Disorders
A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the primary health care provider's documentation and would expect to note which diagnosis?
1. Hypoglycemia
2. Pheochromocytoma
3. Diabetic ketoacidosis (DKA)
4. Hyperglycemic hyperosmolar state (HHS)
What is hyperglycemic hyperosmolar state.
Hyperglycemic hyperosmolar state is seen primarily in individuals with type 2 diabetes who experience a relative deficiency of insulin. The onset of symptoms may be gradual. The symptoms may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. DKA normally occurs in type 1 diabetes mellitus. The clinical signs/symptoms noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical signs/symptoms.
When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is essential?
1. Lower the head of the bed.
2. Test the drainage for glucose.
3. Obtain a culture of the drainage.
4. Continue to observe the drainage.
What is test the drainage for glucose.
After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the drainage should be collected and tested for glucose indicating the presence of CSF.
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
What is rotate the insulin injection sites systematically.
Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.
A client with diabetes mellitus visits the health care clinic. The client previously had been well controlled with glyburide, but recently the fasting blood glucose has been running 180 to 200 mg/dL. Which medication, if added to the client's regimen, may be contributing to the hyperglycemia?
1. Atenolol
2. Allopurinol
3. Prednisone
4. Phenelzine
What is prednisone.
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.
The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's syndrome. Which statement by the student indicates an accurate understanding of this disorder?
1. "Cushing's syndrome is characterized by an oversecretion of insulin."
2. "Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones."
3. "Cushing's syndrome is characterized by an undersecretion of corticotropic hormones."
4. "Cushing's syndrome is characterized by an undersecretion of glucocorticoid hormones."
What is "Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones."
Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones. Addison's disease is characterized by the failure of the adrenal cortex to produce and secrete adrenocortical hormones. Options 1 and 4 are inaccurate regarding Cushing's syndrome
The nurse notes in the medical record that a client with Cushing's syndrome is experiencing fluid overload. Which interventions should be included in the plan of care? Select all that apply.
1. Monitoring daily weight
2. Monitoring intake and output
3. Maintaining a low-sodium diet
4. Maintaining a low-potassium diet
5. Monitoring extremities for edema
What is monitoring daily weight, monitoring intake & output, maintaining a low-potassium diet and monitoring extremities for edema.
The client with Cushing's syndrome experiencing fluid overload should be maintained on a high-potassium and low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water. Monitoring weight, intake, output, and extremities for edema are all appropriate interventions for such a nursing diagnosis.
The nurse is reinforcing discharge teaching to a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood?
1. "I can eat foods that contain potassium."
2. "I will need to limit the amount of protein in my diet."
3. "I am fortunate that I can eat all the salty foods I enjoy."
4. "I am fortunate that I do not need to follow any special diet."
What is "I can eat foods that contain potassium."
A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.
The nurse is reviewing a primary health care provider's prescriptions for a client with newly diagnosed, untreated hypothyroidism. Which medication prescribed for the client should the nurse question and verify?
1. Atenolol
2. Levothyroxine
3. Morphine sulfate
4. Docusate sodium
What is morphine sulfate.
The client with hypothyroidism experiences fatigue, lethargy, and increased somnolence. The decreased metabolism and oxygen consumption is manifested by a slow heart rate, decreased cardiac output, and decreased blood pressure. Levothyroxine, a thyroid hormone, is a component of therapy. Stool softeners such as docusate sodium are prescribed to promote defecation. Morphine sulfate would further depress bodily functions. Atenolol is used with caution in clients with hyperthyroidism.
Which client is at risk for developing thyrotoxicosis?
1. A client with hypothyroidism
2. A client with Graves' disease who is having surgery
3. A client with diabetes mellitus scheduled for debridement of a foot ulcer
4. A client with diabetes insipidus scheduled for an invasive diagnostic test
What is a client with Graves' disease who is having surgery.
Thyrotoxicosis is usually seen in clients with Graves' disease with the symptoms precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, the birth process, or major surgery. It also must be recognized as a potential complication following a thyroidectomy.
The nurse is caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed. The nurse determines that this medication has been prescribed for which reason?
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
What is to treat hypocalcemic tetany.
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery & includes numbness and tingling around the mouth, fingertips, or toes, or muscle spasms or twitching.
The nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further teaching? Select all that apply.
1. "I enjoy exercising but I need to be careful."
2. "I need to pace my activities throughout the day."
3. "I need to limit playing football to only the weekends."
4. "I should gauge my activity level by my energy level."
5. "I should exercise in the evening to encourage a good sleep pattern."
What is "I need to limit playin football to only the weekends" & "I should exercise in the evening to encourage a good sleep pattern".
The client should be instructed to avoid high-impact activity or contact sports such as football. Exercising late in the evening may interfere with restful sleep. The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to use energy level as a guide to activity.
The nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide. The nurse reinforces dietary instructions to the client. Which are appropriate instructions? Select all that apply.
1. Increase dietary intake of calcium.
2. Drink at least 2 to 3 L of fluid daily.
3. Increase dietary intake of potassium.
4. Decrease dietary intake of phosphorus.
5. Eat sparsely when experiencing nausea.
What is drink at least 2 to 3L of fluid daily and increase dietary intake of potassium.
The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption. This is aided by the sufficient intake of fluids. Dietary restriction of calcium may be used as a component of therapy. The parathyroid is responsible for calcium production, and the term hyperparathyroidism can be indicative of an increase in calcium. The client should eat foods high in potassium, especially if the client is taking furosemide. Limiting nutrients is not advisable. Remember the inverse relationship between calcium and phosphorus.
The nurse is caring for a client with Addison's disease. The diagnosis is supported by which noted data? Select all that apply.
1. Hirsutism
2. Weight loss
3. Buffalo hump
4. Skin hyperpigmentation
5. Orthostatic hypotension
What is hirsutism, buffalo hump and skin hyperpigmentation.
Addison's disease is a decreased secretion of the adrenal cortex. Signs and symptoms include orthostatic hypotension, decreased body hair, weight loss, skin hyperpigmentation, and progressive weakness.
The nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique would provide data necessary to support the admitting diagnosis?
1. Auscultation of lung sounds
2. Inspection of facial features
3. Percussion of the thyroid gland
4. Palpation of the adrenal glands
What is inspection of facial features.
Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and a blank expression that are characteristic of myxedema. The techniques in the remaining options will not reveal any data that would support the diagnosis of myxedema.
The nurse is reinforcing discharge instructions to a client who had a unilateral adrenalectomy. Which information should be a component of the instructions?
1. The reason for maintaining a diabetic diet
2. Instructions about early signs of a wound infection
3. Teaching regarding proper application of an ostomy pouch
4. The need for lifelong replacement of all adrenal hormones
What is instructions about early signs of a wound infection.
A client who is undergoing a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Because of the anti-inflammatory properties of corticosteroids, clients who undergo an adrenalectomy are at increased risk for developing wound infections. Because of this increased risk for infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection is present.
What is included in the treatment of Addison's disease? Select all that apply.
1. Radiation
2. Prednisone
3. Spironolactone
4. Adrenalectomy
5. Fludrocortisone
What is prednisone and fludrocortisone.
Addison's disease is treated with replacement therapy to provide the missing hormones, but the patient must continue taking the hormones as lifelong therapy. Prednisone is given to replace glucocorticoids; fludrocortisone is a synthetic adrenocortical steroid to replace the mineralocorticoid aldosterone.
The nurse working on an endocrine nursing unit understands that which correct concepts are used in planning care? Select all that apply.
1. Clients with hyperthyroidism must be monitored for weight gain.
2. Clients with Cushing's syndrome are likely to experience hypertension.
3. Clients who have hyperparathyroidism should be protected against falls.
4. Clients who have diabetes insipidus should be assessed for fluid excess.
5. Clients who have pheochromocytoma should be monitored for signs of orthostatic hypotension.
What is clients with cusihing's syndrome are likely to experience hypertension.
Clients who have hyperparathyroidism should be protected against falls.
Clients who have pheochromocytoma should be monitored for signs of orthostatic hypotension.
Hyperparathyroidism is a disease that involves excess secretion of parathyroid hormone (PTH). Elevation of PTH causes excess calcium to be removed from the bones. There is a decline in bone mass, which may cause a fracture if a fall occurs. Cushing's syndrome is likely to cause hypertension. Clients with hypothyroidism must be monitored for weight gain and clients with hyperthyroidism must be monitored for weight loss. Clients who have diabetes insipidus should be assessed for fluid deficit. Before surgery, the client with pheochromocytoma may be in hypertensive crisis and require close monitoring of vital signs and administration of IV antihypertensive medications. The client should be monitored for signs of orthostatic hypotension related to medication therapy.
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. Which intervention would be appropriate to decrease the client's anxiety?
1. Administer a sedative.
2. Convey empathy, trust, and respect toward the client.
3. Ignore the signs and symptoms of anxiety so that they will soon disappear.
4. Make sure the client knows all the correct medical terms so that he or she can understand what is happening.
What is Convey empathy, trust, and respect toward the client.
The appropriate intervention is to address the client's feelings related to the anxiety and to convey empathy, trust, and respect toward the client. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client's anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.
The nurse is caring for a client with hypothyroidism who is overweight. Which food items should the nurse suggest to include in the plan?
1. Organ meat, carrots, and skim milk
2. Seafood, spinach, and cream cheese
3. Peanut butter, avocado, and red meat
4. Skim milk, apples, whole-grain bread, and cereal
What is skim milk, apples, whole-grain bread, and cereal.
Clients with hypothyroidism may have a problem with being overweight because of their decreased metabolic need. They should consume foods from all food groups, which will provide them with the necessary nutrients; however, the foods should be low in calories. Option 4 is the only option that identifies food items that are low in calories.
The nurse is caring for a child with a diagnosis of diabetes insipidus. The nurse anticipates that the primary health care provider will prescribe which medications?
1.Methimazole
2. Furosemide
3. Propylthiouracil
4. Desmopressin acetate
What is desmopressin acetate.
Desmopressin acetate is used to treat diabetes insipidus. Propylthiouracil is used to treat hyperthyroidism. One of the uses for furosemide is to treat syndrome of inappropriate antidiuretic hormone (SIADH). Methimazole is also used to treat hyperthyroidism.