Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:
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Solution
Consuming a low-carbohydrate, high protein diet and avoiding fasting.
To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn’t help control hypoglycemia.
Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s hyperglycemia?
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Solution
Acromegaly
Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn’t associated with hyperglycemia, nor is growth hormone deficiency.
Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?
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Solution
Fluid intake is less than 2,500 ml/day.
Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn’t been effective.
A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:
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Solution
Trousseau’s sign.
This client’s serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau’s sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans’ sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar’s sign (softening of the uterine isthmus) and Goodell’s sign (cervical softening) are probable signs of pregnancy.
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
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Solution
Restricting fluids
To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client’s already heightened fluid load.
When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect:
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Solution
a blood pressure of 176/88 mm Hg.
Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn’t associated with the other options.
For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?
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Solution
Increased urine osmolarity
In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glycosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.
Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
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Solution
Thyroid crisis
Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?
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Solution
antidiuretic hormone (ADH).
ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and LH levels won’t be affected.
Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following?
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Solution
Muscle weakness
Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren’t seen in hyperkalemia.