NURS 2207 Endocrine EAQ Quiz (Graded) - Questions, Answers and Rationales Which clinical manifestations would the nurse expect a client to exhibit with
... [Show More] a diagnosis of Cushing syndrome? Select all that apply. 1. Emaciation 2. Weakness 3. Hypertension 4. Truncal obesity 5. Intermittent tonic spasms Rationale: Weakness occurs in response to the excessive catabolism of proteins and resulting loss of muscle mass. Hypertension occurs in response to excessive cortisol that causes an increase in circulating volume or an arteriole response to circulating catecholamines. Truncal obesity is caused by abnormal fat metabolism and deposition of fat in the mesenteric bed. Emaciation is associated with Addison disease. Intermittent tonic spasms of the extremities are associated with tetany, a neuromuscular manifestation, because of a decrease in ionized calcium occurring in hypoparathyroidism, not Cushing syndrome. Which nursing intervention is appropriate when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Providing oxygen 2. Encouraging carbohydrates 3. Administering fluid replacement 4. Teaching facts about dietary principles Rationale: As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis. The nurse is providing instructions about foot care for a client with diabetes mellitus. Which would the nurse include in the instructions? Select all that apply. 1. Wear shoes when out of bed. 2. Soak the feet in warm water daily. 3. Dry between the toes after bathing. 4. Remove corns as soon as they appear. 5. Use a heating pad when the feet feel cold. Rationale: Wearing shoes protects the feet from trauma; they should fit well and should be worn over clean socks. Drying between the toes after bathing prevents maceration and skin breakdown, thus maintaining skin integrity. Soaking the feet is contraindicated because it can cause macerations and skin breakdown, which allow a portal of entry for pathogenic organisms. Clients should not self-treat corns, calluses, warts, or ingrown toenails because of the potential for trauma and skin breakdown; these conditions should be treated by a podiatrist. Use of a heating pad, hot water bottle, or hot water is contraindicated because of the potential for burns; diabetic neuropathy, if present, does not allow the client to accurately evaluate the extremes of temperature. The registered nurse (RN) delegates the task of foot care for a client to unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task but was recently hired and is unfamiliar with the client's condition. Which process would the nurse follow in this situation? 1. Provide guidance to the UNP. 2. Observe and motivate the UNP. 3. Establish mutual expectations and conditions. 4. Explain what to do and how to perform the task. Rationale: If the delegatee is new to the workplace, but has the ability and willingness to perform a task, the RN would establish mutual expectations and conditions of performance to establish a good relationship. If the delegatee has limited knowledge and ability to perform a task, the delegator is expected to guide the UNP. The RN is expected to observe and monitor the task performed by the delegatee to ensure the delegatee has the ability and willingness to establish a relationship and accomplish the work. The RN can also explain the task and how to perform it if the situation involves a new task and the relationship is ongoing. A client with diabetes is given instructions about foot care. Which statement made by the client shows effective learning? 1. "I will trim my toenails before bathing." 2. "I will soak my feet daily for 1 hour." 3. "I will examine my feet using a mirror at least once a week." 4. "I will break in my new shoes over the course of several weeks." Rationale: A slower, longer period to break in new, stiff shoes will help prevent blisters and skin breakdown. The toenails should be trimmed by a podiatrist; they are usually trimmed after a foot bath when the nails are softer. Soaking the feet daily for 1 hour will cause maceration of the skin and should be avoided. Examining the feet using a mirror at least once a week is too infrequent; the client should examine the feet daily for signs of trauma. [Show Less]