The nurse is assessing a client with pheochromocytoma. Which...

The nurse in the clinic is caring for a 32-year-old female client.
Item 6 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.

Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]

Orders
1714:
Arrange for a follow-up appointment in 3 days
Lab orders: serum complete blood count, complete metabolic panel, hemoglobin A1C
24-hour urinary cortisol excretion

Progress Notes
Follow-up appointment 3 days later
1544: Client presents for a 3-day follow-up. Laboratory findings confirm Cushing's disease with the 24-hour urine cortisol test at 125 mcg/24 hour [10 to 100 mcg/24]. CMP showed hyperglycemia, hypernatremia, and hypokalemia. Will refer to endocrinology for further evaluation and management. Will prescribe potassium supplementation.

For each of the statements made by the client, click to specify whether the statement indicates an understanding or requires follow-up of the discharge teaching provided on Cushing's disease.

A. I should start using a salt substitute to season my foods.
B. Exercise such as swimming is appropriate.
C. I should start eating snacks high in sodium and potassium.
D. I will limit my caffeine consumption.
E. This condition requires me to avoid getting the seasonal influenza vaccine.
F. I should notify my doctor if I start to develop constipation and muscle weakness.

Correct Answer: A, C, E

Rationale: Salt substitutes reduce sodium, appropriate for Cushing's-related hypertension. High sodium snacks are incorrect due to fluid retention risks. Limiting caffeine is good, and avoiding vaccines is wrongâ€”immunizations are crucial. Notifying the doctor about weakness is correct.

The nurse is caring for a client newly diagnosed with diabetes mellitus (type one). It would be essential to educate the client to

A. check their hemoglobin A1C level every three months.
B. rotate injection sites for insulin administration.
C. examine their feet with a mirror daily.
D. recognize the symptoms of hypoglycemia.

Correct Answer: A, B, C, D

Rationale: HbA1C monitors control, rotation prevents lipohypertrophy, foot checks prevent ulcers, and recognizing hypoglycemia symptoms ensures timely treatment in type 1 diabetes.

The nurse prepares to administer intermediate-acting insulin to a client with diabetes mellitus. Place the following actions in the order in which they should be performed when preparing the injection, starting from first to last.

A. Gently roll the bottle of intermediate-acting insulin in the palms of your hands to mix the insulin.
B. Remove air bubbles in the syringe by tapping on the syringe.
C. Inspect the bottle for the type of insulin and the expiration date.
D. Pull back the plunger to draw air into the syringe and inject it into the vial.
E. Turn the bottle upside down and draw the insulin dose into the syringe.
F. Clean the rubber stopper with an alcohol swab.

Correct Answer: C, F, A, D, E, B

Rationale: Inspect the bottle for type and expiration, clean the stopper, roll to mix, draw air and inject into vial, draw dose, then remove bubbles to ensure accurate, safe administration.

The nurse is caring for a client who has been prescribed a 14-day course of prednisone. Which of the following statements, if made by the nurse, would be correct?

A. This medication may make you gain weight.
B. It is best to take this medication in the morning with food.
C. If you have further pain, it is okay to take naproxen.
D. Your blood pressure may decrease while taking this medication.
E. Do not abruptly stop taking this medication.

Correct Answer: A,B,E

Rationale: Prednisone can cause weight gain, should be taken in the morning with food to mimic cortisol rhythms and reduce gastrointestinal upset, and must not be stopped abruptly to prevent adrenal insufficiency. Naproxen should be avoided due to increased gastrointestinal bleeding risk, and prednisone typically increases, not decreases, blood pressure.

The nurse is teaching a client about newly prescribed insulin glargine. The nurse recognizes the need for further instruction when the client makes the following statement?

A. I will take this insulin right before my meals.
B. I should roll this vial of insulin before removing it with the syringe.
C. This insulin will help control my glucose for 24 hours.
D. I can only inject this insulin into my abdomen.
E. I'm glad to know I can mix this with my regular insulin.

Correct Answer: A,B,D,E

Rationale: Insulin glargine is a long-acting insulin taken once daily, not before meals, provides 24-hour coverage, and should not be mixed with other insulins. It is clear and does not require rolling, and can be injected in multiple sites, not just the abdomen. Only the statement about 24-hour control is correct.

NCLEX RN Questions on Endocrine System Related

Correct Answer: A, B, E