Snickers
A client is prescribed levothyroxine to take daily. What is the most important instruction to teach for administration of this drug?
1. Taper the dose and discontinue if mental and emotional problems stabilize.
2. Take the medication at bedtime to avoid the side effects of nausea and flatus.
3. Call the doctor immediately at the onset of palpitations or nervousness.
4. Decrease the intake of juices and fruits with high potassium and calcium contents.
Correct Answer: 3
Rationale:
Levothyroxine increases the metabolic rate of body tissues. Some serious side effects include cardiovascular collapse, dysrhythmias, and tachycardia. Because of these side effects, clients should be instructed not to take the medication if their pulse is greater than 100 beats/min and to notify their provider of headaches, nervousness, chest pain, palpitations, or any unusual symptoms. (Lehne, 8 ed., p. 743.)
A client with a diagnosis of type 2 diabetes has been ordered a course of prednisone for severe arthritic pain. Which expected change requires close monitoring by the nurse?
1. Increased blood glucose level
2. Increased platelet aggregation
3. Increased creatinine clearance
4. Decreased white blood cell (WBC) count
Correct Answer: 1
Rationale:
An adverse reaction to corticosteroids is hyperglycemia. A client with type 2 diabetes must monitor blood glucose levels closely while taking steroids. Creatinine clearance measures renal function. Platelet aggregation is associated with hematologic disorders. Clients taking corticosteroids are at increased risk for infection as a result of suppressed immune response, not a decrease in WBCs.
It is important for the nurse to teach the client which of the following about metformin?
1. It may cause constipation.
2. It should be taken at night.
3. It should be taken with meals.
4. It may increase the effects of aspirin.
Correct Answer: 3
Rationale:
Metformin is administered with meals to minimize gastrointestinal (GI) effects. These adverse effects are abdominal bloating, diarrhea, nausea, vomiting, and an unpleasant metallic taste. Metformin interacts with alcohol and cimetidine and is contraindicated in clients with compromised renal function, heart failure, and liver disease.
When caring for a client in a thyroid crisis, which order would the nurse question?
1. IV fluids
2. Propranolol
3. Propylthiouracil (PTU)
4. A hyperthermia blanket
Correct Answer: 4
Rationale:
Fever (hyperthermia) is a symptom of thyroid storm. The correct treatment would be a hypothermia blanket to cool the client. All other choices (IV fluids, propranolol, and PTU) are appropriate interventions for this diagnosis.
Which medication will the nurse have available for emergency treatment of tetany in the client who has had a thyroidectomy?
1. Calcium chloride
2. Potassium chloride
3. Magnesium sulfate
4. Propylthiouracil (PTU)
Correct Answer: 1
Rationale:
Calcium chloride or calcium gluconate should be available to treat tetany caused by accidental removal of the parathyroid glands during surgery. The parathyroid glands regulate calcium metabolism. Potassium chloride replaces the electrolyte potassium. Magnesium sulfate is used in the treatment of preeclampsia (i.e., pregnancy-induced hypertension). Propylthiouracil is an antithyroid medication used to block production of thyroid hormones.
A client with diabetes receives 10 units of regular insulin at 6:00 am and does not eat breakfast. Around noon, what observation would the nurse expect to see?
1. Polydipsia
2. Polyphagia
3. Polyuria
4. Diaphoresis
Correct Answer: 4
Rationale:
The nurse would expect symptoms of hypoglycemia, which include diaphoresis, shakiness, fatigue, hunger, and low blood sugar. The three Ps—polydipsia, polyphagia, and polyuria—are observed in hyperglycemia.
What is the primary action of insulin in the body?
1. Enhances the transport of glucose across cell walls
2. Aids in the process of gluconeogenesis
3. Stimulates the pancreatic beta cells
4. Decreases the intestinal absorption of glucose
Correct Answer: 1
Rationale:
Insulin acts to lower the blood sugar level, primarily by improving the transport of glucose into the cells. It is the principal regulator of the metabolism and storage of fats, carbohydrates, and proteins. It is a hormone produced in the beta cells in the islets of Langerhans of the pancreas. The rise in insulin after a meal stimulates the conversion of glucose to glycogen, inhibits gluconeogenesis, enhances fat deposition, and increases protein synthesis. It does not decrease intestinal absorption of glucose but works in the bloodstream to promote glucose transport across the cell membrane to the cytoplasm of the cell.
The nurse is administering metformin to a client. Which observation indicates a therapeutic response to this medication?
1. Blood sugar level maintained at 90 to 100 mg/dL (5.0 to 5.6 mmol/L)
2. Decrease in the serum uric acid levels
3. Urine output increased to 60 mL/hr
4. BP increased to 120/80 mm Hg
Correct Answer: 1
Rationale:
Metformin is an oral antidiabetic medication in the biguanides category used for the control of adult-onset (type 2) diabetes. The desired response is a normal blood sugar level, which is 70 to 120 mg/dL (3.9 to 6.7 mmol/L).
The nurse is teaching a client about taking a thyroid replacement hormone. Which should be included as symptoms to watch for associated with overdose?
1. Dry skin, tremors, and weight gain
2. Sneezing, coughing, and insomnia
3. Tachycardia, angina, and nervousness
4. Bradycardia, somnolence, and sweating
Correct Answer: 3
Rationale:
The client should be taught signs of thyroid hormone overdose, which are tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremor, and weight loss. If the dosage is especially large, then a thyrotoxic crisis may occur.
The nurse would expect which medication to be part of a maintenance therapy treatment plan for hypoparathyroidism?
1. Phosphorus supplements
2. Parenteral parathyroid hormone
3. Calcium supplements
4. Vitamin C
Correct Answer: 3
Rationale:
Clients with hypoparathyroidism require long-term drug therapy with oral calcium supplements. Hormone replacement (parathyroid hormone) is not used for treatment because of the expense and the need for parenteral replacement. Vitamin C is not used in the treatment of hypoparathyroidism.
Which statement describes correct administration of insulin lispro?
1. It needs to be taken after meals.
2. It should be taken within 15 minutes of beginning a meal.
3. It is to be taken once daily at the noon meal.
4. It is taken only in the evenings with a snack before bedtime.
Correct Answer: 2
Rationale:
Rapid-acting insulins, such as insulin lispro and insulin aspart, can more closely mimic the body's natural rapid insulin output after consumption of a meal, which is why both medications usually are administered within 15 minutes before or after a meal. (Lehne, 8 ed., p. 712.)
The nurse is teaching the parents of a child who is experiencing difficulty with control of his diabetes. Which agent should the nurse teach the parents to administer if their child loses consciousness and has a severe hypoglycemic reaction?
1. IV dextrose
2. SubQ insulin
3. SubQ glucagon
4. Oral fast-acting carbohydrate
Correct Answer: 3
Rationale:
If the child has a severe hypoglycemic episode, he frequently is neurologically compromised. It is important to administer subQ or IM glucagon. SubQ insulin would further worsen the child's condition. IV dextrose would be given in the hospital. Oral administration of fast-acting carbohydrates is reserved for the conscious child who is not having a severe hypoglycemic reaction.
A client with type 1 diabetes calls the nurse because of nausea and not feeling well. What would be important for the nurse to tell the client?
1. "Hold the oral hypoglycemics until you can begin eating again."
2. "Take the insulin as scheduled, increase water intake, and continue to monitor your blood glucose."
3. "Take your regular dose of insulin, replace food with fruit juices, and monitor your blood glucose."
4. "Do not take any insulin as long as you are nauseous and cannot maintain intake."
Correct Answer: 3
Rationale:
This client is on insulin for diabetic control. He or she should continue taking the regularly scheduled dose of insulin and eating the prescribed diet, as well as increasing the amount of low-calorie fluids (e.g., broth, water, decaffeinated tea). If the client is unable to consume solid foods or keep food down, then caloric intake can be increased by drinking carbohydrate fluids (e.g., juices and soups). It is important for the client to check his or her blood glucose levels every 4 hours. Additionally, for the type 1 diabetic client with blood glucose levels greater than 240 mg/dL, urine testing for ketones every 3 to 4 hours is required, and findings should be reported to the health care provider. The blood sugar may continue to rise because of the illness, which is why it is important to continue medication.
The nurse is caring for a client in diabetic ketoacidosis (DKA). An order exists for insulin to be added to the current infusing IV. What type of insulin will the nurse use?
1. Insulin detemir
2. Regular insulin
3. NPH insulin
4. Insulin glargine
Correct Answer: 2
Rationale:
Regular insulin and the rapid acting insulins (i.e., insulin lispro, insulin aspart, and insulin glulisine) are the only forms of insulin recommended for IV use. The rapid- and slower-acting insulins are clear. All the other insulins are for subQ injection or are cloudy.
A client states that he has been maintaining good control of his diabetes. What value would be reflected in an A1C level?
1. Less than 7%
2. Greater than 8%
3. Less than 10%
4. Between 11% and 13%
Correct Answer: 1
Rationale:
For good diabetic blood sugar control, the A1C level should be lower than 7%. The serum test result reflects about 120 days of average control of the blood sugar level.
A client with diabetes asks the nurse about the A1C test. What is the nurse's best response regarding the purpose of this test?
1. "It determines how close the client is to having an insulin reaction."
2. "It reflects blood glucose control for 3 months before the current status."
3. "It determines how much glucose is excreted over a 24-hour control period."
4. "It helps determine the amount of retinopathy the client is experiencing."
Correct Answer: 2
Rationale:
The A1C test provides information regarding the client's control of blood sugar for about 120 days or 3 months. This is beneficial for clients who experience fluctuations in control. It measures the reaction when the glucose combines with the hemoglobin molecule and is indicative of the general blood sugar control the client has had over the previous 3 to 4 months. It is not influenced by the type of treatment, the current level of blood sugar, or the client's intake over the past several hours. An A1C of more than 6.5% indicates an increased risk of microvascular disease such as retinopathy.
After a thyroidectomy, the nurse assesses the client for possible complications. The nurse determines the client is experiencing tingling and numbness of the fingers and toes, muscle twitching, and muscle spasms. What complication may be developing?
1. Hypocalcemia
2. Hypovolemia
3. Hyponatremia
4. Hypokalemia
Correct Answer: 1
Rationale:
Accidental removal or damage to the parathyroid glands, which regulate calcium metabolism, can occur during a thyroidectomy. The symptoms of a decreased calcium level (hypocalcemia, tetany) relate to the decrease in the calcium levels secondary to a decrease in the parathyroid hormone level.
Which finding is an initial urinary sign or symptom of diabetes mellitus in a client?
1. Dysuria
2. Hematuria
3. Urgency
4. Polyuria
Correct Answer: 4
Rationale:
An initial urinary symptom of diabetes mellitus is polyuria, which is produced by the osmotic effect of glucose. Dysuria is a clinical finding associated with bladder inflammation, trauma, or inflammation of the urethral sphincter. Urgency may be caused by a full bladder, bladder irritation from infection, incompetent urethral sphincter, or psychological stress. Hematuria is noted with conditions such as neoplasms of the bladder or kidney, glomerular disease, infection of the kidney or bladder, trauma to urinary structures, calculi, or bleeding disorders.
A client newly diagnosed with type 1 diabetes mellitus is learning about diabetic foot care. What will the nurse instruct the client to avoid?
1. Emollient lotions
2. Foot powder
3. Foot soaks
4. Nail files
Correct Answer: 3
Rationale:
Foot soaks macerate the skin and can increase the risk of breaks in the skin. Water-soluble lotions are recommended to moisturize the feet. Nail files are preferred over nail clippers or scissors. Foot powder may be used when foot perspiration exists.
A client with diabetes mellitus calls the office nurse to review insulin administration sick day rules. Which statement indicates a need for further instruction?
1. "I will hold my insulin if I am feeling sick."
2. "I should call the office if I am sick more than 2 days."
3. "If I am sick, I will check my blood glucose every 4 hours."
4. "When not feeling well, I should increase my intake of fluids."
Correct Answer: 1
Rationale:
Insulin should be taken consistently especially when sick. The stress response created by illness can make the blood sugar increase. Checking blood sugar more frequently is recommended. Fluids are recommended. If the sugar is running low, then fluids with sugar are recommended. If the blood sugar is running high, then fluids without sugar are recommended. Illnesses lasting longer than 2 days should be investigated.
The nurse is assessing an 80-year-old client with type 2 diabetes. The assessment findings include rapid, deep, respirations at a rate of 36 breaths/min. Lethargy and tachycardia are present. What would the symptoms most indicate?
1. Hyponatremia
2. Hypoglycemia
3. Diabetic ketoaidosis (DKA)
4. Hyperglycemic hyperosmolar syndrome (HHS)
Correct Answer: 4
Rationale:
Kussmaul respirations, which are deep, regular, sighing respirations with tachypnea, along with the presence of tachycardia and CNS symptoms (lethargy) correlate with hyperglycemia. Because of the client's age, the problem would most likely be HHS (formerly known as hyperglycemic-hyperosmolar nonketotic syndrome [HHNS]). DKA occurs most often in younger clients with type 1 diabetes. Hypoglycemia is a low blood glucose level. In DKA and in HHS, the blood glucose level is greater than 300 mg/dL (16.7 mmol/L). The sodium levels may be high, low, or normal.
An adolescent with type 1 diabetes mellitus is experiencing a problem with diabetic ketoacidosis (DKA). Which laboratory results reflect this condition?
1. Hematocrit of 37%
2. Serum glucose level of 150 mg/dL (8.3 mmol/L)
3. Blood pH of 7.28
4. Serum creatinine level of 5.6 mg/dL (495 μmol/L)
Correct Answer: 3
Rationale:
DKA is reflected in the decreased pH (7.28), which indicates metabolic acidosis. This often is accompanied by an increased temperature and urine output, dry mouth, abdominal pain, flushing, decreased energy, and an elevated blood glucose level greater than 300 mg/dL (16.7 mmol/L). The hematocrit is within normal range. The serum glucose is not high enough for DKA (usually the value is greater than 250 mg/dL [13.9 mmol/L]). Creatinine is elevated to three times more than normal, but this would not necessarily reflect DKA, because it is associated more with diabetic nephropathy.
The nurse would understand that moist skin with fine hair, prominent eyes, lid retraction, and a staring expression are characteristics associated with which disease process?
1. Graves disease
2. Multiple sclerosis
3. Cushing's syndrome
4. Diabetes
Correct Answer: 1
Rationale:
Graves disease, or hyperthyroidism, is an autoimmune disorder affecting the thyroid gland that has the following symptoms: moist skin, fine hair, prominent eyes, tachycardia, hypertension, and a staring expression. Multiple sclerosis is an autoimmune disorder of the nervous system characterized by muscle weakness and visual field disturbances (diplopia). Cushing's syndrome is caused by hypersecretion of corticosteroids by the adrenal glands and is characterized by thinning hair, hirsutism in women, gynecomastia in men, moon face, buffalo hump, abdominal striae, weight gain, truncal obesity, thin limbs, acne, hypertension, and mood changes. Diabetes is characterized by polyuria, polyphagia, and polydipsia.
An insulin-dependent client wakes up at 3:00 am and calls the nurse complaining of slight headache, nausea, and trembling. While the nurse assesses the client, she notices that his extremities are cool and moist. What would be a priority nursing intervention?
1. Call the laboratory for a stat blood glucose.
2. Administer acetaminophen and aprepitant.
3. Have the client drink a glass of orange juice.
4. Use a glucometer to obtain a capillary blood glucose.
Correct Answer: 4
Rationale:
The client's symptoms indicate hypoglycemia and should be confirmed with a quick bedside glucometer test. Because the client is insulin dependent, the blood glucose should be assessed initially in the most expedient manner (i.e., bedside glucometer). When the blood sugar value is known, the nurse could offer orange juice. It is not necessary to administer medications such as acetaminophen and aprepitant because the pain and nausea should subside after the blood sugar is increased to normal levels.
A client had her thyroid gland surgically removed because of hyperthyroidism. The nurse is assessing for complications on the first postoperative day. What symptoms would confirm the client is experiencing a complication?
1. Muscle spasms and a positive Chvostek sign
2. A rash over the trunk and decreased peristalsis
3. Back pain with nausea and vomiting
4. Urinary output of 300 mL in 8 hours
Correct Answer: 1
Rationale:
Tetany is a post operative complication of thyroidectomy surgery. This may occur if the parathyroid glands were accidentally damaged or removed. The problem occurs because of low calcium levels. The symptoms of tetany are muscle spasms and positive Chvostek and Trousseau signs.