Endocrine Flashcards
A nurse is caring for a male Muslim client. The nurse and the provider discuss the importance of having a male provider care for the client. This discussion represents which of the following foundational critical care competencies?
a. The ability to collaborate as a team member
b. The ability to act as a charge nurse
c. The ability to insert an endotracheal tube
d. The ability to precept another nurse
a. The ability to collaborate as a team member
The ability to work in a team is an important foundational competency for a critical care nurse.
A nurse is assisting in the care of a client who has manifestations of hyperosmolar hyperglycemic syndrome (HHS).
Complete the following sentence by using the lists of options.
Diagnostic Results
Today, 1030:
Chest x-ray results indicate pneumonia in right lower lobe.
Nurses’ Notes
Yesterday, 1200:
Client alert and oriented to person, place, and time. Lungs clear to auscultation. S1, S2, no murmur. Abdomen soft, nontender, bowel sounds present in all 4 quadrants. Skin color appropriate for race and ethnicity, moist mucous membranes.
Today, 0945:
Client to transfer from medical surgical unit to critical care unit. Client lethargic and not oriented to person, place, or time. Lung fields demonstrate crackles in right lower lobe. S1, S2, no murmur. Abdomen soft, slightly distended, nontender, bowel sounds present in all 4 quadrants. Skin pale, dry mucous membranes.
1020:
Transferred to critical care unit. Client lethargic and not oriented to person, place, or time. Lung fields demonstrate crackles in right lower lobe. S1, S2, no murmur. Abdomen soft, slightly distended, nontender, bowel sounds present in all 4 quadrants. Skin pale, dry mucous membranes.
Vital Signs
Yesterday, 0900:
Blood pressure 106/78 mm Hg
Heart rate 88/min
Respiratory rate 14/min
Temperature 37° C (98.6° F)
Oxygen saturations 97% on room air
Today, 1030:
Blood pressure 101/72 mm Hg
Heart rate 112/min
Respiratory rate 20/min
Temperature 37.9° C (100.2° F)
Oxygen saturation 95% on room air
Laboratory Results
Yesterday, 0900:
Serum glucose 404 mg/dL (74 to 106 mg/dL)
Today, 0900:
Serum glucose 675 mg/dL (74 to 106 mg/dL)
Ketones: present in urine (none)
The nurse should anticipate prescriptions for __________________ and _______________.
When generating solutions for a client who is experiencing hyperosmolar hyperglycemic syndrome (HHS), the nurse should anticipate a prescription for a large-bore IV catheter, such as a 16-gauge or 18-gauge for administration of an isotonic solution such as 0.9% sodium chloride IV 15 mL/kg over 1 hr. Clients who are experiencing HHS should receive an initial IV infusion of isotonic fluids such as 0.9% sodium chloride to increase intravascular volume, and many clients who have HHS respond favorably to isotonic fluids alone without administration of IV insulin.
A nurse is reinforcing teaching about exercise with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
a. “I will carry a complex carbohydrate snack with me when I exercise.”
b. “I should exercise first thing in the morning before eating breakfast.”
c. “I should avoid injecting insulin into my thigh if I am going to go running.”
d. “I will increase the intensity of my exercise routine if my urine is positive for ketones.”
c. “I should avoid injecting insulin into my thigh if I am going to go running.”
The nurse should reinforce that the client should avoid injecting insulin into an area that will soon be exercised to avoid increasing the absorption rate of the insulin.
A nurse is reinforcing teaching about the manifestations of hyperglycemia with a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
a. “I might experience blurry vision at times.”
b. “I will be more thirsty than usual.”
c. “My breath may have a fruity odor.”
d. “My appetite will be decreased.”
b. “I will be more thirsty than usual.”
This statement indicates the client understands the teaching as increased thirst is a manifestation of hyperglycemia.
A nurse is providing care for an older adult client who has diabetes insipidus (DI). The nurse should monitor the client for which of the following neurologic effects?
a. Dilute urine
b. Poor skin turgor
c. Ataxia
d. Hypotension
c. Ataxia
Ataxia (uncoordinated gait) is a neurologic effect of DI and includes increased thirst and, if dehydration persists or worsens, irritability and decreased cognition.
A nurse is reinforcing teaching with a client who has neutropenia. Which of the following instructions should the nurse include in the teaching?
a. Eat plenty of fresh fruits and vegetables. b. Avoid crowded places.
c. Participate in gardening for mild exercise.
d. Take temperature weekly.
b. Avoid crowded places.
The nurse should inform the client to avoid crowds due to a suppressed immune system.
The nurse is evaluating the effectiveness of diabetic management education with a client who had been recently diagnosed with type 2 diabetes mellitus.
Plan of Care
3 months ago:
History of hypertension, hyperlipidemia, obesity, metabolic syndrome
Initiate metformin 500 mg po twice daily. Referral to diabetic education nurse for client education on blood glucose monitoring, nutrition, and exercise. Follow-up in 3 months.
Laboratory Results
3 months ago:
Random blood glucose 297 mg/dL (74 to 106 mg/dL)
Glycosylated hemoglobin 8.2% (4% to 5.9%)
Nurses’ Notes
3 months ago:
Diabetic education session/nutrition consult
Education provided to client:
Demonstration of insulin administration
Discussion of use of a sliding scale, dosing, and schedule of ordered doses.
Etiology and pathophysiology of the disorder
Food journaling
Foot care and other diabetes preventative care
How to count carbs; long-term effects of uncontrolled diabetes (neuropathy, blindness, peripheral artery disease (PAD), cardiac/renal disease)
Expected labs and necessary follow-up appointments with endocrinologist
Clinical manifestations of hypoglycemia and hyperglycemia
When to seek emergency medical attention
Today:
Client reports the following:
“I got myself a medical alert bracelet to wear (shows nurse the bracelet on their wrist).”
“I hope that one day I can stop using insulin and maintain this with proper diet and exercise.”
“I can eat as many carbs as I want, I just need to adjust my sliding scale insulin when I do so.”
“If I am feeling sick and cannot eat, I may need to adjust or hold my insulin, so I do not let my sugar go too low.”
“I only need to check my blood sugar when I am symptomatic.”
Assessment
3 months ago:
Neuro: Alert and oriented x3; complains of occasional blurred vision for the last 3 months or so
Cardiac: S1S2 present; regular; capillary refill of 3 seconds
Respiratory: Lung sounds clear x5 lobes
Abdomen: Rounded, soft, non-tender; bowel sounds absent
Extremities: All extremities warm, pulse sites +2 (radial, pedal)
Client still reporting increased thirst, drinking 12 glasses of water and diet soda daily, and frequent urination, especially at night (client reports waking up multiple times throughout the night).
Weight 143.6.kg (315.9 lb)
Today:
Neuro: Alert and oriented x3; complains of occasional blurred vision for the last 3 months or so
Cardiac: S1S2 present; regular; capillary refill of 3 seconds
Respiratory: Lung sounds clear x5 lobes
Abdomen: Rounded, soft, non-tender; bowel sounds absent
Extremities: All extremities warm, pulse sites, regular, +2 (radial, pedal)
Skin: 2-inch laceration noted on sole of left foot near big toe; client was unaware of this wound; sensation diminished in toes in both extremities
Client reports increased thirst, drinking 12 glasses of water and soda daily, and frequent urination, especially at night (client reports continuing to wake up multiple times throughout the night).
Select the “3” education topics requiring further teaching.
a. Medical alert bracelet
b. Foot care
c. Sick day alterations
d. Insulin dosing for increased carbohydrate intake
e. Frequency of blood sugar monitoring
b. Foot care
d. Insulin dosing for increased carbohydrate intake
e. Frequency of blood sugar monitoring
When evaluating outcomes of client education, the nurse must identify key aspects of client knowledge and understanding in regard to health care management in order to determine if further teaching is necessary. The client demonstrated adequate understanding of the need for a medical alert bracelet and that times of illness may require an alteration in insulin dosing. The client did not understand that increasing insulin doses just to take in as many carbohydrates as they wanted can increase obesity and other obesity-related diseases. Additionally, the client did not understand that they will need to monitor their blood glucose levels daily (before meals and at bedtime) instead of just when they experience symptoms of hypo- or hyperglycemia, when it may be too late. Furthermore, the client is likely not performing daily foot care since they were unaware of the laceration on their foot due to decreased sensation in their toes.
A nurse is assisting with the care of a client who is undergoing his initial peritoneal dialysis treatment. Which of the following findings is the nurse’s priority?
a. Dialysate inflow causing discomfort
b. Blood-tinged dialysate during outflow
c. Dialysate leakage during inflow
d. Purulent dialysate outflow
d. Purulent dialysate outflow
When using the urgent vs. nonurgent approach to client care, the nurse determines that the priority finding for this client is purulent dialysate outflow. Peritonitis is an inflammation of the peritoneum and a major complication of peritoneal dialysis. Manifestations of peritonitis include cloudy dialysate outflow, fever, nausea, and vomiting. If untreated, the client can become severely ill, progressing to bacterial septicemia and hypovolemic shock. Peritonitis can be prevented with meticulous site care. The nurse and client should wear a mask when accessing the catheter. Strict aseptic technique should be used when connecting and disconnecting the catheter.
A nurse is reviewing the plan of care for a client being discharged to home following radioactive iodine (radioiodine) therapy. Which of the following interventions should the nurse initiate?
a. Information on reducing risk of exposure to others
b. Instruction on management of the wound
c. Instructions on monitoring for the signs/symptoms of hypocalcemia
d. Education on thyroid storm symptoms
a. Information on reducing risk of exposure to others
Radioiodine therapy requires implementation of radiation safety measures. The nurse provides instruction to the client on how to reduce the risk of exposure to others before being discharged home.
A nurse is caring for a female client.
Physical Examination
Client reports an increase in appetite and a 3.6-kg (8-lb) weight loss over a 4-week period. Client has bilateral exophthalmos and reports blurred vision.
Client reports heart palpitations, apical heart rate is rapid and regular.
Client reports two to three bowel movements per day, increased fatigue, difficulty concentrating, and insomnia.
Vital Signs
Temperature 38.1° C (100.6° F)
Blood pressure 168/70 mm Hg
Heart rate 110/min
Respiratory rate 24/min
Oxygen saturation 95% on room air
Diagnostic Results
Fasting blood glucose 150 mg/dL (expected reference range 70 to 110 mg/dL)
Serum T3 220 ng/dL (expected reference range 70 to 205 ng/dL)
Serum T4 (total) 20 mcg/dL (expected reference range 5 to 12 mcg/dL)
Hct 38% (expected reference range 37% to 47%)
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to collect data about the client’s progress.
The nurse should offer the client a diet high in calories and provide a calm environment for the client because the client is most likely experiencing hyperthyroidism. The nurse should monitor the client’s T3 and T4 to identify worsening of the client’s hyperthyroidism and check the client’s temperature and blood pressure frequently to monitor for manifestations of thyroid storm.
A nurse is contributing to the plan of care of a client who has acute pancreatitis. Which of the following interventions should the nurse include in the plan?
a. Provide frequent small snacks.
b. Ambulate the client twice daily.
c. Monitor urine output hourly.
d. Encourage deep breathing and coughing every 2 hr.
c. Monitor urine output hourly.
The nurse should recognize that the client who has pancreatitis is at increased risk for acute kidney injury resulting from decreased cardiac output. This manifests as a urine output of less than 30 mL/hr, which should be reported to the provider.
A nurse is caring for a client who has hyperparathyroidism. Based on this diagnosis, the nurse should monitor the client for which of the following complications?
a. Impaired skin integrity
b. Fluid retention
c. Pathologic fractures
d. Dysphagia
c. Pathologic fractures
Hyperparathyroidism results in the release of calcium and phosphate into the blood, which decreases bone density and places the client at risk for pathologic fractures.
A nurse is reinforcing teaching to a graduating nurse about fluid volume deficit. Which of the following concepts about water balance should the nurse explain to the graduating nurse?
a. A negative fluid balance occurs when the body takes in more water than the body needs.
b. The intracellular space contains most of the body’s water.
c. A fluid volume deficit inhibits baroreceptors.
d. When the body loses water, the intracellular space experiences the water loss.
b. The intracellular space contains most of the body’s water.
The intracellular space contains most of the total body water (TBW) and, as such, is prone to experiencing the greatest water deficit.
A nurse is reinforcing teaching for a client who has type 1 diabetes mellitus about foot care. Which of the following client statements should indicate to the nurse an understanding of the instructions?
a. “I’ll wear sandals in warm weather.”
b. “I’ll put lotion between my toes.”
c. “I’ll check my feet every day for sores and bruises.”
d. “I’ll soak my feet in warm, soapy water every night before I go to bed.”
c. “I’ll check my feet every day for sores and bruises.”
The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see.
A nurse is reinforcing teaching with a group of clients about common findings that can indicate cancer. The nurse should instruct the clients to monitor for and report which of the following findings? (Select all that apply.)
a. Nagging cough
b. Unilateral calf tenderness
c. A nonhealing sore
d. Change in bowel pattern
e. Unintended weight gain
a. Nagging cough
c. A nonhealing sore
d. Change in bowel pattern
A nonhealing sore is correct. A client who has cancer might exhibit a nonhealing sore.
Unintended weight gain is incorrect. The nurse should instruct the clients that unintended weight loss can indicate cancer.
Change in bowel pattern is correct. A client who has cancer might exhibit a change in bowel pattern.
Unilateral calf tenderness is incorrect. A client who has unilateral calf tenderness can have a venous thromboembolism.
Nagging cough is correct. A client who has cancer might exhibit a nagging cough.
A nurse is caring for a chronically ill client who states that they have been under a lot of stress since being diagnosed with cancer. Which of the following laboratory findings would indicate the body’s appropriate response to stress by regulating hormones for glucose and fluid distribution?
a. Decreased testosterone hormone level.
b. Increased progesterone hormone level.
c. Increased corticosteroid hormone level.
d. Decreased luteinizing hormone level.
c. Increased corticosteroid hormone level.
Corticosteroid hormones are released during times of stress to regulate glucose use and fluid distribution.
A nurse is planning care for a client who has type 1 diabetes mellitus and is scheduled for joint replacement surgery. Which of the following considerations should the nurse include in the plan of care?
a. The client will be less able to handle temperature changes.
b. The client may need more time to feel the effects of pain medication.
c. The client’s blood glucose levels may fluctuate more severely.
d. The client is at higher risk for developing loss of bone density
c. The client’s blood glucose levels may fluctuate more severely.
Stressors, such as surgery, can affect the blood glucose balance of a client with type 1 diabetes more severely.
A nurse in a provider’s office is collecting data from a client who has hypothyroidism. Which of the findings should the nurse expect?
a. Blurred vision
b. Moist skin
c. Bradycardia
d. Insomnia
c. Bradycardia
Reduced thyroid hormone levels (hypothyroidism) reduce the body’s metabolic rate and thus slow down various body functions. Bradycardia reflects slowed cardiovascular function.
A nurse is reinforcing teaching about glucose monitoring with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates understanding of the teaching?
a. “I will check my urine once a day for glucose.”
b. “I will notify my provider if preprandial glucose is more than 120 mg/dL.”
c. “I will check blood glucose every 4 hours when I am sick.”
d. “I will check blood glucose 20 minutes after I treat a hypoglycemic episode.”
c. “I will check blood glucose every 4 hours when I am sick.”
The client should follow specific guidelines when sick, including checking the blood glucose every 4 hr, or every 2 hr if illness is severe. Extra insulin can be required to keep the glucose below 200 mg/dL, and the provider can inform the client of adjustments to make.
A nurse is reviewing teaching with a client who has osteoarthritis and is to start taking celecoxib. Which of the following findings should the nurse instruct the client to monitor for and report to the provider?
a. Tinnitus
b. Dry mouth
c. Polyuria
d. Tarry stools
d. Tarry stools
The nurse should inform the client that celecoxib can cause gastrointestinal bleeding. The client should watch for and report black, dark-colored, or bloody stools, abdominal pain, or coffee-ground emesis. The client should also take celecoxib with food to reduce gastric irritation.
A nurse is assisting with the care of an older adult client who is scheduled for surgery. The nurse should identify that the client is at risk for with of the following? (Select all that apply.)
a. A decrease in the skin elasticity
b. A decrease in medication efficacy
c. An increase in metabolism
d. A decrease in kidney function
e. An increase in cardiac output
a. A decrease in the skin elasticity
d. A decrease in kidney function
A decrease in kidney function is correct. This is a surgical risk the nurse should be aware of. Older adults have a risk for complications that is three times higher than that of younger adult.
A decrease in the skin elasticity is correct. Older adults have a decrease in skin elasticity. This is a surgical risk the nurse should be aware of.
A decrease in medication efficacy is incorrect. Older adults have an increase in medication efficacy. A decline in cardiac, renal, or liver function can delay the metabolism or excretion of medications.
An increase in metabolism is incorrect. Older adults have a decrease in metabolism. A decline in cardiac, renal, or liver function can delay the metabolism or excretion of medications.
An increase in cardiac output is incorrect. Older adults have a decreased cardiac output. A decline in cardiac output can delay the metabolism or excretion of medications.
A nurse is caring for a client who has type 2 diabetes mellitus and reports blurred vision, numbness in feet, and has had a wound on the right leg for the last 2 months. The clinic nurse notes that the client’s Hemoglobin A1C is 8.1%. Which of the following should the nurse include in the client’s plan of care?
a. “The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that you’ll have to start taking insulin.”
b. “The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that your blood sugar level has had too many highs and lows.”
c. “The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that you have been exercising too much.”
d. “The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that your blood sugar level has been too high.”
d. “The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that your blood sugar level has been too high.”
Blurred vision, numbness in feet, a non-healing wound, and an elevated Hemoglobin A1C indicate that the average blood glucose level has been too high.
A nurse is assisting with the care of a client who has hypertension and chronic kidney disease. The client is scheduled for hemodialysis. Which of the following actions should the nurse plan to take while caring for this client? (Select all that apply.)
a. Administer a sedative to the client.
b. Check the graft site for a palpable thrill.
c. Verify the glomerular filtration rate.
d. Document vital signs.
e. Obtain the client’s weight.
b. Check the graft site for a palpable thrill.
d. Document vital signs.
e. Obtain the client’s weight.
Document vital signs is correct. The client’s vital signs should be taken and documented prior to dialysis for baseline data. The client’s blood pressure, in particular, should be monitored prior to, during, and after dialysis due to the potential for hypotension during and after the treatment. If the blood pressure drops too low, an infusion of intravenous normal saline may be required to replace fluid volume and restore the blood pressure.
Obtain the client’s weight is correct. Hemodialysis shunts the client’s blood from the body through a dialyzer and back into the client’s circulation. During hemodialysis, the blood is passed through the dialysis machine to remove waste products and excess fluid. The amount of fluid to be removed is determined by the client’s weight immediately prior to dialysis. The client’s dry weight, which is determined by the provider, is subtracted from the weight immediately prior to the start of dialysis. For example, if the dry weight is 70 kg (154.32 lb) and the current weight is 72 kg (158.73 lb), the dialysis machine is programmed to remove 2 kg (4.4 lb), or 2 L (0.5 gal) of fluid.
Verify the glomerular filtration rate is incorrect. End-stage kidney disease (ESKD) is a progressive, irreversible kidney disease. End-stage kidney disease, also known as end-stage renal failure (ESRD), exists when 90% of the functioning nephrons have been destroyed and are no longer able to maintain fluid, electrolyte, or acid-base homeostasis. This means the kidneys are no longer able to sustain life, and the client will die if dialysis is not initiated. The client’s glomerular filtration rate (GFR) is used to determine the severity of kidney damage. The GFR is expected to be greater than 90 mL/min. Chronic kidney disease (CKD) is comprised of five stages: Stage 1, minimal kidney damage with normal GFR; Stage 2, mild kidney damage with mildly decreased GFR; Stage 3, moderate kidney damage with a moderate decrease in GFR; Stage 4, severe kidney damage with a severe decrease in GFR; and Stage 5, kidney failure and end-stage kidney disease with little or no glomerular filtration and renal replacement therapy required. Glomerular filtration rate is an indicator of renal function and is checked to evaluate how well the kidneys are working. Because ESKD is irreversible, it is not necessary to check the GFR prior to dialysis because the GFR level in these clients is elevated and will remain that way unless a renal transplantation is performed.
Administer a sedative is incorrect. The client is awake during hemodialysis and is a painless procedure for the client. Therefore, a sedative is not needed.
Check the graft site for a palpable thrill is correct. Hemodialysis requires access to the client’s blood by way of a graft, arteriovenous (AV) fistula, or central venous access device. The nurse should check patency of the access site (presence of bruit, palpable thrill, distal pulses, and circulation). This ensures vascular flow and proper functioning of the graft prior to the dialysis procedure. If a thrill is not found, this can indicate the graft has clotted and hemodialysis will not be possible. This would need to be reported to the provider. Measures to protect the graft include avoiding taking blood pressure, administering injections, performing venipuncture, or inserting IV lines on an extremity with an access site.
A nurse is discussing the care of a client who has type 1 diabetes mellitus with an assistive personnel (AP). Which of the following situations should the nurse instruct the AP to report immediately?
a. The client reports dizziness when standing.
b. The client refuses breakfast and requests to sleep.
c. The client asks the AP to trim his broken toenail.
d. The client reports urine that is dark yellow in color.
b. The client refuses breakfast and requests to sleep.
The greatest risk to this client is hypoglycemia which could be caused by the client’s refusal to eat and request to sleep. Therefore, the AP should report this situation to the nurse immediately.
A nurse is reinforcing education about insulin management with a client newly diagnosed with type 1 diabetes mellitus. Which of the following statements by the nurse about injection site selection is accurate?
a. “Injections will work most quickly when given in the abdomen.”
b. “Injections will work most quickly when given in the thigh.”
c. “Injections will work most quickly when given in the upper arm.”
d. “Injections will work most quickly when given in the buttocks.”
a. “Injections will work most quickly when given in the abdomen.”
Abdomen, upper arms, thighs, and buttocks are all acceptable injection sites. Injections will work most quickly when given in the abdomen.
A nurse is caring for a client in the clinic.
History and Physical
49-year-old client
Height 161.5 cm (63 in)
Weight 76 kg (167.6 lb)
Laboratory Results
12 months ago:
T4 12 mcg/mL (4 to 12 mcg/mL)
TSH 0.9 mcg/mL (0.3 to 5 mcg/mL)
Today:
T4 3.2 mcg/mL (4 to 12 mcg/mL)
TSH 6 mcg/mL (0.3 to 5 mcg/mL)
Assessment
12 months ago:
Client reports no concerns at annual physical exam.
Review of systems within normal limits.
Today:
Attempted to diet but has gained 11.3 kg (24.9 lb) in the last 6 months.
Reports sleeping 14 to 16 hr per day and constantly feeling cold.
Slight enlargement noted in the neck area; coarse textured hair and dry skin
For each client finding, click to specify if the client finding is associated with hyperthyroidism or hypothyroidism. Each finding may fall under more than 1 column.
Assessment Finding
TSH level
T4 level
Client’s weight
Skin assessment
Energy Level
Client’s temperature tolerance
Neck assessment
When analyzing cues for a client experiencing hypothyroidism, the nurse will need to inquire about dry skin, voice changes, hair loss, constipation, fatigue, muscle cramps, cold intolerance, sleep disturbances, menstrual cycle abnormalities, weight gain, and galactorrhea. Serum TSH level is used to screen for primary hypothyroidism in most clients. In overt hypothyroidism, TSH levels are elevated and free T4 levels are low. In subclinical hypothyroidism, TSH levels are elevated and free T4 levels are normal.
The client’s lab work shows a decrease in their T4 level from 12 mcg/mL to 3.2 mcg/mL, and TSH level from 0.9 mcg/mL to 6 mcg/mL from their visit 12 months ago. The client is also experiencing a weight gain of 11.3 kg (24.9 lb), reports sleeping 14 to 16 hr per day, has dry skin, and is always cold. These all indicate hypothyroidism.
A nurse is caring for a client who is postoperative and has a history of Addison’s disease. For which of the following manifestations should the nurse monitor?
a. Hypernatremia
b. Hypotension
c. Bradycardia
d. Hypokalemia
b. Hypotension
The client who has Addison’s disease is at risk for developing Addisonian crisis following a major physiological stressor such as surgery. Manifestations such as hypotension and tachycardia, extreme weakness and a decrease in mental status are noted. Untreated, Addisonian crisis may result in death.
A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus. Which of the following statements from the client indicates to the nurse the teaching is effective?
a. “I will shake the insulin vial vigorously to mix.”
b. “I will freeze unopened insulin vials.”
c. “I should increase my insulin when I exercise.”
d. “I should inject the insulin into my abdominal area.”
d. “I should inject the insulin into my abdominal area.”
The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.
A nurse is reinforcing teaching with a client who has a new diagnosis of metabolic syndrome. Which of the following statements by the nurse regarding treatment options is appropriate to include in the teaching?
a. “Inhalers are often used to treat metabolic syndrome.”
b. “Treatment will focus on lowering your blood pressure, cholesterol, and blood sugar.”
c. “There are no surgical treatments for metabolic syndrome.”
d. “Metabolic syndrome is easily treated with medications.”
b. “Treatment will focus on lowering your blood pressure, cholesterol, and blood sugar.”
Treatment of metabolic syndrome focuses on treating and preventing obesity. Lifestyle changes focused on weight loss, physical activity, smoking cessation, and a nourishing diet are often prescribed. Medications are used to treat elevated lipid levels, diabetes, and hypertension.
A nurse is collecting data from a client who has Graves’ disease. Which of the following findings should the nurse expect?
a. Polydipsia
b. Polyuria
c. Hirsutism
d. Goiter
d. Goiter
The nurse should expect to see a goiter in a client who has Graves’ disease.
An adult client newly diagnosed with type 2 diabetes mellitus asks a nurse to explain how he developed the condition. Which of the following responses should the nurse make?
a. Your body’s immune system has destroyed cells in your pancreas.
b. Your body doesn’t process glucose well.
c. Your body will continue producing too much insulin without medicine to counteract it.
d. Your body’s hemoglobin is not binding to the sugar you consume.
b. Your body doesn’t process glucose well.
Type 2 diabetes mellitus is characterized by insulin resistance, where insulin does not interact with glucose appropriately. As a result, the body makes more insulin, until it eventually loses the ability for insulin production.
A nurse is providing care for a client who has hyperosmolar hyperglycemic syndrome (HHS). Which of the following is a clinical manifestation of HHS?
a. Metabolic acidosis
b. Hypervolemia
c. Ketosis
d. Insulin resistance
d. Insulin resistance
Insulin resistance is a manifestation of HHS.
A nurse is reinforcing teaching about preventing long-term complications of retinopathy and neuropathy with an older adult client who has diabetes mellitus. Which of the following actions is the most important for the nurse to include in the teaching?
a. “Plan to have an eye examination once per year.”
b. “Examine your feet carefully every day.”
c. “Wear closed-toed shoes daily.”
d. “Maintain stable blood glucose levels.”
d. “Maintain stable blood glucose levels.”
The greatest risk for the client is injury from hyperglycemia that contributes to neuropathic disease, microvascular complications, and risk factors for macrovascular complications. Therefore, the most important action is for the client to maintain stable blood glucose levels.
The nurse is discussing the epidemiology of type 2 diabetes mellitus with a group of nursing students. Which of the following statements is appropriate for the nurse to make?
a. More males are diagnosed than females with type 2 diabetes.
b. The incidence of new cases of type 2 diabetes is highest among adults over 68 years of age.
c. Prevalence of type 2 diabetes has steadily been decreasing over the last decade.
d. Most people diagnosed with diabetes mellitus have type 2 diabetes.
d. Most people diagnosed with diabetes mellitus have type 2 diabetes.
According to the CDC, 90 to 95% percent of people with diabetes mellitus in the United States have type 2 diabetes, and only about 5% have type 1 diabetes.
