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endocrine system dm

endocrine and dm questions for week 4

Question	Answer
The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client will be the most appropriate to assign to an LPN/LVN?	Client with Cushing's syndrome who requires orthostatic vital signs assessments. An LPN/LVN will be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs.
A client is hospitalized with a possible disorder of the adrenal cortex. Which one of these nursing activities would be best for the charge nurse to delegate to an experienced nursing assistant?	Check blood glucose levels every 4 hours.Blood glucose monitoring is within the nursing assistant's level of practice if the nursing assistant has received education and evaluation in the skill.
A client is hospitalized for pituitary function testing. Which of the nursing actions included in the client's plan of care will be most appropriate for the RN to ask the LPN/LVN to do?	Inject regular insulin for the growth hormone stimulation test.
A client with a possible adrenal gland tumor is admitted to the medical unit for testing and treatment. Which nursing action will be most appropriate for the charge nurse to delegate to the nursing assistant?	Remind the client to avoid drinking coffee and sudden position changes. Drinking caffeinated beverages and changing position suddenly are not safe for a client with a potential adrenal gland tumor because of the effects of catecholamines
The nurse is reviewing these laboratory test results for a client admitted with a possible pituitary disorder. Which information has the most immediate implication for the client's care?	Serum sodium 110 mEq/L. The normal range for serum sodium is 135 to 145 mEq/L. A result of 110 mEq/L is considered hyponatremia and is extremely dangerous. This client is at risk for increased intracranial pressure, seizures, and death.
To best determine how well a client with diabetes mellitus is controlling blood glucose, which test will the nurse monitor?	Glycosylated hemoglobin (HbA1c) - Glycosylated hemoglobin indicates the average blood glucose over several months and is the best indicator of overall blood glucose control.
The nurse is teaching the client about the correct procedure for a 24-hour urine test for creatinine clearance. Which statement by the client indicates a need for further teaching?	"I should not eat any protein when I am collecting urine for this test." Eating protein does not interfere with collection or testing of the urine sample.
The nurse is teaching the client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish?	Iodized salt for cooking - Dietary deficiencies in iodide-containing foods may be a cause of an endocrine disorder. For clients who do not eat saltwater fish on a regular basis, teach them to use iodized salt in food preparation.
The client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response?	Can you please tell me more?" - Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly.
The nurse is assessing the client for endocrine dysfunction. Which comment by the client indicates a need for further assessment?	"I don't have any patience with my kids. I lose my temper faster." Many endocrine problems can change a client's behavior, personality, and psychological responses.
The nurse is instructing the client who will undergo a suppression test. Which statement by the client indicates that teaching was effective?	"I am being tested to see whether my hormone glands are hyperactive." Suppression tests are used when hormone levels are high or in the upper range of normal. Failure of suppression of hormone production during testing indicates hyperfunction.
Which statement is true about hormones and their receptor sites?	Hormones need a specific receptor site to work. each receptor site type is specific for only one hormone. Hormone receptor actions work in a "lock and key" manner in that only the correct hormone (key) can bind to and activate the receptor site (lock).
Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients?	Glucagon release - Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, which keeps blood sugar levels normal during sleep.
In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose?	Homeostasis - Insulin injections maintain homeostasis, or normal balance, between insulin and glucose in the client with type 1 diabetes.
The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor?	Antidiuretic hormone (ADH) production - A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss.
The client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client?	Cranial computed tomography (CT) - ADH is a hormone of the posterior pituitary. Brain abscess, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These could be seen on a CT scan of the brain.
Which gland releases catecholamines?	The adrenal medulla releases catecholamines in response to stimulation of the sympathetic nervous system.
An elementary school student asks a nurse about injecting steroids. What does the nurse know is most commonly involved in steroid abuse?	Testosterone is the most commonly abused hormone associated with steroid abuse. Testosterone is abused owing to its ability to increase muscle mass. The side effects of abuse include extreme mood swings and irreversible health problems such as liver damag
The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation?	Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily - is the most stable of the clients described and would be most appropriate to assign to an inexperienced RN.
An RN and LPN/LVN are caring for a group of clients on the medical-surgical unit. Which client will be the best to assign to the LPN/LVN?	Client with infiltrative ophthalmopathy who needs administration of high-dose prednisone (Deltasone)
An older client with an elevated serum calcium level is receiving IV furosemide (Lasix) and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to a nursing assistant?	Measure the client's intake and output hourly.
Which action should the postanesthesia care unit (PACU) nurse take first when caring for a client who has just arrived after a total thyroidectomy?	Monitor oxygen saturation using pulse oximetry - Airway assessment and management is always the first priority with every client. This is especially important for a client who has had surgery that involves potential bleeding and edema near the trachea.
The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first?	Client with parathyroidectomy yesterday who has muscle twitching - A client who is 1 day postoperative parathyroidectomy and has muscle twitching is showing signs of hypocalcemia and is at risk for seizures. Rapid assessment and intervention are needed.
The client has been diagnosed with hypothyroidism. What medication is usually prescribed to treat this disease?	: Levothyroxine is a synthetic form of T4 that is used to treat hypothyroidism.
A student nurse asks an RN on the medical-surgical floor what effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client. What effect does the RN tell the student nurse?	Hypertension and heart failure are a possibility if the dose is started too high or raised too rapidly because levothyroxine would essentially put the client into a hyperthyroid state.
A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the RN's best response?	"You should see some effects of this medication within 2 weeks." Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The client should see in 2 weeks
The client is being discharged with hypothyroidism. Which environmental change may the client experience in the home?	Increased thermostat setting - Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary.
The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? Select all that apply.	Calcium gluconate, Emergency tracheotomy kit, oxygen, suction
The client has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention?	Unlicensed assistive personnel (UAP) pulling the client up in bed by the shoulders - The client with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the client carefully
The client is being discharged with propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse?	I can return to my job at the nursing home." - Correct: The client should avoid large crowds and people who are ill. Propylthiouracil reduces blood cell counts and the immune response, which increases the risk for infection
The client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next?	Encourages the client to rest - The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. Accept the client's behavior, and provide a calm, quiet, and comfortable environment.
Family members of the client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's response?	The mood swings should diminish over time with treatment. This will provide information to the family, as well as reassurance.
The nurse reviews the vital signs of the client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next?	Assesses the client's cardiac status completely - If the client's temperature has increased by even 1°, the nurse's first action is to notify the health care provider. Continuous cardiac monitoring should be the next step.
The client being treated for hyperthyroidism calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response?	Asks whether the client has increased cold sensitivity or weight gain - are symptoms of hypothyroidism, indicating an overcorrection of the medication. The client must be assessed further because he may require a lower dose of medication.
The client is 18 hours post parathyroidectomy. Which finding requires immediate attention?	Hoarseness or stridor is an indication of respiratory distress and requires immediate attention.
The nurse is teaching the client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching?	"If I continue to lose weight, I may need an increased dose." - Weight loss indicates a need for a decreased dose, not an increased dose.
The client recently admitted with hyperparathyroidism has a very high urine output. Of the following actions, what does the nurse do next?	Monitors intake and output - Diuretic and hydration therapies are used most often for reducing serum calcium levels in clients with hyperparathyroidism.
A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching?	"I'm ready to hold my newborn grandson now." - Avoid close contact with pregnant women, infants, and young children for 1 week after treatment. Remain at least 1 meter (39 inches or roughly 3 feet) away, and limit exposure to less than 1 hour per day.
Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II?	Medullary carcinoma commonly occurs as part of multiple endocrine neoplasia (MEN) type II, which is a familial endocrine disorder.
Which explanation best assists the client in differentiating type 1 diabetes from type 2 diabetes?	People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin.
The client with type 1 diabetes mellitus received regular insulin at 7 AM. The client should be monitored for hypoglycemia at which time?	11am - Onset of regular insulin in ½ to 1 hour; peak is 2 to 4 hours. Therefore 11 AM is the anticipated onset time for regular insulin received at 7 AM.
The client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family?	The causes and treatment of hypoglycemia - must be understood by the client and family to manage the client's diabetes effectively.
The nurse is providing discharge teaching to the client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching?	"I can break in my shoes by wearing them all day."
The nurse is teaching the client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching?	"I should begin exercising for at least an hour a day."
The nurse is providing discharge teaching to the client with newly diagnosed diabetes. Which statement by the client indicates correct understanding about the need to wear a medical alert bracelet?	"If I become hypoglycemic, I could become unconscious."
The nurse is teaching the client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates	"I should eat three graham crackers."
The client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess before providing instruction about the disease and its management?	Educational and literacy level
The client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response?	"Let's tackle it piece by piece. What is most scary to you?" This approach will allow the client to have a sense of mastery with acceptance.
The client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine?	While performing the test in the hospital
Which is the best referral that the nurse can suggest to a client newly diagnosed with diabetes?	The American Diabetes Association can provide national and regional support and resources to clients with diabetes and their families.
The diabetic client has a hemoglobin (Hb)A1c level of 9.4. What does the nurse say to the client regarding this finding?	"What are you doing differently?" - Assessing the client's regimen or changes he may have made is the basis for formulating interventions to gain control of blood glucose.
The nurse is teaching the client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective?	"I must inspect my shoes for foreign objects before putting them on."
The intensive care client with ketoacidosis (DKA) is receiving insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make?	With insulin therapy, serum potassium levels fall rapidly as Potassium shifts into the cells. Detecting and treating the underlying cause is essential
In reviewing the physician admission requests for the client admitted with hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis?	1 ampule NaHCO3 IV now - given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state, which presents with hyperglycemia and absence of ketosis/acidosis.
The nurse caring for four diabetic clients has the following activities to perform. Which of these is appropriate to delegate to the nursing assistant?	Performing bedside glucose monitoring is an activity that may be delegated because it does not require extensive clinical judgment to perform; the nurse follows up with the results.
You have just taken change-of-shift report on a group of clients on the medical unit. Which client should you assess first?	The client taking glyburide (Diabeta) who is dizzy and sweaty - This client has symptoms consistent with hypoglycemia and should be assessed first because he displays the most serious adverse effect of antidiabetic medications
You have just received change-of-shift report on the endocrine unit. Which client should you see first?	The type 1 diabetic client whose insulin pump is beeping "occlusion"- Because glucose levels will increase quickly in clients who use continuous insulin pumps, the nurse should assess this client and the insulin pump first to avoid DKA.
Which of these nursing actions can the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes?	Assist the client with washing his feet and applying moisturizing lotion. Assisting with personal hygiene is included in the role of home health aides.
Which of these clients with diabetes should the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit?	A 70-year-old who needs blood glucose monitoring and insulin before each meal
A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." These are the client's vital signs: T 98.4° F (36.9º C), P 112, R 38, BP 91/54, and O2 saturation 99% on room air. Which action shou	Check the blood glucose. The client's clinical presentation is consistent with diabetic ketoacidosis, and the nurse should initially check the client's glucose level.
A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (HbA1c) is 8.2%. Which action will the nurse plan to take next?	Ask the client about current dietary intake and medication use.
The client with type 2 diabetes has been admitted for surgery, and the physician has placed her on insulin. The client wants to know why she should have to take this. What is your best response?	"Your body is under more stress, so you will need to have insulin to support your medication."
When preparing a mixed insulin injection, which action does the nurse perform first?	Putting air in the longer-acting insulin vial is the first step in preparing a mixed insulin injection.
Hyperosmolality and hyperglycemia	occur due to lack of effective insulin; ketosis is minimal or absent
Hyperglycemia causes	osmotic diuresis with loss of water and electrolytes; hypernatremia and increased osmolality occur
metformin (GLUCOPHAGE)	Inhibits glucose production in the liver Decreases intestinal absorption of glucose Sensitizes insulin receptors in fat ands skeletal muscle (makes receptors more sensitive to insulin)
Increased risk for lactic acidosis and renal failure, Stop Metformin 48 h prior to and 48 h after diagnostic procedures using a contrast agent.	metformin (GLUCOPHAGE
Glucophage uses	Type II diabetes, May be combined with other antidiabetic agents SE / ADR: Primarily GI effects - bloating, nausea, cramping, diarrhea
Hyperthyroidism: Patho	Excessive thyroid secretion from the thyroid gland
Thyroid hormones increase	metabolism in all body organs = increase SNS activity, HR & SV = increased CO, SBP, protein synthesis and breakdown of proteins – breakdown exceeds synthesis, Decrease glucose tolerance = hyperglycemia, Increased fat metabolism = body fat decreases Weigh
Hyperthyroidism: Etiology: Graves Disease	An autoimmune disorder Antibodies (thyroid stimulating immunoglobulins) are made and attach to TSH receptors in thyroid tissue
Thyroid response	Increase number and size of cells (goiter, enlarged thyroid) Overproduction of thyroid hormones Pretibial myxedema (dry, waxy swelling of front of lower legs)
Thyroid Storm	Life-threatening, uncontrolled hyperthyroidism S & S = high fever, severe HTN Immediately report an increase of temp greater than 1 degrees Fahrenheit Assess cardiac status (tele)
Graves Disease:	Most often in women 20-40 years old Affects women 10 times more often than men
Toxic Multinodular Goiter	Usually occurs after age 50 More common in women (4X)
Hyperthyroidism: S & S	Exophthalmos most common in Graves Disease Edema in extraocular muscles Increased fatty tissue behind the eye
Thyroid Storm	Life-threatening, uncontrolled hyperthyroidism S & S = high fever, severe HTN Immediately report an increase of temp greater than 1 degrees Fahrenheit Assess cardiac status (tele)
Thyroid scan evaluates	the position, size, and functioning of the thyroid gland. Radioactive iodine (RAI [123I]) is given by mouth, and the uptake of iodine by the thyroid gland (radioactive iodine uptake [RAIU]) is measured. The half-life of 123I is short, and radiation precau
Hyperthyroidism InterventionsNon-Surgical	Monitor B/P, P, T every 4 hours Have pt report palpitations, dyspnea, vertigo C/P Reduce stimulation Encourage rest Limit visitors Cool room temp, cool shower, ice water
Hyperthyroidism InterventionsDrug Therapy	Anti-thyroid drugs is initial treatment Thionamides: Prevent hormone production by preventing iodine binding in the thyroid
Propylthiouracil (PTU)	PTU also prevents T4 from converting to T3 (more powerful) in tissues, ADR liver injury & failure
Methimazole (Tapazole)	Teratogenic (can cause birth defects)
Hyperthyroidism InterventionsDrug Therapy - Iodine Preparations	For short term therapy Decrease blood flow through the thyroid = decrease production and release of hormones Monitor for hypothyroidism
Hyperthyroidism InterventionsDrug Therapy - Lithium	Inhibits thyroid hormone release
Hyperthyroidism InterventionsDrug Therapy Beta blockers	(propanolol) for supportive therapy
Radioactive Iodine Therapy (RAI)	Oral administration Some cells that take up RAI are destroyed 6-8 weeks for complete symptom relief (storage sources still present) Not for pregnant patients Usually one dose (but may need 2 or 3) Some radioactivity in pt’s body fluids for few weeks
Hypothyroidism	Thyroid tissue fails to produce thyroid hormones
Hypothyroidism causes	Cellular damage Person does not ingest enough iodine or tyrosine (needed to make thyroid hormones) Results in decreased metabolic rate
Hypothyroidism S & S part one	Cellular energy decreased, metabolites build up in cells = increase in mucus and water = cellular edema (myxedema)
Hypothyroidism S & S part 2	Non-pitting edema (especially around eyes, hands, feet, between shoulder blades) Tongue thickness, edema in larynx = husky voice
Myxedema Coma	Rare, serious complication of untreated or poorly treated hypothyroidism - Heart muscle becomes “flabby”, chambers increase in size = decreased CO = decreased organ perfusion High mortality rate Most common cause of death is respiratory failure
Hypothyroidism: Incidence	Most often in women 30-60 yrs old 7-10 times more often in women
Parathyroid Patho	Parathyroid glands maintain calcium and phosphate know this Increased levels of Parathyroid hormone (PTH) act in kidney to cause reabsorption of calcium and phosphate excretion
Hyperparathyroidism	Bone loss of calcium = decrease bone density Chronic hypercalcemia results in calcium in tissues (not in bone) Renal calculi Bone fractures Osteoporosis Weight loss Fatigue lethargy
Hyperparathyroid: TX	Diuretic and hydration to decrease serum calcium level in pts not surgical candidates Oral phosphates (when calcium levels must be lowered rapidly) Calcitonin decreases release of skeletal calcium (glucocorticoids enhance effect of calcitonin) Calcium
HYPOPARATHYROIDISM: Interventions	Correct hypocalcemia, hypomagnesemia, & Vit. D deficiencies Severe hypocalcemia 10% solution of calcium chloride or calcium gluconate given IV test questions Acute vit. D deficiency treated with Calcitrol Long term therapy for hypocalcemia Calcium 0
Diabetes Type 1: Treatment	Insulin Diet Exercise Education
Diabetes Mellitus Type 2	Insulin resistance – a decrease in tissue sensitivity to insulin Insulin is less effective at stimulating glucose uptake by the tissues and regulating glucose release by the liver.
Type 2: Treatment	Diet, Exercise, Education Oral hypoglycemic agents and when necessary insulin Treatment is started with lifestyle measures plus drug therapy
DM Diet	ADA recommendation: Carbohydrates = 60-70% of caloric intake Polyunsaturated Fat = 10% of caloric intake Protein 15-20% of caloric intake
DM: Exercise Precautions	Exercise lowers blood glucose levels by increasing uptake of glucose and increasing insulin utilization Potential exists for post exercise hypoglycemia Need to monitor blood glucose levels
Illness & Stress and Glucose Levels	May contribute to hyperglycemia Increase in stress hormones = increase in glucose levels
Education: Sick Day Management	Do not eliminate insulin doses when nausea & vomiting occur Take prescribed sick day dose and eat frequent, small portions of carbohydrates Drink fluid to prevent dehydration (½ cup broth, 1 cup Gatorade every ½ to 1 hour) Monitor BS & urine ketones ev
Hypoglycemia: Management	Give 15 g of fast-acting, concentrated carbohydrate 3 or 4 glucose tablets 4 to 6 ounces of juice or regular soda (not diet soda) 2 to 3 teaspoons of honey
Hypoglycemia: Emergency Treatment	Pt blood glucose is 60 or less, pt is unable to swallow, unresponsive, or cannot have anything by mouth: Administer: 25 to 50 mL 50% Dextrose solution IV
Signs of Hyperglycemia	SLOW onset Hunger & the 3 poly’s skin: warm / hot & dry (“Sugar’s high!”) Lethargic As progresses - if DKA - ketones will be present in urine Resp: rapid & deep (Kussmal) Breath: sweet & frui
Causes of Hyperglycemia	Too little insulin / oral antidiabetic Failure to follow diet (Too much food) Any “stress” on the body (surgery, trauma, stress, infection) Untreated diabetes
Insulin	Insulin is a hormone produced in the beta cells of the pancreas, secreted at a rate of 0.5 to 1 unit per hour. Average insulin secretion in adult is up to 30-50 Units per day.
Insulin requirements	is required for entry of glucose into skeletal and heart muscle and fat also is important in protein and lipid metabolism.
Decrease in insulin = decrease in glucose into cell =	hyperglycemia
Insulin Concentration	100 Units per mL
Insulin is the drug of choice for	type 1 and type 2 uncontrolled by diet, exercise or oral hypoglycemic agents
Insulin dosage is	“tailored” to each patient specifics metabolic needs to achieve stable blood glucose levels
Rapid Acting Insulins	Insulin Lispro (Humalog) Insulin Aspart (NovoLog) Insulin Glulisine (Aprida)
Rapid Acting Onset / Peak / Duration	10 min / 1 -3 hr / 3-6 hrs.

Created by: hajet

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