Exam 5 Iggy 10th Ed Questions Flashcards
Chapter 58: Concepts of Care for Patients With Problems of the Thyroid and Parathyroid Glands
And awaaaaaay we go!
Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min?
A) Increasing the IV infusion rate
B) Initiating the Rapid Response Team
C) Assessing temperature
D) Applying oxygen by mask
D) Applying oxygen by mask
The most common cause of death with severe hypothyroidism is respiratory failure with decreased gas exchange. The nurse would apply oxygen first and then initiate the Rapid Response Team. Although a decreased body temperature would support the findings that a client with severe hypothyroidism is worsening, assessing it would not be helpful in this situation. Increasing the IV flow rate may not even improve cardiac output because the slow heart rate is not related to a volume deficit but to reduced myocardial contractility.
Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)?
A) “Increase the amount of fiber in your diet to prevent the side effect of constipation.”
B) “Stop this drug immediately if you discover you are pregnant.”
C) “Avoid over-the-counter medications unless prescribed by your primary health care provider.”
D) “If you miss a dose, double your next day’s dose.”
C) “Avoid over-the-counter medications unless prescribed by your primary health care provider.”
The amount of drug in synthetic thyroid hormone tablets is very small and many other foods and drugs interfere with its absorption. The client is instructed to not take over-the-counter medications without approval from the primary health care provider. Fiber greatly interferes with the drug’s absorption and is not to be taken with or within 4 hours of HRT. In addition, the drug does not cause constipation. Thyroid HRT must continue during pregnancy. The therapy works best when blood levels are maintained. The client is taught to take the forgotten drug as soon as it is remembered and not to double the next day’s dose.
For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider?
A) Calf muscle cramping
B) Runny nose
C) Anorexia
D) Hand tremors
D) Hand tremors
Hand tremors are an indication of HRT toxicity with increased central nervous system stimulation. The dose must be decreased to prevent more serious neurologic and cardiac toxicities. Anorexia, runny nose, and muscle cramping are neither side effects of the drug nor indications of toxicity.
Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed?
A) “If I continue to lose weight, I may need an increased dose.”
B) “I will have more energy with this medication.”
C) “If I often am constipated and feel tired, I may need an increased dose.”
D) “I will take the medication every morning.”
A) “If I continue to lose weight, I may need an increased dose.”
The statement, “If I continue to lose weight, I may need an increased dose,” indicates a need for further teaching. Weight loss indicates a need for a decreased dose, not an increased dose.
One of the symptoms of hypothyroidism is lack of energy. Thyroid replacement therapy would cause the client to have more energy. The correct time to take thyroid replacement therapy is in the morning. Frequent constipation and continuing to feel tired are indications that the dose may need to be increased.
Why is a goiter often present in clients who have Graves disease?
A) The low circulating levels of thyroid hormones stimulates the feedback system and triggers the anterior pituitary gland to secrete more thyroid-stimulating hormone, which increases the numbers and size of glandular cells in the thyroid gland.
B) The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland.
C) The autoantibodies stimulate blood vessel growth and blood storage within the thyroid gland, increasing its overall size.
D) The autoantibodies stimulate the inflammatory and immune responses to increase the number of white blood cells circulating in the thyroid gland, which increases tissue size without increasing the number of glandular cells.
B) The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland.
Graves disease is an autoimmune disorder in which antibodies (thyroid-stimulating immunoglobulins [TSIs]) are made and attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid tissue. The thyroid gland responds by increasing the number and size of glandular cells, which enlarges the gland, forming a goiter and overproduces thyroid hormones (thyrotoxicosis).
Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy?
A) Administering morphine for pain
B) Assessing the wound dressing for bleeding
C) Hyperextending the neck
D) Monitoring oxygen saturation
D) Monitoring oxygen saturation
Airway assessment and management is always the first priority with every client, especially for a client who has had surgery that involves potential bleeding and edema near the trachea.
Assessing the wound dressing for bleeding is a high priority, which is performed next after assessing airway and breathing. Pain control is important, but can be addressed after airway assessment. The neck should not be extended or hyperextended because this position puts too much tension on the incision.
What is the nurse’s best response when family members of a client with hyperthyroidism express concern about the client’s frequent mood swings?
A) “Do the client’s mood swings make you feel angry?”
B) “The medications will make the mood swings disappear completely.”
C) “Your family member is sick. You must be patient.”
D) “Mood swings are common should diminish with treatment.”
D) “Mood swings are common should diminish with treatment.”
Telling the family that the client’s mood swings should diminish over time with treatment provides information to the family, as well as reassurance that this behavior is expected.
Asking the family if the client’s mood swings make them angry is a closed-ended question and could make the family members feel guilty. The response needs to be client-centered. Any medications or treatment may not completely remove the mood swings associated with hyperthyroidism. The family is aware that the client is sick. Telling them to be patient can also cause feelings of guilt and does not address the family’s concerns.
The nurse reviews the vital signs of a client diagnosed with Graves disease and notes that the client’s temperature is 99.6° F (37.6° C). After notifying the primary health care provider, what is the nurse’s best next action?
A) Administering acetaminophen
B) Observing for the presence of chills
C) Initiating the Rapid Response Team
D) Assessing cardiac status
D) Assessing cardiac status
Graves disease is manifested by symptoms of hyperthyroidism and increased metabolic rate, including fever. The nurse must next assess the client’s cardiac status as atrial fibrillation or other dysrhythmias may have developed. If the client has a cardiac monitor, the nurse needs to check for any dysrhythmias.
Administering a nonsalicylate antipyretic such as acetaminophen is appropriate, but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time as no instability has been noted. Unlike with infection, temperature elevations in a client with hyperthyroidism are not associated with chills.
Which statement made by a client who is undergoing therapy with radioactive iodine (RAI) for Graves disease indicates a lack of understanding about the disorder and its treatment?
A) “Luckily, I have my own bathroom, so I won’t be exposing the rest of my family to radiation.
B) “If this treatment works, maybe I will stop sweating all the time.
C) “It will be great to lose my “bug-eyed” appearance.
D) “I hope I don’t gain too much weight when my thyroid function is normal.
C) “It will be great to lose my “bug-eyed” appearance.
Although successful radioactive iodine (RAI) therapy for Graves disease results in reducing most physical symptoms, the exophthalmia does not respond to this therapy. Other measures, such as drug therapy targeted to the exophthalmos and not the hyperthyroidism and surgery to remove tissue from behind the eye, are needed to improve the eye appearance. All other client statements demonstrate accurate understanding of the disorder and its treatment.
With which client will the nurse be aware of an increased risk for hypoparathyroidism?
A) A 28-year-old woman with pregnancy-induced hypertension
B) A 35-year-old woman who had radiation therapy for Graves disease
C) A 50-year-old man starting on insulin therapy for type 2 diabetes mellitus
D) A 55-year-old man with moderate heart failure after myocardial infarction
B) A 35-year-old woman who had radiation therapy for Graves disease
Hypoparathyroidism is a relatively rare disorder. It is most often caused by treatment for hyperthyroidism that resulted in injury to the parathyroid glands. None of the other client health problems increase the risk for development of hypoparathyroidism.
Which trends in serum electrolyte values will the nurse expect to find in a client who has untreated hypoparathyroidism?
A) Below normal calcium levels; above normal phosphorus levels
B) Below normal calcium levels; below normal phosphorus levels
C) Above normal calcium levels; above normal phosphorus levels
D) Above normal calcium levels; below normal phosphorus levels
A) Below normal calcium levels; above normal phosphorus levels
With hypoparathyroidism, the lack of parathyroid hormone (PTH) decreases serum calcium levels by increasing kidney calcium excretion and inhibiting calcium absorption from the GI tract. Low levels of calcium cause a corresponding increase in serum phosphorus levels because calcium and phosphorus exist in a balanced reciprocal relationship in which a decrease in one always causes an increase in the other.
Which type of drug therapy will the nurse prepare to teach about to a client who has mild hyperparathyroidism?
A) Antipyretics
B) Opioid analgesics
C) Furosemide diuretics
D) Calcium supplements
C) Furosemide diuretics
High ceiling or loop diuretics, such as furosemide increase calcium excretion and are used to manage calcium levels in clients who have mild hyperparathyroidism. Antipyretics are not routinely prescribed because fever is not associated with the disorder. Opioid analgesics are used only when a problem causing acute pain is present and not for typical management of mild hyperparathyroidism. Calcium supplements are contraindicated because hyperparathyroidism results in chronic hypercalcemia.
Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed?
A) Hypoactive bowel sounds
B) Apical pulse of 92 beats/min
C) Bilateral leg muscle twitching
D) Dry mouth
C) Bilateral leg muscle twitching
Clients are at risk for hypocalcemia and seizures after removal of the parathyroid glands. Muscle twitching is an indication of hypocalcemia and requires assessment and intervention. The other findings are abnormal but not associated with complications from the surgery.
Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism?
(Select all that apply.)
A) Goiter B) Non-pitting edema of hands and feet C) Warm, moist skin D) Decreased deep tendon reflexes E) Agitation and inability to sleep F) Pulse rate below 60 beats/min
B) Non-pitting edema of hands and feet
D) Decreased deep tendon reflexes
F) Pulse rate below 60 beats/min
Hypothyroidism slows the metabolism and function of all systems and the ones that are usually first noticed and can lead to life-threatening complications are the cardiac and central nervous systems. Thus, the heart rate is usually slower than 60 beats/min, and the deep tendon reflexes are decreased. Metabolites that are compounds of proteins and sugars called glycosaminoglycans (GAGs) build up inside cells, which increase the mucus and water, forming cellular edema that is nonpitting.
The onset is so slow and insidious that clients may not even notice them until severe changes are present. A goiter only indicates a thyroid problem and can occur with both hypothyroidism and hyperthyroidism. The skin reflects the client’s overall decreased metabolism and is cool and dry.
Which statements regarding hyperthyroidism are accurate? (Select all that apply.)
A) Has a sudden onset of symptoms.
B) Is much more common among women than men.
C) Produces symptoms of a hypermetabolic state.
D) Most common form is Graves disease.
E) Can be diagnosed by the presence of a goiter.
F) Often occurs weeks after exposure to ionizing radiation.
B) Is much more common among women than men.
C) Produces symptoms of a hypermetabolic state.
D) Most common form is Graves disease.
Hyperthyroidism increases the metabolism and function of all systems. The most common cause of hyperthyroidism is Graves disease, which is an autoimmune disorder, often occurring after an episode of thyroid inflammation leading to the production of autoantibodies (thyroid-stimulating immunoglobulins [TSIs]) that attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid gland. The increased stimulation of TSH receptors greatly increases thyroid hormone production. All thyroid problems are from five to ten more common among women than men.
The onset is so slow and insidious that clients may not even notice them until severe changes are present. A goiter only indicates a thyroid problem and can occur with both hypothyroidism and hyperthyroidism. Exposure to ionizing radiation can induce hypothyroidism, not hyperthyroidism.
Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.)
A) Hypertonic saline B) Furosemide C) Calcium gluconate D) Oxygen E) Suction F) Emergency tracheotomy kit
C) Calcium gluconate
D) Oxygen
E) Suction
F) Emergency tracheotomy kit
Calcium gluconate needs to be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema occludes the airway. Oxygen always needs to be at the bedside and especially for the thyroidectomy client who may experience respiratory distress from swelling or damage to the laryngeal nerve leading to spasm. It is also important to have suction available at the client’s bedside because of the risk for increased secretions.
Furosemide is a diuretic used to treat hypercalcemia associated with hyperparathyroidism. However, hypocalcemia from inadvertent parathyroid removal during thyroidectomy is the greater concern. Hypertonic saline is not necessary for this client. This client is not expected to have hyponatremia after surgery.
Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.)
A) Elevated temperature B) Tachycardia C) Somnolence D) Elevated systolic blood pressure E) Abdominal pain and nausea F) Slow respiratory rate
A) Elevated temperature
B) Tachycardia
D) Elevated systolic blood pressure
E) Abdominal pain and nausea
Symptoms of thyroid storm are caused by excessive thyroid hormone release, which dramatically increases metabolic rate. Key symptoms include fever, tachycardia, and systolic hypertension. Additional symptoms include abdominal pain, nausea, vomiting, diarrhea, tremors, and anxiety.
The increased metabolic rate causes the respiratory rate to increase. Clients are agitated, not somnolent.
An assistive personnel reports that a nursing home client who has hypothyroidism has a pulse of 48 beats per minute this morning. Which assessments have the highest priority for the nurse to perform immediately? Select all that apply.
A. Checking body temperature
B. Testing deep tendon reflex responses
C. Measuring oxygen saturation by pulse oximetry
D. Checking blood pressure, heart rate, and rhythm
E. Determining level of consciousness and cognition
F. Identifying presence or absence of swallowing reflex
G. Examining feet and ankles for peripheral edema
C. Measuring oxygen saturation by pulse oximetry
D. Checking blood pressure, heart rate, and rhythm
All changes in any of these parameters are important and would be expected to be abnormal in a client with hypothyroidism whose metabolism is decreasing. However, the most common cause of death for a client with severe hypothyroidism is respiratory failure with reduced gas exchange and perfusion. Thus, measuring oxygen saturation should be performed first followed by assessment of cardiac function in order to implement the most effective interventions as soon as possible.
Which assessment finding of a client 8 hours after a subtotal thyroidectomy does the nurse consider most relevant as an indication of a possible complication?
A. The client’s hand spasms during blood pressure measurement.
B. The respiratory rate has dropped from 18 to 14 breaths per minute.
C. The dressing has a moderate amount of serosanguinous drainage.
D. The client responds to questions correctly but does not open the eyes while talking.
A. The client’s hand spasms during blood pressure measurement.
Hand spasms in the presence of decreased oxygen (as would happen while a blood pressure cuff was inflated above systolic pressure) is an indication of hypocalcemia, a possible complication of reduced parathyroid function that can result from thyroid surgery. The respiratory rate is within normal limits for a healthy adult. A moderate amount of drainage may be more than expected but is not an indication of obstruction. After general anesthesia, most clients are sleepy. Not opening his or her eyes during a response to a question is not an indication of a complication.
A client at continuing risk for hyperparathyroidism is prescribed to take furosemide 40 mg and to drink at least 3 to 4 L of fluid daily. He tells the nurse he believes taking a “water pill” and then drinking so much seems wrong. How will the nurse respond?
A. “This combination of a water pill and drinking more ensures protects you from buildup of excess sodium in the kidney.”
B. “The furosemide makes you lose water and you need to increase your intake to keep from becoming dehydrated.”
C. “The drug helps you to get rid of calcium and drinking more helps dilute your blood calcium so the level doesn’t get too high.”
D. “You are correct. I will check with your primary health care provider to determine whether you should restrict your fluid intake.”
C. “The drug helps you to get rid of calcium and drinking more helps dilute your blood calcium so the level doesn’t get too high.”
The purpose of the furosemide and hydration therapy is to lower the blood calcium levels to manage the hypercalcemia associated with hyperparathyroidism. Although it is true that increasing fluid intake while on furosemide can help prevent dehydration and also helps excrete sodium, that is not the desired outcome in hyperparathyroidism.
58-1. Performance of which assessment is a priority for the nurse before giving a client the first oral dose of hormone replacement for hypothyroidism?
A. Measuring heart rate and rhythm
B. Checking core body temperature
C. Asking about previous allergic drug reactions
D. Listening to bowel sounds in all four abdominal quadrants
A. Measuring heart rate and rhythm
The side effects and adverse effects of thyroid hormone replacement drugs increase metabolic rate and cardiac activity. Checking heart rate and rhythm before giving the drug provides a baseline to determine whether or not the drug is working correctly or is causing an overdose effect. Although changes in core body temperature and bowel sounds will eventually indicate responses to the prescribed therapy, the most critical to assess are those related to cardiac function. Thyroid replacement hormone has not been taken by this client before and is not associated with any other types of drug allergies
58-2. Which assessment findings in a client with hyperthyroidism indicates to the nurse that the client is in danger of thyroid storm? Select all that apply.
A. Increased salivation
B. Client report of increased palmar sweating
C. Decreased pulse pressure from 40 mm Hg to 36 mm Hg
D. Diminished bowel sounds in all four abdominal quadrants
E. An increase in temperature from 99.5o F (37.5o C) to 101.3o F (38.5o C)
F. Serum sodium level increase from 136 mEq/L (mmol/L) to 139 mEq/L (mmol/L)
G. Increase in premature ventricular heart contractions from 4 per minute to 28 per minute
B. Client report of increased palmar sweating
E. An increase in temperature from 99.5o F (37.5o C) to 101.3o F (38.5o C)
G. Increase in premature ventricular heart contractions from 4 per minute to 28 per minute
The changes most associated with impending thyroid storm (thyroid crisis) are the increase in sweating, body temperature, and irregular heartbeats. This client requires immediate attention. Increased salivation and diminished bowel sounds are not associated with thyroid storm. The changes in pulse pressure and serum sodium values are still within normal limits and not insignificant.
58-3. The nurse reviewing the laboratory values of a client with hypoparathyroidism finds a serum calcium level of 7.9 mg/dL (1.76 mmol/L). Which parameter is most important for the nurse to assess to prevent harm? A. Temperature B. Heart rate and rhythm C. Deep tendon reflexes D. Level of consciousness
C. Deep tendon reflexes
The serum calcium is low, placing the client in danger of increased muscle contractions and tetany. The client’s deep tendon reflexes should be evaluated for hyperreflexia, which is an indicator of impending tetany. The other parameters are much less affected by hypocalcemia.
Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy?
A) Loss of sensation in both feet
B) Hyperglycemia
C) Intermittent constipation
D) Increased thirst
A) Loss of sensation in both feet
Chapter 59: Concepts of Care for Patients With Diabetes Mellitus
You’ve been diagnosed with the “betes”
What is the nurse’s best response to a client newly diagnosed with diabetes who asks why he is always so thirsty?
A) “Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks.”
B) “The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst.”
C) “Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost.”
D) “The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.”
D) “The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.”
The high blood glucose levels that are present, because movement of glucose into cells is impaired, increase the osmolarity of the blood. The increased osmolarity stimulates the osmoreceptors in the hypothalamus, which triggers the thirst reflex. In response, the person drinks more water (not sugary fluids or hyperosmotic fluids), which helps dilute blood glucose levels and reduces blood osmolarity.
What is the nurse’s best response when a client with diabetes who is being treated for hypoglycemic asks why people without diabetes don’t become severely hypoglycemic even after fasting for 8 hours?
A) In a person without diabetes, fasting for 8 hours converts proteins into glycose (gluconeogenesis) so that hypergycemia develops rather than hypoglycemia.
B) In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis).
C) Normal metabolism is so slow when a person without diabetes fasts that blood glucose does not enter cells to be used for energy. As a result, hypoglycemia does not occur.
D) Lipolysis (fat breakdown) in fat stores occurs faster in the nondiabetic person, which converts fatty acids into glucose to maintain blood glucose levels.
B) In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis).
Glucagon is a counter-regulatory hormone secreted by pancreatic alpha cells when blood glucose levels are low, as they would be during an 8 hour fast. The body’s metabolic rate does decrease during sleep (which is not stated in this question) but not sufficiently to prevent hypoglycemia. Glucagon works on the glycogen stored in the liver, breaking it down to glucose (glycogenolysis) molecules that are then released into the blood to maintain blood glucose levels and prevent hypoglycemia. Although proteins can be broken down and converted to glucose, they are not converted to glycogen. Fat break down through lipolysis can provide fatty acids for fuel but this is not glucose and lipolysis does not occur until all stored glycogen is used.
Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys?
A) White blood cells (WBCs) in the urine during a random urinalysis
B) Ketone bodies in the urine during acidosis
C) Glucose in the urine during hyperglycemia
D) Protein in the urine during a random urinalysis
D) Protein in the urine during a random urinalysis
Urine should not contain protein and the presence of proteinuria in a client with marks the beginning of renal problems known as diabetic nephropathy, that progresses eventually to end-stage renal disease. Chronically elevated blood glucose levels cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. The excess leakiness allows larger substances, such as proteins, to be filtered into the urine.
What is the nurse’s best response to a client newly diagnosed with type 1 diabetes who asks why insulin is only given by injection and not as an oral drug?
A) “Injected insulin works faster than oral drugs to lower blood glucose levels.”
B) “Oral insulin is so weak that it would require very high dosages to be effective.”
C) “Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes.”
D) “Insulin is a “high alert drug” and could more easily be abused if it were available as an oral agent.”
C) “Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes.”
Because insulin is a small protein that is easily destroyed by stomach acids and intestinal enzymes, it cannot be used as an oral drug. Most commonly, it is injected subcutaneously.
A client expresses fear and anxiety over the life changes associated with diabetes, stating, “I am scared that I can’t do it all and will get so sick that I will be a burden on my family.” What is the nurse’s best response?
A) “Let’s tackle it piece by piece. What is most scary to you?”
B) “It is overwhelming, isn’t it?”
C) “Let’s see how much you can learn today, so you are less nervous.”
D) “Many people live with diabetes and do it just fine.”
A) “Let’s tackle it piece by piece. What is most scary to you?”
The nurse’s best response is to suggest that the client tackle it piece by piece and ask what is most scary to him or her. This is the best client-centered response, and acknowledges the client’s concern, letting the client master survival skills first.
Referring to the illness as overwhelming may reflect the client’s feelings, but is a closed-ended question and does not encourage the client to express his feelings about the underlying fear. Trying to see how much the client can learn in 1 day may add to his anxiety by overwhelming him with information and the need to “do it all” in 1 day. Suggesting that other people handle the illness just fine criticizes the client and does not recognize his concerns.
Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, “I can’t catch my breath.” and has vital signs of: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air?
A) Administering oxygen
B) Connecting a cardiac monitor
C)Assessing arterial blood gas (ABG) values
D) Assessing blood glucose level
D) Assessing blood glucose level
The nurse would first obtain the client’s glucose level. Breathing deeply and stating, “I can’t catch my breath” is indicative of Kussmaul respirations which is a sign of diabetic ketoacidosis (DKA).
Based on the oxygen saturation, oxygen administration is not indicated. The diagnosis of DKA does not require ABGs. Cardiac monitoring may be implemented, but the first action would be to obtain the glucose level.
Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management?
A) Current energy level and rest patterns
B) Sexual orientation
C) Current lifestyle for diet and exercise
D) Education and literacy levels
D) Education and literacy levels
The most important factor for the nurse to determine before providing instruction to the newly diagnosed client with diabetes is the client’s educational level and literacy level. A large amount of information must be synthesized. Written instructions are typically given. The client’s ability to learn and read is essential to provide the client with instructions and information about diabetes.
Although lifestyle would be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential.
What is the nurse’s best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet?
A) Testing the sensory perception of the client’s hands
B) Examining both feet for indications of injury
C) Explaining to the client that peripheral neuropathy is now present
D) Documenting the finding as the only action
B) Examining both feet for indications of injury
When reduced peripheral sensory perception is present, the likelihood of injury is high. Any open area or other problem on the foot of a person with diabetes is at great risk for infection and must be managed carefully and quickly. Checking for sensory perception on the hands and other areas is important but can come after a thorough foot examination.
What action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot?
A) “Make an appointment with your podiatrist as soon as possible.”
B) “Make an appointment with a pedicurist and have them cut or file off the callus.”
C) “Soak your feet nightly in warm water and peel of a little of the callus every day.”
D) “Apply an over-the-counter callus-dissolving pad and follow the package directions.”
A) “Make an appointment with your podiatrist as soon as possible.”
The client with diabetes is taught to see his or her diabetes health care provider or a podiatrist for calluses, corns, or any other foot lesion and never to self-treat such problems. The risk for development of an ongoing injury with chronic infection is very high could lead to eventual amputation.
How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible?
A) “You can have a beer with a meal if you test yourself for hypoglycemia an hour later.”
B) “You can have a beer with a meal if you test yourself for hyperglycemia an hour later.”
C) “There are nonalcoholic beers available that you can substitute for a regular beer.”
D) “If you gave up dessert, you can still have one beer.”
A) “You can have a beer with a meal if you test yourself for hypoglycemia an hour later.”
Alcohol consumption contributes to hypoglycemia. This risk is reduced if the alcohol is consumed with or shortly after a meal. The client is instructed to check blood glucose levels about an hour after alcohol is consumed to determine if either more food is needed or if insulin dosage needs to be adjusted.
Which statement by a client indicates to the nurse correct understanding of what to do when the sensations of hunger and shakiness occur?
A) “I will eat three graham crackers.”
B) “I will drink a glass of water.”
C) “I will sit down and rest.”
D) “I will give myself a dose of glucagon.”
A) “I will eat three graham crackers.”
Feeling hungry and shaky are symptoms of mild hypoglycemia. Correct understanding of what the client needs to do when these symptoms occur is to eat three graham crackers. This is the correct management strategy for mild hypoglycemia.
Drinking a glass of water or sitting down and resting does not remedy hypoglycemia. Glucagon is generally administered for episodes of severe not mild hypoglycemia.
Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with “dawn phenomenon” to achieve better control?
A) Eat a bedtime snack containing equal amounts of protein and carbohydrates.”
B) Avoid eating any carbohydrate with your evening meal.”
C) Take your evening insulin dose right before going to bed instead of at supper time.”
D) Inject the insulin into your arm rather than into the abdomen around the navel.”
C) Take your evening insulin dose right before going to bed instead of at supper time.”
A client with “dawn phenomenon,” diagnosed by checking blood glucose levels during the night, has morning hyperglycemia that results from a nighttime release of adrenal hormones causing blood glucose elevations at about 5 to 6 a.m. It is managed by providing more insulin for the overnight period (e.g., giving the evening dose of intermediate-acting insulin at 10 p.m. instead of with the evening meal).
Bedtime snacks are needed for “Somogyi phenomenon” that is morning hyperglycemia caused by the counterregulatory response to nighttime hypoglycemia. Changing the injection site would not prevent morning hyperglycemia. Not eating any carbohydrate with a meal is more likely to cause severe hypoglycemia during the night and is dangerous.
How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 82 mg/dL (mmol/L) and an A1c of 5.9%?
A) The values indicate that the client has poorly managed his or her disease.
B) The values indicate that the client has managed his or her disease well.
C) The client’s glucose control for the past 24 hours has been good but the overall control is poor.
D) The client’s glucose control for the past 24 hours has been poor but the overall control is good.
B) The values indicate that the client has managed his or her disease well.
Fasting blood glucose levels provide an indication of the client’s adherence to drug and nutrition therapy for DM has been for the previous 24 hours. This client’s FBG is well within the normal range.
A1c provides an indication of general blood glucose control for the past several months because when glucose attaches to hemoglobin, the attachment is permanent for as long as those hemoglobin molecules are present within red blood cells. Normal red blood cell life span is about 120 days. This client’s A1c level is within the desirable range, indicating good long-term glucose control as well as short-term control.
Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm?
A) “Check your hands and feet weekly for chronic excessive sweating.”
B) “Change positions slowly when moving from sitting to standing.”
C) “Avoid drinking caffeine or caffeinated beverages.”
D) “Be sure to take your blood pressure drug daily.”
B) “Change positions slowly when moving from sitting to standing.”
Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels. This problem contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance. Most often, CAN leads to orthostatic (postural) hypotension and syncope (brief loss of consciousness on standing). These problems are from failure of the heart and arteries to respond to position changes by increasing heart rate and vascular tone. As a result, blood flow to the brain is interrupted briefly. Orthostatic hypotension and syncope increase the risk for falls, especially among older adults.
Although taking blood pressure medication daily is important, it does not prevent orthostatic hypotension and in fact, may make orthostatic hypotension worse. Sensation changes are associated with peripheral neuropathy, not cardiovascular autonomic neuropathy. Avoiding caffeine is no longer a recommended action.
