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The nurse is conducting health screenings for hypothyroidism at the community health fair. Which client is at the highest risk for this condition? A client who is
- A. underweight, anxious, has a rapid pulse, and reports persistent diarrhea.
- B. overweight, reports perspiration while playing sports, and reports feeling cold all the time.
- C. obese, has high blood pressure, and has frequent reports of thirst.
- D. obese, has periorbital edema, and reports a decrease in motivation.
Correct Answer: D
Rationale: Hypothyroidism causes weight gain, edema, and fatigue or decreased motivation. Underweight, rapid pulse, and diarrhea suggest hyperthyroidism; thirst and hypertension are less specific.
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The nurse observes the newly hired registered nurse prepare to administer neutral protamine hagedorn (NPH) insulin to a client. Which action by the newly hired nurse requires follow-up?
- A. asks the client which site the insulin was last injected.
- B. checks the client's blood glucose levels prior to administering the insulin injection.
- C. shakes the insulin vial before withdrawing insulin.
- D. reminds the client to report symptoms of clammy skin and disorientation.
Correct Answer: C
Rationale: NPH insulin should be gently rolled, not shaken, to mix the suspension without creating bubbles, which can affect dosing accuracy. Asking about injection sites, checking glucose, and reminding about hypoglycemia symptoms are correct actions.
The nurse is teaching a client about diabetes mellitus. Which of the following information should the nurse include?
- A. You will need yearly hemoglobin A1C lab tests.
- B. Your diet should consist mostly of simple carbohydrates.
- C. Annual visual examinations are recommended.
- D. You should take more insulin before exercising.
- E. Your liver enzymes will be monitored closely.
- F. Check your blood sugar if you start to feel shaky.
Correct Answer: A, C, F
Rationale: HbA1C monitors long-term control, ideally every 3 months, but yearly is a start. Annual eye exams detect retinopathy. Checking glucose during shakiness prevents hypoglycemia. Simple carbs raise glucose rapidly, insulin needs vary, and liver monitoring is not routine.
The nurse is caring for a client who presents with a blood glucose level of 45 mg/dL (2.4975 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]. Which of the following findings are expected?
- A. Blurred vision
- B. Increased urinary output
- C. Cool and clammy skin
- D. Palpitations
- E. Orthostatic hypotension
- F. Paresthesias
Correct Answer: C, D, F
Rationale: Hypoglycemia causes sympathetic activation (cool, clammy skin; palpitations) and neurological symptoms (paresthesias). Blurred vision and increased urination are more typical of hyperglycemia, and orthostatic hypotension is less directly related.
The nurse is caring for a client with Cushing's disease. Which of the following complications are associated with this condition?
- A. cataracts
- B. diabetes mellitus
- C. orthostatic hypotension
- D. osteoporosis
- E. venous thromboembolism
Correct Answer: A, B, D, E
Rationale: Cushing's excess cortisol causes cataracts, diabetes from hyperglycemia, osteoporosis from bone loss, and thromboembolism from hypercoagulability. Orthostatic hypotension is not typical.
The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory tests require careful monitoring?
- A. Potassium
- B. Sodium
- C. Glucose
- D. Magnesium
Correct Answer: B
Rationale: SIADH causes water retention, diluting sodium and risking hyponatremia. Close sodium monitoring prevents neurological complications like seizures or coma.