Diabetes Mellitus: Multiple Choice Questions and Answers, Exams of Nursing

Download Diabetes Mellitus: Multiple Choice Questions and Answers and more Exams Nursing in PDF only on Docsity! A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to ini;ate which an;cipated health care provider's prescrip;on? 1. Endotracheal intuba;on 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate Intravenous infusion of normal saline The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabe;c ketoacidosis (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 SAUNDERS NCLEX ENDOCRINE 2024/2025 FINAL EXAM (QUESTIONS AND VERIFIED ANSWERS) RATED A+ drop in serum potassium levels. Intuba;on and mechanical ven;la;on are not required to treat HHS. An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the func;oning of the pump, the nurse bases the response on which informa;on about the pump? 1. It is ;med to release programmed doses of either short-dura;on or NPH insulin into the bloodstream at specific intervals. 2. It con;nuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3. It is surgically aVached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. 4. It administers a small con;nuous dose of short-dura;on insulin subcutaneously. The client can self-administer an addi;onal bolus dose from the pump before each meal. It administers a small con;nuous dose of short-dura;on insulin subcutaneously. The client can self-administer an addi;onal bolus dose from the pump before each meal. An insulin pump provides a small con;nuous dose of short-dura;on (rapid- or short-ac;ng) insulin subcutaneously throughout the day and night. The client can self-administer an addi;onal bolus dose from the pump before each meal 6. Fruity breath odor 2. Shakiness 3. Palpita;ons 5. Lightheadedness Shakiness, palpita;ons, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifesta;ons of hyperglycemia. A client with diabetes mellitus demonstrates acute anxiety when admiVed to the hospital for the treatment of hyperglycemia. What is the appropriate interven;on to decrease the client's anxiety? 1. Administer a seda;ve. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety, an;cipa;ng 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. Convey empathy, trust, and respect toward the client. Anxiety is a subjec;ve feeling of apprehension, uneasiness, or dread. The appropriate interven;on is to address the client's feelings related to the anxiety. Administering a seda;ve is not the most appropriate interven;on 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 educa;on can occur. The nurse provides instruc;ons to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabe;c ketoacidosis 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 ;mes of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will no;fy my health care provider (HCP) if my blood glucose level is higher than 250 mg/dl (14.2 mmol/L)." "I will no;fy my health care provider (HCP) if my blood glucose level is higher than 250 mg/dl (14.2 mmol/L)." During illness, the client with type 1 diabetes mellitus is at increased risk of diabe;c 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 no;fy the HCP if the level is higher than 250 mg/dl (14.2 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during ;mes 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. A client is admiVed to a hospital with a diagnosis of diabe;c ketoacidosis (DKA). The ini;al blood glucose level is 950 mg/dl (54.2 mmol/L). A con;nuous intravenous (IV) infusion of short-ac;ng insulin is ini;ated, along with IV rehydra;on with normal saline. The serum glucose level is now decreased to 240 mg/dl (13.7 mmol/L). The nurse would next prepare to administer which medica;on? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the preven;on of seizures IV fluids containing dextrose Emergency management of DKA focuses on correc;ng fluid and electrolyte imbalances and normalizing the serum glucose level. If the correc;ons occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the health care provider (HCP) because of these symptoms." "I need to stop my insulin." When a client with diabetes mellitus is unable to eat normally because of illness, the client s;ll should take the prescribed insulin or oral medica;on. The client should consume addi;onal fluids and should no;fy the HCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones during illness. The nurse is caring for a client ager hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which ini;al ac;on? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Con;nue to observe the drainage. Test the drainage for glucose. Ager hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if posi;ve, this would indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Con;nuing to observe the drainage without taking ac;on could result in a serious complica;on. The nurse is admi ng a client who is diagnosed with syndrome of inappropriate an;diure;c hormone secre;on (SIADH) and has serum sodium of 118 meq/L (118 mmol/L). Which health care provider prescrip;ons should the nurse an;cipate receiving? Select all that apply. 1. Ini;ate 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. 1. Ini;ate an infusion of 3% nacl. 3. Restrict fluids to 800 ml over 24 hours. 5. Administer a vasopressin antagonist as prescribed Clients with SIADH experience excess secre;on of an;diure;c hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilu;onal hyponatremia. Management is directed at correc;ng the hyponatremia and preven;ng 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 restric;on is a useful strategy aimed at correc;ng dilu;onal hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilu;onal 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 supplementa;on 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 to avoid s;mula;ng stretch receptors in the heart that signal to the pituitary that more ADH is needed. A client is admiVed to an emergency department, and a diagnosis of myxedema coma is made. Which ac;on should the nurse prepare to carry out ini;ally? hypoglycemic reac;on may occur in response to increased exercise, so clients should exercise either an hour ager meal;me or ager consuming a 10- to 15- gram carbohydrate snack, and they should check their blood glucose level before exercising. Op;on 1 is incorrect because clients with diabetes should exercise, though they should check with their health care provider before star;ng a new exercise program. Op;on 3 in incorrect; clients should avoid exercise during the peak ;me of insulin. NPH insulin peaks at 4 to 12 hours; therefore, agernoon exercise takes place during the peak of the medica;on. Op;ons 4 is incorrect; NPH insulin in an intermediate-ac;ng insulin, not a basal insulin. The nurse is comple;ng an assessment on a client who is being admiVed for a diagnos;c workup for primary hyperparathyroidism. Which client complaint would be characteris;c of this disorder? Select all that apply. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain 1. Polyuria 3. Bone pain The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorp;on (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmo;c diuresis and thus polyuria. This diuresis leads to dehydra;on (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Op;ons 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointes;nal symptoms include anorexia, nausea, vomi;ng, and cons;pa;on. The nurse is teaching a client with hyperparathyroidism how to manage the condi;on at home. Which response by the client indicates the need for addi;onal teaching? 1. "I should limit my fluids to 1 liter per day." 2. "I should use my treadmill or go for walks daily." 3. "I should follow a moderate-calcium, high-fiber diet." 4. "My alendronate helps to keep calcium from coming out of my bones." "I should limit my fluids to 1 liter per day." In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secre;on. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorp;on (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to 2 liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical ac;vity, par;cularly weight-bearing ac;vity, minimizes bone resorp;on and helps to protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Clients should follow a moderate-calcium, high-fiber diet. Even though serum calcium is already high, clients should follow a moderate-calcium diet because a low-calcium diet will surge PTH. Calcium causes cons;pa;on, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorp;on. In bone resorp;on, bone is broken down and calcium is deposited into the serum. A client with a diagnosis of Addisonian crisis is being admiVed to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia with this disorder? 1. A urinary output of 50 ml/hour 2. A coagula;on ;me of 5 minutes 3. A heart rate that is 90 beats/minute and irregular 4. A blood urea nitrogen level of 20 mg/dl (7.1 mmol/L) A heart rate that is 90 beats/minute and irregular Pheochromocytoma is a catecholamine-producing tumor usually found in the adrenal medulla, but extraadrenal loca;ons include the chest, bladder, abdomen, and brain; it is typically a benign tumor but can be malignant. Excessive amounts of epinephrine and norepinephrine are secreted. The complica;ons associated with pheochromocytoma include hypertensive re;nopathy and nephropathy, myocardi;s, increased platelet aggrega;on, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissec;ng aor;c aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A coagula;on ;me of 5 minutes is normal. A urinary output of 50 ml/hour is an adequate output. A blood urea nitrogen level of 20 mg/dl (7.1 mmol/L) is a normal finding. The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postopera;ve complica;on? Select all that apply. 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 ml/hour 5. Clear drainage on nasal dripper pad 2. Leukocytosis 4. Urinary output of 800 ml/hour 5. Clear drainage on nasal dripper pad Acromegaly results from excess secre;on of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or par;al hypophysectomy. The sublingual transsphenoidal approach is ogen through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery and infec;on is a primary concern. Leukocytosis, or an elevated white count, may indicate infec;on. Diabetes insipidus is a possible complica;on of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secre;on of an;diure;c hormone and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is sugges;ve of a cerebrospinal fluid leak. The surgeon should be no;fied and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postopera;ve risk of meningi;s. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no associa;on with complica;ons of sublingual transsphenoidal hypophysectomy. The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fas;ng blood glucose level of 120 mg/dl (6.8 mmol/L), temperature of 101°F (38.3°C), pulse of 102 beats/minute, respira;ons of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respira;on 3. Temperature 4. Blood pressure that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia 1. Fever 2. Nausea 4. Tremors 5. Confusion Thyroid storm is an acute and life-threatening complica;on that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addi;on, as the condi;on progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia. The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preopera;ve teaching instruc;ons should include which statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate ager surgery." 4. "Brushing your teeth needs to be avoided for at least 2 weeks ager surgery." "Brushing your teeth needs to be avoided for at least 2 weeks ager surgery." A transsphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland. Based on the loca;on of the surgical procedure, spinal anesthesia would not be used. In addi;on, the hair would not be shaved. Although ambula;ng is important, specific to this procedure is avoiding brushing the teeth to prevent disrup;on of the surgical site. The nurse should include which interven;ons in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine prepara;ons will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur. The clinical manifesta;ons of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interven;ons are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client ogen has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduc;on and high 4. Exercise is best performed during peak ;mes of insulin. Take a blood glucose test before exercising. A blood glucose test performed before exercising provides the client with informa;on regarding the need to consume a snack before exercising. Exercising during the peak ;mes of insulin or before meal;me places the client at risk for hypoglycemia. Insulin should be administered as prescribed. The nurse should include which interven;ons in the plan of care for a client with hyperthyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. The clinical manifesta;ons of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interven;ons are aimed at reduc;on of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client ogen has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condi;on experience increased appe;te. Iodine prepara;ons are used to treat hyperthyroidism. Iodine prepara;ons decrease blood flow through the thyroid gland and reduce the produc;on and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would no;fy the health care provider if chest pain occurs because it could be an indica;on of an excessive medica;on dose. A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call the health care provider (HCP) the next ;me I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1. The client needs immediate educa;on before discharge. 2. The client requires follow-up teaching regarding the administra;on of oral an;diabe;cs. 3. The client's statement is inaccurate, and he or she should be scheduled for outpa;ent diabe;c counseling. 4. The client's statement is inaccurate, and he or she should be scheduled for educa;onal home health visits. The client needs immediate educa;on before discharge. If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the HCP should be no;fied. The client's statement indicates a need for immediate educa;on to prevent hyperosmolar hyperglycemic syndrome (HHS), a life-threatening emergency. Although all of the other op;ons may be true, the most appropriate analysis is that the client requires immediate educa;on. A client with type 1 diabetes mellitus is having trouble remembering the types, dura;on, and onset of the ac;on of insulin. The client tells the nurse that family members have not been suppor;ve. Which response by the nurse is best? 1. "What is it that you don't understand?" 2. "You can't always depend on your family to help." 3. short-ac;ng insulin and is not appropriate for the emergency treatment of DKA. The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 110 mg/dl (6.28 mmol/L) 3. A potassium (K+) level of 3.0 meq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L) A potassium (K+) level of 3.0 meq/L (3.0 mmol/L) The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cor;sol and adrenocor;cotropic hormone levels. These abnormali;es are caused by the effects of excess glucocor;coids and mineralocor;coids in the body. The laboratory values listed in the remaining op;ons would not be noted in the client with Cushing's syndrome. The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1. Unresponsive pupils 2. Posi;ve Trousseau's sign 3. Nega;ve Chvostek's sign 4. Hyperac;ve bowel sounds Posi;ve Trousseau's sign Hypoparathyroidism is related to a lack of parathyroid hormone secre;on or a decreased effec;veness of parathyroid hormone on target ;ssues. The end result of this disorder is hypocalcemia. When serum calcium levels are cri;cally low, the client may exhibit Chvostek's and Trousseau's signs, which indicate poten;al tetany. The remaining op;ons are not related to the presence of hypocalcemia. The nurse is providing instruc;ons to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complica;on should be included on the list? 1. Shakiness 2. Increased thirst 3. Profuse swea;ng 4. Decreased urine output Increased thirst The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse swea;ng and shakiness would be noted in a hypoglycemic condi;on. The emergency department nurse is preparing a plan for ini;al care of a client with a diagnosis of hyperosmolar hyperglycemic syndrome (HHS). The nurse recognizes that the hyperglycemia associated with this disorder results from which occurrence? 1. Increased use of glucose 2. Overproduc;on of insulin 3. Increased produc;on of glucose 4. Increased osmo;c movement of water Increased produc;on of glucose Hyperglycemia results from decreased use and increased produc;on of glucose. Increased use of glucose and overproduc;on of insulin would most likely cause hypoglycemia. Op;on 4 is incorrect. 4. Hypertension Hypertension Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifesta;ons of pheochromocytoma; however, they are not major symptoms. The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which should the nurse expect to note on assessment of the client? 1. Skin atrophy 2. The presence of sunken eyes 3. Drooping on 1 side of the face 4. A rounded "moonlike" appearance to the face A rounded "moonlike" appearance to the face With excessive secre;on of adrenocor;cotropic hormone (ACTH) and chronic cor;costeroid use, the person with Cushing's syndrome develops a rounded moonlike face; prominent jowls; red cheeks; and hirsu;sm on the upper lip, lower cheek, and chin. The remaining op;ons are not associated with the assessment findings in Cushing's syndrome The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors Dry skin Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining op;ons are noted in the client with hyperthyroidism. The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Bulging eyeballs 3. Periorbital edema 4. Coarse facial features Bulging eyeballs Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifesta;ons include nervousness, fa;gue, weight loss, muscle cramps, and heat intolerance. Addi;onal signs found in this disorder include tachycardia; shortness of breath; excessive swea;ng; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance. The nurse has provided instruc;ons for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instruc;ons by iden;fying which method as the best method for monitoring blood glucose levels? 1. "I will check my blood glucose level every day at 5:00 p.m." 2. "I will check my blood glucose level 1 hour ager each meal." 3. "I will check my blood glucose level 2 hours ager each meal." 4. "I will check my blood glucose level before each meal and at bed;me." "I will check my blood glucose level before each meal and at bed;me. The most effec;ve and accurate measure for tes;ng blood glucose is to test the 3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4. Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. The ini;al step in preparing an injec;on of insulin that is a mixture of NPH and regular insulin is to inject air into the NPH insulin boVle equal to the amount of insulin prescribed. The client would then be instructed to inject an amount of air equal to the amount of prescribed insulin into the regular insulin boVle. The regular insulin would then be withdrawn, followed by the NPH insulin. Contamina;on of regular insulin with NPH insulin will convert part of the regular insulin into a longer ac;ng form. The nurse is reviewing the health care provider's (HCP's) prescrip;ons for a client with a diagnosis of diabetes mellitus who has been hospitalized for treatment of an infected foot ulcer. The nurse expects to note which finding in the HCP's prescrip;ons? 1. A decreased-calorie diet 2. An increased-calorie diet 3. A decreased amount of NPH insulin daily insulin 4. An increased amount of NPH insulin daily insulin An increased amount of NPH insulin daily insulin Infec;on is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress, such as when an infec;on is present, an increase in the dose of insulin will be required to facilitate the transport of excess glucose into the cells. The client will not necessarily need an adjustment in the daily diet. The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifesta;ons are associated with this complica;on? 1. Slow pulse; lethargy; warm, dry skin 2. Elevated pulse; lethargy; warm, dry skin 3. Elevated pulse; shakiness; cool, clammy skin 4. Slow pulse, confusion, increased urine output Elevated pulse; shakiness; cool, clammy skin Signs and symptoms of mild hypoglycemia include tachycardia; shakiness; and cool, clammy skin. The remaining op;ons do not specify the manifesta;ons of hypoglycemia. The home care nurse is visi;ng a client newly diagnosed with diabetes mellitus. The client tells the nurse that he is planning to eat dinner at a local restaurant this week. The client asks the nurse if ea;ng at a restaurant will affect diabe;c control and if this is allowed. Which nursing response is most appropriate? 1. "You are not allowed to eat in restaurants." 2. "You should order a half-por;on meal and have fresh fruit for dessert." 3. "If you plan to eat in a restaurant, you need to skip the lunch;me meal." 4. "You should increase your daily dose of insulin by half on the day that you plan to eat in the restaurant." "You should order a half-por;on meal and have fresh fruit for dessert." Clients with diabetes mellitus are instructed to make adjustments in their total daily intake to plan for meals at restaurants or par;es. Some useful strategies include ordering a half-por;on, salads with dressing on the side, fresh fruit for dessert, and baked or steamed entrees. Clients are not instructed to skip meals or increase their prescribed insulin dosage. The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing ac;ons should be included in the care plan for this client? Select all that apply. 4. Complaints of weakness and hypertension Hypotension and fever The nurse should be alert to signs and symptoms of adrenal insufficiency ager adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining op;ons are incorrect. The nurse is providing home care instruc;ons to the client with a diagnosis of Cushing's syndrome and prepares a list of instruc;ons for the client. Which instruc;ons should be included on the list? Select all that apply. 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instruc;ons to take the medica;ons exactly as prescribed 4. The importance of maintaining regular outpa;ent follow-up care 5. A reminder to read the labels on over-the-counter medica;ons before purchase 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instruc;ons to take the medica;ons exactly as prescribed 4. The importance of maintaining regular outpa;ent follow-up care The client with Cushing's syndrome should be instructed to take the medica;ons exactly as prescribed. The nurse should emphasize the importance of con;nuing medica;ons, consul;ng with the health care provider (HCP) before purchasing any over-the-counter medica;ons, and maintaining regular outpa;ent follow-up care. The nurse also should instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism. The nurse is developing a plan of care for a client with Addison's disease. The nurse has iden;fied a problem of risk for deficient fluid volume and iden;fies nursing interven;ons that will prevent this occurrence. Which nursing interven;ons should the nurse include in the plan of care? Select all that apply. 1. Monitor for changes in menta;on. 2. Encourage an intake of low-protein foods. 3. Encourage an intake of low-sodium foods. 4. Encourage fluid intake of at least 3000 ml per day. 5. Monitor vital signs, skin turgor, and intake and output. 1. Monitor for changes in menta;on. 4. Encourage fluid intake of at least 3000 ml per day. 5. Monitor vital signs, skin turgor, and intake and output. The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase intake of sodium, protein, and complex carbohydrates and fluids. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required. Menta;on, vital signs, skin turgor and intake and output should be monitored for signs of fluid volume deficit. The nurse is reviewing the postopera;ve prescrip;ons for a client who had a transsphenoidal hypophysectomy. Which health care provider's (HCP's) prescrip;ons, if noted on the record, would indicate the need for clarifica;on? 1. Assess vital signs and neurological status. 2. Instruct the client to avoid blowing his nose. 3. Apply a loose dressing if any clear drainage is noted. 4. Instruct the client about the need for a medicalert bracelet. informa;on? 1. It indicates nerve damage. 2. The hoarseness is permanent. 3. It is normal during this ;me and will subside. 4. It will worsen before it subsides, which may take 6 months. It is normal during this ;me and will subside. Hoarseness in the postopera;ve period usually is the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. The other op;ons are incorrect. The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1. Fever and tachycardia 2. Pallor and tachycardia 3. Agita;on and bradycardia 4. Restlessness and bradycardia Fever and tachycardia Thyrotoxic crisis (thyroid storm) is an acute, poten;ally life-threatening state of extreme thyroid ac;vity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifesta;ons include fever with temperatures greater than 100°F, severe tachycardia, flushing and swea;ng, and marked agita;on and restlessness. Delirium and coma can occur. The nursing instructor asks a nursing student to iden;fy the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by iden;fying an increased risk for thyrotoxicosis in which client? 1. A client with hypothyroidism 2. A client with Graves' disease who is having surgery 3. A client with diabetes mellitus scheduled for a diagnos;c test 4. A client with diabetes mellitus scheduled for debridement of a foot ulcer A client with Graves' disease who is having surgery Thyrotoxicosis usually is seen in clients with Graves' disease in whom the symptoms are precipitated by a major stressor. This complica;on typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, delivery, or major surgery. It also must be recognized as a poten;al complica;on ager thyroidectomy. The client condi;ons in the remaining op;ons are not associated with thyrotoxicosis. The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide and provides dietary instruc;ons to the client. Which statement by the client indicates a need for addi;onal instruc;on? 1. "I need to eat foods high in potassium." 2. "I need to drink at least 2 to 3 L of fluid daily." 3. "I need to eat small, frequent meals and snacks if nauseated." 4. "I need to increase my intake of dietary items that are high in calcium." "I need to increase my intake of dietary items that are high in calcium." The aim of treatment in the client with hyperparathyroidism is to increase the renal excre;on of calcium and decrease gastrointes;nal absorp;on and bone resorp;on of calcium. Dietary restric;on of calcium may be used as a component of therapy. The client should eat foods high in potassium, especially if the client is taking furosemide. Drinking 2 to 3 L of fluid daily and ea;ng small, frequent meals and snacks if nauseated are appropriate instruc;ons for the client. "I should perform my exercise at peak insulin ;me." The client should be instructed to avoid exercise at peak insulin ;me because this is when a hypoglycemic reac;on is likely to occur. If exercises are performed at this ;me, the client should be instructed to eat an hour before the exercise and drink a carbohydrate liquid. The remaining op;ons are correct statements regarding exercise, insulin, and diabe;c control. The nurse is caring for a client admiVed to the hospital with uncontrolled type 1 diabetes mellitus. In the event that diabe;c ketoacidosis (DKA) does occur, the nurse an;cipates that which medica;on would most likely be prescribed? 1. Glucagon 2. Glyburide 3. Regular insulin 4. Neutral protamine Hagedorn (NPH) insulin Regular insulin Giving regular insulin by the intravenous route is the treatment of choice for DKA. A short-ac;ng insulin is the only insulin that can be given intravenously because it can be ;trated to the client's blood glucose levels. Glucagon is used to treat hypoglycemia because it increases blood glucose levels, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus; both agents are inappropriate. NPH insulin is an intermediate-ac;ng insulin and therefore is not appropriate for treatment of DKA. The nurse in a health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the health care provider (HCP). The nurse notes that the HCP has prescribed acarbose. Which preexis;ng disorder, if noted in the client's record, would indicate a contraindica;on to the use of this medica;on? 1. Hypothyroidism 2. Renal insufficiency 3. Arterial insufficiency 4. Coronary artery disease Renal insufficiency Acarbose is an an;diabe;c medica;on that may be administered alone or in conjunc;on with another an;diabe;c medica;on. It is contraindicated in clients with significant renal dysfunc;on. It also is contraindicated in clients with inflammatory bowel disease, colonic ulcera;on, or par;al intes;nal obstruc;on. A nurse is providing home care instruc;ons to a client with a diagnosis of Addison's disease. Which statement by the client indicates a need for further instruc;on? 1. "I need to wear a medicalert bracelet." 2. "I need to purchase a travel kit that contains cor;sone." 3. "I will need to take daily medica;ons un;l my symptoms decrease." 4. "I need an increased dose of glucocor;coid medica;on during stressful minor illnesses." "I will need to take daily medica;ons un;l my symptoms decrease." Client teaching includes the need for lifelong daily medica;ons. The client also is instructed to carry or wear a medical iden;fica;on card or bracelet. A travel kit will need to be purchased. It should contain oral cor;sone along with intramuscular prepara;ons for self-injec;on and intravenous vials for emergency injec;on by a health care provider. Increased glucocor;coid dosage during stressful minor illnesses will be necessary. A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate an;diure;c hormone secre;on (SIADH). The nurse understands that which symptoms are associated characteris;cs of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. "The inser;on site will be locally anesthe;zed." 3. "I will be placed in a high-si ng posi;on for the test." 4. "I may feel a burning sensa;on ager the dye is injected." "I will be placed in a high-si ng posi;on for the test." The test aids in determining whether signs and symptoms are caused by abnormali;es in the adrenal gland. The nurse assesses the client for allergies to iodine before the test. The client is informed that the supine posi;on is necessary to access the femoral vein. An informed consent form is required, the inser;on site will be locally anesthe;zed, and the client will experience a transient burning sensa;on ager the dye is injected A client has been hospitalized for an endocrine system dysfunc;on of the pancreas. The registered nurse asks the new orientee nurse what kind of problem a client hospitalized for endocrine dysfunc;on of the pancreas would expect. The new orientee nurse demonstrates understanding if which statement is made? 1. "Lipase levels will decrease." 2. "Insulin produc;on will be decreased." 3. "There will be overproduc;on of trypsin." 4. "Amylase will be secreted in excess amounts." "Insulin produc;on will be decreased." A client has been hospitalized for impaired func;on of the posterior pituitary gland. The nurse plans to monitor for signs and symptoms of which hormone imbalance? 1. Growth hormone (GH) 2. Luteinizing hormone (LH) 3. An;diure;c hormone (ADH) 4. Follicle-s;mula;ng hormone (FSH) An;diure;c hormone (ADH) ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. The anterior pituitary gland produces GH, LH, and FSH. The nurse is admi ng a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpita;ons and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifesta;ons? 1. Cor;sol 2. Androgens 3. Aldosterone 4. Epinephrine Epinephrine Pheochromocytoma is a catecholamine-producing tumor and causes secre;on of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifesta;on, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during aVacks. In addi;on, the other substances listed (cor;sol, androgens, and aldosterone) are produced by the adrenal cortex. A client has a tumor that is interfering with the func;on of the hypothalamus. The nurse should monitor for signs and symptoms related to which imbalance? 1. Melatonin excess or deficit 2. Complaints of nausea 3. Sodium level of 128 meq/L (128 mmol/L) 5. Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg Findings consistent with a diagnosis of adrenal insufficiency include nausea, vomi;ng, and diarrhea; hyponatremia; salt craving; hyperkalemia; and orthosta;c hypotension. Irritability and depression may also occur in primary adrenal hypofunc;on. A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifesta;ons, the nurse should suspect dysfunc;on of which endocrine gland? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex Thyroid The thyroid gland is responsible for a number of metabolic func;ons in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic func;on places a demand on the cardiovascular system for a higher cardiac output. A client with increased ac;vity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-s;mula;ng hormone. An;diure;c hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the produc;on of glucocor;coids and mineralocor;coids. A client has abnormal amounts of circula;ng thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1. Iodine 2. Calcium 3. Phosphorus 4. Magnesium Iodine A client with medullary carcinoma of the thyroid has an excess func;on of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse should expect which electrolyte abnormality? 1. Sodium 2. Calcium 3. Potassium 4. Magnesium Calcium The C cells of the thyroid gland are helpful in maintaining normal plasma calcium levels. They do not affect the levels of sodium, potassium, or magnesium. A client with hypovolemia experiences ac;va;on of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1. "Cor;sol will be secreted." 2. "Aldosterone will be secreted." 3. "Addi;onal glucagon will be produced." 2. Cor;sol 3. Epinephrine 4. Norepinephrine Cor;sol Cushing's syndrome is characterized by an excess of cor;sol, a glucocor;coid. Glucocor;coids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla. A hospitalized client is experiencing an episode of hypoglycemia. The client is lethargic and has no available intravenous (IV) access. Which medica;on should the nurse an;cipate administering? 1. Insulin 2. Cor;sone 3. Glucagon 4. Epinephrine Glucagon Glucagon, a natural hormone secreted by the pancreas, is available as a subcutaneous injec;on to be given when a quick response to severe hypoglycemia is needed. Glucagon is useful in the unconscious hypoglycemic client without established IV access. The remaining op;ons are incorrect treatments. The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifesta;ons might the nurse expect to note on examina;on of this client? Select all that apply 1. Irritability 2. Periorbital edema 3. Coarse, briVle hair 4. Slow or slurred speech 5. Abdominal disten;on 6. Sog, silky, thinning hair 2. Periorbital edema 3. Coarse, briVle hair 4. Slow or slurred speech 5. Abdominal disten;on The manifesta;ons of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. The client may exhibit skin manifesta;ons, such as coarse, briVle hair; thick, briVle nails; coarse, scaly skin; delayed wound healing; periorbital edema; and face puffiness. Neuromuscular manifesta;ons include lethargy, slow or slurred speech, and impaired memory. Gastrointes;nal manifesta;ons include complaints of cons;pa;on, weight gain, and abdominal disten;on. Irritability and sog, silky, thinning hair on the scalp are manifesta;ons of hyperthyroidism. A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse should an;cipate that which substance will be elevated? 1. Glucose 2. Ketones 3. Glucagon 4. Lactate dehydrogenase Ketones Ketones are a byproduct of fat metabolism. When this process occurs to an A nurse is reviewing the health care provider's prescrip;ons for a client diagnosed with hypothyroidism. Which medica;on prescrip;on should the nurse ques;on and verify? 1. Acetaminophen 2. Docusate sodium 3. Morphine sulfate 4. Levothyroxine sodium Morphine sulfate Medica;ons are administered very cau;ously to the client with hypothyroidism because of altered metabolism and excre;on and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily func;ons. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool sogeners, such as docusate sodium, are prescribed to prevent cons;pa;on. Acetaminophen can be taken. The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabe;c ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1. Serum ph of 9.0 2. Absent ketones in the urine 3. Serum bicarbonate of 22 meq/L (22 mmol/L) 4. Blood glucose level of 500 mg/dl (28.5 mmol/L) Blood glucose level of 500 mg/dl (28.5 mmol/L) In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dl (20 and 85.7 mmol/L), ketonuria, serum ph less than 7.35, and serum bicarbonate less than 15 meq/L (15 mmol/L). The nurse is providing instruc;ons regarding home care measures to a client with diabetes mellitus and instructs the client about the causes of hypoglycemia. The nurse determines that addi;onal instruc;on is needed if the client iden;fies which as a cause of hypoglycemia? 1. OmiVed meals 2. Increased intensity of ac;vity 3. Decreased daily insulin dosage 4. Inadequate amount of fluid intake Decreased daily insulin dosage Decreasing the dose of insulin will lead to hyperglycemia. Causes for hypoglycemic reac;ons include delayed consump;on of meals and lack of necessary amounts of food. Other causes include the administra;on of excessive insulin or oral hypoglycemic medica;ons, vomi;ng associated with illness, and strenuous exercise, which may poten;ate the ac;on of insulin. The clinic nurse is providing instruc;ons to a client with diabetes mellitus about the signs and symptoms of hypoglycemia. The nurse should tell the client that which would be noted in a hypoglycemic reac;on? 1. Thirst 2. Hunger 3. Polydipsia 4. Increased urine output Hunger Signs and symptoms of hypoglycemia include hunger, nervousness, anxiety, dizziness, blurred vision, sweaty palms, confusion, and ;ngling and numbness around the mouth. Polydipsia (thirst) and increased urine output are noted in the client with hyperglycemia. A client with type 2 diabetes mellitus has a blood glucose level greater than 600 mg/dl (34.3 mmol/L) and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider's with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure. A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complica;on? 1. Diarrhea 2. Infec;on 3. Polydipsia 4. Weight gain Polydipsia Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Diarrhea is not indica;ve of the complica;on. Infec;on is not associated with diabetes insipidus. Anorexia and weight loss also may occur. A client is admiVed to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifesta;on of this disorder? 1. Edema 2. Obesity 3. Hirsu;sm 4. Hypotension Hypotension Common manifesta;ons of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea and vomi;ng, abdominal cramps, weight loss, depression, and irritability. The remaining op;ons do not occur with this disease. A client has begun medica;on therapy with propylthiouracil. The nurse should assess the client for which condi;on as an adverse effect of this medica;on? 1. Joint pain 2. Renal toxicity 3. Hyperglycemia 4. Hypothyroidism Hypothyroidism Propylthiouracil is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administra;on of thyroid hormone may be required to treat the hypothyroid state. Propylthiouracil is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia. A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate Polyuria Classic signs and symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. It is important to regularly assess the client for hyperglycemia to prevent the development of more serious complica;ons, such as diabe;c ketoacidosis. The remaining op;ons are not manifesta;ons of hyperglycemia. A client with a history of diabetes mellitus has a fingers;ck blood glucose level of 460 mg/dl. The home care nurse an;cipates that which addi;onal finding would be present with further tes;ng if the client is experiencing diabe;c ketoacidosis (DKA)? 1. 1. Tremors 2. Anorexia 3. Hot, dry skin 4. Muscle cramps Tremors Decreased blood glucose levels trigger autonomic nervous system signs and symptoms, such as nervousness, irritability, and tremors. Hot, dry skin accompanies hyperglycemia. Anorexia and muscle cramps are unrelated to hypoglycemia. A client is admiVed to the hospital with a diagnosis of pheochromocytoma. The nurse would check which item to detect the primary manifesta;on of this disorder? 1. Weight 2. Urine ketones 3. Blood pressure 4. Skin temperature Blood pressure Hypertension is the major symptom associated with pheochromocytoma and is assessed by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are other clinical manifesta;ons of pheochromocytoma; however, hypertension is the major symptom. A nurse is caring for a client with thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complica;on, the nurse should assess for which sign or symptom? 1. Bradycardia 2. Cons;pa;on 3. Hypertension 4. Low-grade temperature Hypertension Thyroid storm is an acute, life-threatening condi;on that occurs in a client with uncontrollable hyperthyroidism. Clinical manifesta;ons of thyroid storm include systolic hypertension, tachycardia, diarrhea, and a fever as high as 106°F. Other manifesta;ons include abdominal pain, dehydra;on, extreme vasodila;on, stupor rapidly progressing to coma, atrial fibrilla;on, and cardiovascular collapse. Bradycardia, cons;pa;on and low-grade temperature are not a part of the clinical picture in thyroid storm. During rou;ne nursing assessment ager hypophysectomy, a client complains of thirst and frequent urina;on. Knowing the expected complica;ons of this surgery, what should the nurse assess next? 1. Serum glucose 2. Blood pressure 3. Respiratory rate 4. Urine specific gravity Urine specific gravity Ager hypophysectomy, temporary diabetes insipidus can result from an;diure;c hormone deficiency. This deficiency is related to surgical manipula;on. The nurse should assess urine specific gravity and no;fy the health care provider if the result is less than 1.005. Although the remaining op;ons may be components of the assessment, the nurse would next assess urine specific gravity. A client has been diagnosed with Cushing's syndrome. The nurse should assess the client for which expected manifesta;ons of this disorder? 1. hypothyroidism. Other common symptoms include intolerance to cold, weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss. A mul;disciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse should include which priority interven;on in the plan of care? 1. Describe the use of loperamide. 2. Restrict fluids to 1000 ml per day. 3. Walk down the hall for 15 minutes 3 ;mes a day. 4. Describe the administra;on of aluminum hydroxide gel. Walk down the hall for 15 minutes 3 ;mes a day. Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposi;on to the forma;on of renal calculi. Fluids should not be restricted. Discussing the use of medica;ons is not the priority with this client. The nurse is preparing for a client's postopera;ve return to the unit ager a parathyroidectomy procedure. The nurse should ensure that which piece of medical equipment is at the client's bedside? 1. Cardiac monitor 2. Tracheotomy set 3. IntermiVent gastric suc;on device 4. Underwater seal chest drainage system Tracheotomy set Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a paramount concern for the nurse managing the care of a postopera;ve client who has had a parathyroidectomy. An emergency tracheotomy set is rou;nely placed at the bedside of the client who has undergone this type of surgery, in an;cipa;on of this complica;on. The items in the remaining op;ons are not specifically needed with this surgical procedure. A 33-year-old female client is admiVed to the hospital with a tenta;ve diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the ini;al assessment? 1. Amenorrhea 2. Menorrhagia 3. Metrorrhagia 4. Dysmenorrhea Amenorrhea Amenorrhea or a decreased menstrual flow occurs in the client with Graves' disease. Menorrhagia, metrorrhagia, and dysmenorrhea are also disorders related to the female reproduc;ve system; however, they are not typical manifesta;ons of Graves' disease. The nurse is preparing to care for a client ager parathyroidectomy. The nurse should plan for which ac;on for this client? 1. Maintain an endotracheal tube for 24 hours. 2. Administer a con;nuous mist of room air or oxygen. 3. Place the client in a flat posi;on with the head and neck immobilized. 4. Use only a rectal thermometer for temperature measurement. Administer a con;nuous mist of room air or oxygen Humidifica;on of air or oxygen helps to liquefy mucous secre;ons and promotes easier breathing ager parathyroidectomy. Pooling of thick mucous secre;ons in the trachea, bronchi, and lungs will cause respiratory obstruc;on. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi Fowler's posi;on is the posi;on of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required.