Diabetes
Addisons Disease
Cushing's Disease
Nursing Management
Thyroid Disorders
100
The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? A.“I will stop taking my insulin if I’m too sick to eat.” B. “I will decrease my insulin dose during times of illness.” C. “I will adjust my insulin dose according to the level of glucose in my urine.” D. “I will notify my health care provider (HCP) if my blood glucose level is higher than 250mg/dL.”
What is D. Answer: D Rationale: During illness, the client should monitor blood glucose levels and should notify the HCP if the level is higher than 250mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the HCP’s advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.
100
The nurse is admitting a client who has been diagnosed with primary adrenal cortex insufficiency (Addison disease). Which signs and symptoms support the diagnosis of Addison disease> a. Bronze pigmentation, hypotension, and anorexia b. Moon face, buffalo hump, and hyperglycemia c. Hirsutism, fever, and irritability d. Tachycardia, bulging eyes, and goiter
What is A Rationale: Bronze pigmentation of the skin, particularly of the knuckles and other areas of skin creases, occurs in Addison disease. Hypotension
and anorexia also occur. Moon face, buffalo hump, and hyperglycemia are due to Cushing syndrome, which is hyperfunction of the adrenal gland.
100
Cushing Syndrome causes the anterior pituitary gland to secret an excess amount of which hormone? A. CRH B. cortisol C. ACTH D. GH
What is C Answer: C Rationale: In patients with Cushing Syndrome, the anterior pituitary secretes an excess of ACTH. The hypothalmus secretes CRH. ACTH stimulates the release of cortisol and other gluccortiods. Cushing Syndrome does not cause an excess of GH to be released by the anterior pitutary.
100
Jabba complains to nurse Valentine about the development of hirsutism after abusing corticosteroid for her hemorrhoid. What is the most probable etiology for her newly found symptom? A. Addison’s disease B. Manal’s disease C. Prolactinoma D. Hemorrhoid
What is C Rationale: Cushing syndrome and prolactinoma are amongst the possible etiologies for hirsutism. Evidence can be found in Lewis p. 1146 Table 48.5. For further questions and complaints. please contact Sharon L. Lewis.
100
Causes of primary hypothyroidism in adults include a. malignant or benign thyroid nodules b. surgical removal or failure of the pituitary gland c. surgical removal or radiation of thyroid gland d. autoimmune-induced atrophy of the gland
What is D both Graves disease and Hasimotos thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure, and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.)
200
2. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? A. Polyuria B. Diaphoresis C. Hypertension D. Increased pulse rate
What is A Answer: A Rationale: Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Options C & D are not signs of hyperglycemia.
200
An ACTH stimulation test is commonly used to diagnose: a. Grave's disease b. Adrenal insufficiency and Addison's disease c. Cystic fibrosis d. Hashimoto's disease
What is B B: The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic adrenal insufficiency or Addison's disease generally do not respond with the expected increase in cortisol levels. An abnormal ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.
200
Sodium and water rentention seen in a client with Cushing's syndrome contribute to which of the following commonly seen disorder? A. Hypoglycemia and dehydration B. Hypotension and hypergylcemia C. Pulmnoary edema and dehydration D. Hypertension and heart failure
What is D Answer D Rationale: Increased mineralcorticoid in a client with Cushing's syndrome commonly contributes to hypertension and heart failure. Hypoglycemia and dehydration are uncommon in clients with Cushing's Syndrome. Diabetes mellitus may occur, but hypotension is not a part of the disease process. Pulmonary edema and dehydration are not a complication of Cushing's syndrome
200
Mr. Schons is about to undergo a free cortisol urine test. After patient teaching, which one of the following statements from Mr. Schons proves that the teaching was not in vain? A. “If my cortisol level is above the 90mcg/24hrs barrier then that’s when I know I’m healthy” B. “I will go lift hard in the evening to get myself pumped up for the test” C. “I can go 420 blaze it tonight with the boys” D. “I will stop studying for my med-surg finals tonight to cheer myself up before the test, you have my word as a Schons”
What is D Ding ding D: Rationale: The nursing responsibility during the free cortisol urine test is to instruct patient to avoid stressful situations and excessive physical exercise. Some drugs such as amphetamines, marijuana, etc may alter the results. Therefore, Mr. Schons shan’t lift hard nor should he 420 blaze it with the boys. A reference above 90mcg/24hrs is above the reference range and signify a cortisol excess typically found in Cushing disease. As a result, the remaining choice regarding avoidance of the med-surg final is the only logical choice to pick in this dilemma. Reference: pg. 1150 Table 48-6 Lewis 9th edition med-surg for nursing. You are very welcome.
200
A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find a. hoarseness and laryngeal stridor b. bulging eyeballs and arrhythmias c. elevated temperature and signs of heart failure d. lethargy progressing suddenly to impairment of consciousness
What is C a hyperthyroid crisis results in marked manifestations of hyperthyroidism, with fever tachycardia, heart failure, shock, hyperthermia, agitation, N/V/D, delirium, and coma. Although exophthalmos may be present in the patient with Gravs' dz, it is not a significant factor in hyperthyroid crisis. Hoarsness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism, and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.
300
The nurse is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply. A. Cakes, candies, cookies, and regular soft drinks should be avoided. B. Gestational diabetes increases the risk that the mother will develop diabetes later in life. C. Gestational diabetes usually resolves after the baby is born. D. Insulin injections may be necessary. E. The baby will likely be born with diabete F. The mother should strive to gain no more weight during the pregnancy.
What is A,B,C, D Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts. Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.
300
A patient with Addison's disease comes to the emergency department with complaints of N/V/D, and fever. The nurse would expect collaborative care to include a. parenteral injections of ACTH b. IV administration of vasopressors c. IV administration of hydrocortisone d. IV administration of D5W with 20mEq of KCl c. IV administration of hydrocortisone (rationale- vomiting and diarrhea are early indicators of addisonian crisis and fever indicates an infection, which s causing additional stress for the patient. treatment of a crisis requires immediate glucocorticoid replacement, and IV hydrocortisone, fluids, sodium and glucose are necessary for 24hours. Addison's disease is a primary insufficiency of the adrenal gland, and ACTH is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's. Potassium levels are increased in Addison's dz, and KCl would be contraindicated.)
What is c. IV administration of hydrocortisone (rationale- vomiting and diarrhea are early indicators of addisonian crisis and fever indicates an infection, which s causing additional stress for the patient. treatment of a crisis requires immediate glucocorticoid replacement, and IV hydrocortisone, fluids, sodium and glucose are necessary for 24hours. Addison's disease is a primary insufficiency of the adrenal gland, and ACTH is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's. Potassium levels are increased in Addison's dz, and KCl would be contraindicated.)
300
Which nursing intervention would you not implement with a patient who is Diagnosed with Cushing's Syndrome? A. Minimize stress in the environment B. Monitor vital signs; observe for hypertension, edema C. Tell patient to increase caloric intake to maintain body weight. D. Protect client from exposure to infection
What is C. Answer C Rationale: In patients with Cushing Syndrome, weight gain is a side effect, therefore monitoring caloric intake is an important aspect for the patient to monitor.
300
Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient a. how to support the head with the hands when moving b. that coughing should due avoided to prevent pressure on the incision c. that the head and neck will need to remain immobile until the incision heals d. that any tingling around the lips or in the fingers after surgery is expected and temporary
What is A to prevent strain on the suture line postoperatively, the head must be manually supported while turning and moving in bed, but range-of-motion exercise for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing, and they should be carrier out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery, and should be reported immediately
300
Physical changes of hypothyroidism that must be monitored when replacement therapy is started include a. achlorhydria and constipation b. slowed mental processes and lethargy c. anemia and increased capillary fragility d. decreased cardiac contractility and coronary atherosclerosis
What is D hypothyroidism affects the heart in many ways, causing cardiomyopathy, coronary atherosclerosis, bradycardia, pericardial effusions, and weakened cardiac contractility. when thyroid replacement therapy is started, myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac arrhythmias, and heart failures. It is important to monitor patients with compromised cardiac status when starting replacement therapy
400
The benefits of using an insulin pump include all of the following except: " A. By continuously providing insulin they eliminate the need for injections of insulin B. They simplify management of blood sugar and often improve A1C C. They enable exercise without compensatory carbohydrate consumption D. They help with weight loss
What is D Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.
400
The client diagnosed with possible Addison disease is admitted to the emergency department. The client is lethargic, confused, and weak. Which intervention should the emergency department implement first? a. Have the lab draw serum cortisol levels stat. b. Check the client’s medic alert bracelet to confirm Addison disease. c. Administer replacement steroids intravenously d. Start an intravenous line and administer normal saline rapidly.
What is B Correct answer B: Rationale: The nurse should look for an identification band alerting the health-care professional of a chronic disease and then start the intravenous line and administer steroids.
400
To prevent complications in the patient with Cushing syndrome, the nurse monitors the patient for a. hypotension b. hypoglycemia c. cardiac arrhythmias d. decreased cardiac output
What is C rationale- electrolyte changes that occur in Cushing syndrome include sodium retention and potassium excretion by the kidney, resulting in hypokalemia, which may lead to cardiac arrhythmias or arrest. Hypotension, hypoglycemia, and decreased cardiac strength and output are characteristic of adrenal insufficiency.)
400
A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect? a. Dysuria b. Leg cramps c. Tachycardia d. Blurred vision
What is C Answer C. Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren’t associated with levothyroxine.
400
A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse a. explains that caloric intake must be reduced when drug therapy is started b. provides written instruction for all information related to the medication therapy c. assures the patient that a return to normal function will occur with replacement therapy d. informs the patient that medications must be taken until hormone balance is reestablished
What is B (rationale- because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.)
500
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? A. Endotracheal intubation B. 100 units of NPH insulin C. Intravenous infusion of normal saline D. Intravenous infusion of sodium bicarbonate
What is C The primary goal of treatment is hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to rehydrate the client to restore the fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic keto acidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.
500
Nurse Troy is aware that the most appropriate for a client with Addison’s disease? a. Risk for infection b. Excessive fluid volume c. Urinary retention d. Hypothermia
What is A Answer A. Addison’s disease decreases the production of all adrenal hormones, compromising the body’s normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison’s disease include Deficient fluid volume and Hyperthermia. Urinary retention isn’t appropriate because Addison’s disease causes polyuria.
500
A doctor is seeing a client in the clinic and suspects that the client has Cushing Syndrome. The nurse may suspect the doctor will order which of the following tests to aid him/her in making their diagnosis: (Select all that apply) A. Blood chemistries for sodium, potassium, and glucose B. CBC with WBC differential C. CT scan and/or MRI D. 24-hour free cortisol test
What is A,B,D Answer: A, B, D Rationale: A. Blood chemistries for sodium, potassium, and glucose are used to detect hyperglycemia, hypokalemia, and hyperaldosteronism which are seen in clients with Cushing Syndrome. B. A CBC with WBC differential can detect the leukocytosis and lymphocytopenia, often seen in clients with Cushing Syndrome. C. A CT scan and or/MRI may be ordered after the diagnosis is made in the event the client needs surgery. D. A 24-hour free cortisol test determines if there are high levels of cortisol in the urine. Clients with Cushing Syndrome will have higher levels of cortisol in their urine.
500
An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting: a. 2 to 5 g of a simple carbohydrate. b. 10 to 15 g of a simple carbohydrate. c. 18 to 20 g of a simple carbohydrate. d. 25 to 30 g of a simple carbohydrate.
What is B Answer B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
500
Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina 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? a. Diabetic ketoacidosis b. Thyroid crisis c. Hypoglycemia d. Tetany
What is B Answer B. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
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