Endocrine system
Which gland controls phosphorous and Ca+ metabolism?
Parathyroid
You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient?
A. Fluid volume overload
B. Fluid volume deficient
C. Acute pain
D. Impaired skin integrity
Fluid volume overload
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention 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, anticipating that they will soon disappear.
4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.
Answer: 2
Rationale: Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client’s anxiety. The nurse should not ignore the client’s anxious feelings. Anxiety needs to be managed before meaningful client education can occur.
The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed?
1. Polyuria
2. Diaphoresis
3. Pedal edema
4. Decreased respiratory rate
Answer: 1
Rationale: Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus.
The nurse is caring for a client with diabetes who reports paresthesia in the toes and feet. Place the clinical events in order of development that may have contributed to this report:
A) Neuropathy develops
B) Peripheral nerves are damaged
C) Diabetes causes internal tissue damage
D) Blood is shunted away from small vessels to large vessels
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The nurse is caring for a client with diabetes who reports paresthesia in the toes and feet. Place the clinical events in order of development that may have contributed to this report:
A) Neuropathy develops
B) Peripheral nerves are damaged
C) Diabetes causes internal tissue damage
D) Blood is shunted away from small vessels to large vessels
C, D, B, A
Rationale: Diabetes (or onset of trauma or chronic disease) causes internal tissue damage--> Blood is shunted from small vessels to large vessels--> Peripheral nerves are damaged--> Neuropathy develops
An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first?
a. Obtain intravenous access.
b. Administer hydrocortisone succinate (Solu-Cortef).
c. Assess blood glucose.
d. Administer insulin and dextrose.
A
All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.
Which of the following signs and symptoms is NOT expected with Diabetes Insipidus?
A. Polyuria
B. Polydipsia
C. Polyphagia
D. Extreme thirst
Polyphagia
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply.
1.Increase in pH
2.Comatose state
3.Deep, rapid breathing
4.Decreased urine output
5.Elevated blood glucose level
Answer: 2, 3, 5
Rationale: Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid by-products of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul’s respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect, because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.
The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 70 mg/dL (3.9 mmol/L), temperature of 101° F (38.3° C), pulse of 82 beats per minute, respirations of 20 breaths per minute, and blood pressure of 118/68 mm Hg. Which finding would be the priority concern to the nurse?
1. Pulse
2. Respiration
3. Temperature
4. Blood pressure
Answer: 3
Rationale: In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.
A nurse is providing care for a client diagnosed with diabetes mellitus and peripheral neuropathy. Which nonpharmacologic treatment is appropriate for this client?
1) Daily foot care
2)Neurontin
3)Electromyography (EMG)
4)Nerve biopsy
daily foot care
S & S of hyperaldosteronism
Remember, if you encounter a patient with hyperaldosteronism, focus on monitoring electrolyte levels, managing blood pressure, and addressing the underlying cause.
Can cause life threatening renal and cardiac emergencies
The primary health care provider (PHCP) prescribes semaglutide for a client with type 1 diabetes mellitus who takes insulin. The nurse would plan to take which most appropriate intervention?
1. Withhold the medication and call the PHCP, questioning the prescription for the client.
2. Teach the client about the signs and symptoms of hypoglycemia and hyperglycemia.
3. Monitor the client for gastrointestinal side effects after administering the medication.
4. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.
Answer: 1
Rationale: Semaglutide is a glucagon-like peptide-1 agonist used for type 2 diabetes mellitus only. It is not recommended for clients with type 1 diabetes. Hence the nurse would withhold the medication and question the PHCP regarding this prescription. Although options 2 and 3 are correct statements about the medication, in this situation the medication would not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention 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, anticipating that they will soon disappear.
4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.
Answer: 2
Rationale: Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client’s anxiety. The nurse should not ignore the client’s anxious feelings. Anxiety needs to be managed before meaningful client education can occur.
Diabetic microvascular disease
What are the risk factors of diabetic retinopathy?
What are the risk factors of diabetic retinopathy?
1. Duration of diabetes
2. Poor glycaemic control
3. Hypertension
4. Smoking
5. Overweight and obesity
6. Pregnancy
In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion. What is the nurse's best action?
a. Request a "time-out" to determine whether this is a valid prescription.
b. Ask the client whether he or she usually takes prednisone.
c. Hold the dose because the client has a high cortisol level.
d. Administer the drug as prescribed.
d. although the client will have high amounts of cortisol due to hyperaldosteronism, post-surgery cortisol levels will decrease and stress on the body will increase. IV cortisol administration decreases the risk of post procedural adrenal crisis
The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions would the nurse anticipate receiving? Select all that apply.
1.Initiate an infusion of 3% NaCl.
2.Administer intravenous furosemide.
3.Restrict fluids to 800 mL over 24 hours.
4.Elevate the head of the bed to high-Fowler’s.
5.Administer a vasopressin antagonist as prescribed.
Answer: 1, 3, 5
Rationale: Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia.
Management is directed at correcting the hyponatremia and preventing cerebral edema.
Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed, and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia.
Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored.
To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.
The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus about measures to take if feeling sick to prevent diabetic ketoacidosis (DKA). The nurse recognizes accurate understanding of measures to prevent DKA when the client makes which statement?
1. “I will stop taking my insulin if I’m too sick to eat.”
2. “I will decrease my insulin dose during times of illness.”
3. “I will adjust my insulin dose according to the level of glucose in my urine.”
4. “I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L).”
Answer: 4
During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the PHCP if the level is higher than 250 mg/dL (13.9 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the PHCP’s advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.
Name 3 complications of microvascular disease
How does the body compensate for the retinal ischemia in diabetes retinopathy?
6 / 41
1. AV - shunt
2. Neovascularization (formation of new vessels)
A patient is scheduled for a bilateral adrenalectomy. Preoperatively, the patient is ordered by the doctor to take an alpha-adrenergic blocker. After administering a dose of this medication, what type of side effect will you monitor the patient for?
A. Bradypnea
B. Hyperglycemia
C. Reflex tachycardia
D. Hypertension
Reflex tachycardia
Alpha-adrenergic blockers (Cardura, Minipress, Hyrtin) block noradrenaline which reduces catecholamine. This will help decrease blood pressure and prevent hypertensive crisis during surgery. However, a side effect of this medication is reflex tachycardia due to the decrease in blood pressure. The heart will try to compensate by increasing the heart rate.
A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client?
1. Hoarseness
2. Hypocalcemia
3. Audible stridor
4. Edema at the surgical site
Answer: 3
Rationale: Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.
Test-Taking Strategy: Note the strategic word, priority. Use the ABCs—airway, breathing, and circulation—to assist in directing you to the correct option.
The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention?
1. Correct the acidosis.
2. Administer 5% dextrose intravenously.
3. Apply a monitor for an electrocardiogram.
4. Administer short-duration insulin intravenously.
Answer: 4
Rationale: Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration (normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.
Diabetes affects the feet mainly in two ways. These are:
A. Can cause nerve damage
B. Can cause hardening of the blood vessels
C. Both A and B are correct
Diabetes can affect the feet in two main ways. Firstly, it can cause nerve damage, known as diabetic neuropathy, which can result in loss of sensation, tingling, or pain in the feet. This can lead to injuries going unnoticed and untreated, increasing the risk of infections and ulcers. Secondly, diabetes can cause hardening of the blood vessels, known as peripheral arterial disease. This reduces blood flow to the feet, making it harder for wounds to heal and increasing the risk of infections. Therefore, both A (nerve damage) and B (hardening of blood vessels) are correct in terms of how diabetes affects the feet.
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful?
a. "Smokeless tobacco products decrease the risk of kidney damage."
b. "I can help control my blood pressure by avoiding foods high in salt."
c. "I should have yearly dilated eye examinations by an ophthalmologist."
d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful?
a. "Smokeless tobacco products decrease the risk of kidney damage."
b. "I can help control my blood pressure by avoiding foods high in salt."
c. "I should have yearly dilated eye examinations by an ophthalmologist."
d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
b. "I can help control my blood pressure by avoiding foods high in salt."
Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.