Diabetes and Endocrine Disorders – Flashcards
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A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate
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3. R: The primary goal of treatment in HHNS is to rehydrate the client to restore fluid volume and to correct electrolyte defiency. Intravenous fluid replacement is similar to that administered in DKA and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.
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An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: 1. Is timed to release programmed doses of regular or NPH insulin into the BS at specific intervals 2. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels 3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the BS 4. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
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4. R: An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
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A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency department. Which finding would a nurse expect to note as confirming this diagnosis? 1. Comatose state 2. Decreased urine output 3. Increased respirations and an increased pH 4. Elevated blood glucose level and low plasma bicarbonate level
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4. R: In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher that 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.
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A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which of the following symptoms develops? 1. Polyuria 2. Shakiness 3. Blurred vision 4. Fruity breath odor
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2. R: Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. A fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.
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A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client's anxiety is to: 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety so that they will soon disappear. 4. Make sure that the client knows all the correct medical terms to understand what is happening.
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2. R: The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client's anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.
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A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent DKA when the client states: 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 physician if my blood glucose level is higher than 250mg/dL."
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4. R: During illness, the client should monitor blood glucose levels and should notify the physician if the level is higher than 250mg/dL. Insulin may need to be increased during times of illness. Doses should not be adjusted without the physician's advice and are usually adjusted based on blood glucose levels, not urinary glucose readings.
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A client is admitted to a hospital with a diagnosis of DKA. The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of regular insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which of the following? 1. Ampule of 50% dextrose 2. NPH insulin SubQ 3. Intravenous fluids containting 5% dextrose 4. Phenyton (Dilantin) for the prevention of seizures
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3. R: During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a 5% dextrose in 0.45% saline is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers for ketosis. NPH insulin is not used to treat DKA. Fifty percent dextrose is used to treat hypoglycemia. Phenytoin (Dilantin) is not a usual treatment measure for DKA.
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A nurse is monitoring a client newly diagnosed with DM for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate
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1. R: Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options 2, 3, and 4 are not signs of hyperglycemia.
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A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: 1. Deficient knowledge 2. Deficient fluid volume 3. Compromised family coping 4. Imbalanced nutrition, less than body requirements
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2. R: An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are no related specifically to the subject of the question.
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A home health nurse visits a client with a diagnosis of type 1 DM. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "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 physician because of these symptoms."
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1. R: When a client with DM is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the physician. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine keytones.
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A nurse is caring for a client after hypophysectomy. The nurse notices clear nasal drainage from the client's nostril. The initial nursing action would be to: 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.
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2. R: After 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 fir the presence of cerebrospinal fluid. The head of the bed should not be lowered to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.
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After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse performs an assessment on a client, knowing that which symptom is indicative of this disorder? 1. Fatigue 2. Diarrhea 3. Polydipsia 4. Weight gain
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3. R: Diabetes insipidus is characterized by a hyposecretion of the antidiuretic hormone and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Anorexia and weight loss occur. Option 1 is a vague symptom. Options 2 and 4 are not specific to the disorder.
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A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.
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2. R: The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement, keeping the client warm, monitoring VS, and administering thyroid hormones by the intravenous route.
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A nurse is caring for a client admitted to the emergency department with DKA. In the acute phase, the priority nursing action is to prepare to: 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Administer regular insulin intravenously. 4. Apply a monitor for a electrocardiogram.
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3. R: Lack (absolute or relative) of insulin is the primary cause of DKA. Treatment consists of insulin administration (regular insulin), intravenous fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority action.
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A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? 1. "The best time for me to exercise is after I eat." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "The best time for me to exercise is after my morning snack."
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3. R: A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4-12 hours; therefore, afternoon exercise takes place during the peak of the medication. Options 1, 2, and 4 do not address peak action times.
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A nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? 1. Diarrhea 2. Polyuria 3. Polyphagia 4. Weight gain
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2. R: Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diruesis leads to dehydration (weight loss rather than weight gain). Options 1, 3, and 4 are gastrointestinal symptoms and are not associated with the common gastrointestinal symptoms typical of hyperparathyroidism (nausea, vomiting, anorexia, constipation).
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A nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a serious, life-threating complication may be developing, requiring immediate notification of the physician? 1. Laryngeal stridor 2. Abdominal cramps 3. Difficulty in voiding 4. Mild to moderate incisional pain
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1. R: During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which causes swelling and compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration; stridor is caused by compression of the trachea, leading to respiratory distress. Stridor is an acute emergency situation that requires immediate attention to avoid complete obstruction of the airway. Options 2, 3, and 4 do not identify signs of a life threatening-complication.
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A client is diagnosed with pheochromocytoma. A nurse prepares a plan of care for the client; while planning, the nurse understands that pheochromocytoma is a condition that: 1. Causes profound hypotension 2. Is manifested by severe hypoglycemia 3. Is not curable and is treated symptomatically 4. Causes the release of excessive amounts of catecholamines
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4. R: Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine. Hypertension is the principal manifestation, and the client has episodes of high BP accompanied by pounding headaches. The excessive release of catecholamine also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. Pheochromocytoma is curable. The primary treatment is surgical removal of one or both the adrenal glands, depending on whether the tumor is unilateral of bilateral.
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A nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, the priority nursing action would be to monitor: 1. VS 2. I and O 3. BUN results 4. Urine for glucose and ketones
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1 R: Pheochromocytoma is a catecholamine-producing tumor. Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all the options are accurate nursing interventions for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs, particularly the blood pressure.
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A nurse is performing an assessment on a client with pheochromocytoma. Which of the following assessment data would indicate a potential complication associated with this disorder? 1. A coagulation time of 5 minutes 2. A urinary output of 50 mL per hour 3. A BUN level of 20 mg/dL 4. A heart rate that is 90 beats/min and irregular
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4 R: The complications associated with pheochromocytoma include hypertensive reinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A urinary output of 50 mL/hr is adequate output. A BUN level of 20 mg/dL is a normal finding. A coagulation of 5 minutes is normal.
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A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 1. "Cushing's disease results from an oversecretion of insulin." 2. "Cushing's disease results from an undersecretion of corticotropic hormones." 3. "Cushing's disease results from anundersecretion of mineralocoritcoid hormones." 4. "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone."
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4 R: Cushing's disease is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of adrenocorticotropic hormone (ACTH) secreted by the pituitary gland. Addison's disease is characterized by the hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids) from the adrenal gland, resulting in deficiency of the corticosteroid hormones. Options 1, 2, and 3 are inaccurate regarding Cushing's disease.
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A nursing performs a physical assessment on a client with type 2 DM. Findings included a fasting blood glucose of 120 mg/dL, temperature of 101 F, pulse of 88 bpm, respirations of 22 b/m, and bp of 100/72 mmHg. Which finding would be of most concern to the nurse? 1. Pulse 2. Respiration 3. Temp 4. BP
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3. R: An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. The other findings noted in the question are within normal limits.
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A nurse is interviewing a client with type 2 DM. Which statement by the client indicates an understanding of the treatment for this disorder? 1. "I take oral insulin instead of shots." 2. "By taking these medications, I am able to eat more." 3. "When I become ill, I need to increase the number of pills I take." 4. "The medications I'm taking help to release the insulin I already make."
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4 R: Clients with type 2 DM have decreased of impared insulin secretion. Oral hypoglycemic agents are given to these clients to facilitate glucose uptake. Insulin injections may be given during times of stress-induced hyperglycemia. Oral insulin is not available because of the breakdown of the insulin by digestion. Options 1, 2, and 3 are incorrect.
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A nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? 1. "I can eat foods that have a lot of potassium in them." 2. "I will need to limit the amount of protein in my diet." 3. "I am fortunate that I can eat all the salty foods I enjoy." 4. "I am fortunate that I do not need to follow any special diet."
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1 R: A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema hypertension, control of hypokalemia, and rebuilding of wasted tissue.
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The nurse is caring for a client who is 2 days postoperative following an abdominal hysterectomy. The client has a history of DM and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carbohydrate-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is appropriate at this time? 1. Call a code to obtain needed assistance immediately. 2. Obtain a capillary blood glucose level and perform a focused assessment. 3. Stay with the client and ask the nursing assistant to call the physician for a prescription for intravenous 50% dextrose. 4. Ask the nursing assistant to stay with the client while obtaining 15 to 30 g of a carbohydrate snack for the client to eat.
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2 R: The rational for this is huge, look it up.
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A nurse is monitoring a client who was diagnosed with type 1 DM and is being treated with NPH and regular insulin. Which client complaint(s) would alert the nurse to the presence of a possible hypoglycemic reaction? 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps
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1, 3, 4 R: Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the signs of hypoglycemia.
