about having tremors, being weak and anxious. The nurse should
have the client drink a glass of milk or orange juice.
Before supper, an adult client who has type-2 diabetes and requires insulin tells the nurse about having tremors, being weak and anxious. The nurse should:
have the client drink a glass of milk or orange juice.
The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation when?
having oral surgery
For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate:
hypocalcemia.
The health care provider (HCP) instructs a client with alcohol-induced cirrhosis to stop drinking alcohol. The expected outcome of this intervention is:
improved liver function.
Vasopressin is administered to the client with diabetes insipidus because it:
increases tubular reabsorption of water.
When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should:
inject air in the vial with the long-acting insulin first.
Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The nurse does this to monitor for signs of:
laryngeal nerve damage.
A client asks the nurse how long it will be necessary to take the medicine for hypothyroidism. The nurse's response is based on the knowledge that:
lifelong daily medicine is necessary.
Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, the nurse should recommend that the client:
maintain a regular program of weight-bearing exercise.
To reduce the risk of developing type 2 diabetes mellitus the nurse should instruct the client to:
maintain weight in normal limits.
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:
most likely related to low thyroid hormone levels and will improve with treatment.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:
myxedema coma.
Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza?
obtaining adequate food intake
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:
offer to assist with the discharge teaching needs.
The nurse is reviewing the postoperative prescriptions (see chart) just written by a health care provider (HCP) for a client with type 1 diabetes who has returned to the surgery floor from the recovery room following surgery for a left hip replacement. The client has pain of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. After obtaining the client's glucose level, the nurse sho
ontact the health care provider (HCP) to rewrite the insulin prescription.
To confirm an acid-base imbalance, it is necessary to assess which findings from the results of a client's arterial blood gas (ABG) results? Select all that apply.
pH PaCO2 HCO3
When evaluating a client's arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH 7.48
A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to:
perform a tracheotomy.
The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:
perform the procedure safely and correctly.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
phosphorus
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:
protruding eyes and a fixed stare.
A nurse should expect a client with hypothyroidism to report:
puffiness of the face and hands.
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:
rapid-acting insulin only.
The nurse notes grapefruit juice on the breakfast tray of a client taking repaglinide. The nurse should:
remove the grapefruit juice from the client's tray and bring another juice of the client's
To provide oral hygiene for a client recovering from transsphenoidal hypophysectomy, the nurse should instruct the client to:
rinse the mouth with saline solution.
A client is admitted with severe abdominal pains and the diagnosis of acute pancreatitis. The nurse should develop a plan of care during the acute phase of pancreatitis that will involve interventions to manage:
severe pain
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:
sodium and potassium abnormalities.
The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes?
steroids
After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. The expected outcome of these injections is:
stimulated protein metabolism.
The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. The nurse should assess this client for:
tachycardia.
The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. Teaching regarding the use of these medications is effective if the client will take:
the levothyroxine before breakfast and the other medications 4 hours later.
A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the:
upper gingival mucosa in the space between the upper gums and lip.
After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to:
use relaxation techniques such as music.
When caring for a client with diabetes insipidus, the nurse expects to administer:
vasopressin.
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and:
vitamin D.
A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat:
within 10 to 15 minutes after the injection
A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat
within 10 to 15 minutes after the injection.
The nurse is receiving results of a blood glucose level from the laboratory over the telephone. The nurse should:
write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller.
