Endocrine Med-Surg – Flashcards
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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?
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Client with Cushing's syndrome who requires orthostatic vital signs assessments Correct: An LPN/LVN will be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs
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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?
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Check blood glucose levels every 4 hours. Correct: Blood glucose monitoring is within the nursing assistant's level of practice if the nursing assistant has received education and evaluation in the skill.
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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?
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Inject regular insulin for the growth hormone stimulation test. Correct: Injection of insulin is within the LPN/LVN scope of practice.
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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?
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Remind the client to avoid drinking coffee and sudden position changes. Correct: 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. Reminding the client about previous instructions is an appropriate role for a nursing assistant who may observe the client doing potentially risky activities
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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?
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Serum sodium 110 mEq/L Correct: 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. The RN must act rapidly because this client requires immediate intervention.
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To best determine how well a client with diabetes mellitus is controlling blood glucose, which test will the nurse monitor?
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Glycosylated hemoglobin (HbA1c) Correct: Glycosylated hemoglobin indicates the average blood glucose over several months and is the best indicator of overall blood glucose control.
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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?
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"I should not eat any protein when I am collecting urine for this test." Correct: Eating protein does not interfere with collection or testing of the urine sample.
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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?
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Iodized salt for cooking Correct: 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
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The client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response?
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"Can you please tell me more?" Correct: Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly.
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The nurse is assessing the client for endocrine dysfunction. Which comment by the client indicates a need for further assessment?
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"I don't have any patience with my kids. I lose my temper faster." Correct: Many endocrine problems can change a client's behavior, personality, and psychological responses.
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The nurse is instructing the client who will undergo a suppression test. Which statement by the client indicates that teaching was effective?
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"I am being tested to see whether my hormone glands are hyperactive." Correct: 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.
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Which statement is true about hormones and their receptor sites?
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Hormones need a specific receptor site to work. Correct: In general, 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).
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Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients?
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Glucagon release Correct: 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.
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In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose?
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Homeostasis Correct: Insulin injections maintain homeostasis, or normal balance, between insulin and glucose in the client with type 1 diabetes
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The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor?
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Antidiuretic hormone (ADH) production Correct: 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.
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The client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client?
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Cranial computed tomography (CT) Correct: 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.
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Which gland releases catecholamines?
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Adrenal Correct: The adrenal medulla releases catecholamines in response to stimulation of the sympathetic nervous system.
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An elementary school student asks a nurse about injecting steroids. What does the nurse know is most commonly involved in steroid abuse?
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Testosterone Correct: 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 damage, some cancers, hypertension, and kidney failure.
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The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit?
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Client with Cushing's syndrome who has an elevated blood glucose and requires frequent administration of insulin Correct: An RN who works with pediatric clients would be familiar with glucose monitoring and insulin administration.
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A client with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the client's care would be best to delegate to a nursing assistant?
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Assist with personal hygiene and skin care. Correct: Assisting a client with bathing and skin care is included in the nursing assistant scope of practice
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A client is referred to a home health agency after a trans-sphenoidal hypophysectomy. Which action will the RN case manager delegate to the home health aide who will see the client daily?
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Test any nasal drainage for the presence of glucose. Correct: Cerebrospinal fluid (CSF) will test positive using a glucose "dipstick." Nasal drainage that is positive for glucose after a trans-sphenoidal hypophysectomy would indicate a CSF leak that would require immediate notification of the health care provider. Nursing assistants and home health aides can be taught the correct technique to use this procedure.
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These data are obtained by the RN who is assessing a client who had a trans-sphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care?
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Client report of a headache and stiff neck Correct: Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care.
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A client with syndrome of inappropriate antidiuretic hormone (SIADH) is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider should the nurse address first?
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Administer infusion of 150 mL of 3% NaCl over 3 hours. Correct: The client with a sodium level of 105 mEq/L is at high risk for seizures and coma. The priority intervention is to increase the 105 sodium level to a more normal range. Ideally, 3% NaCl should be infused through a central line or with a small needle through a large vein to prevent irritation.
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After receiving change-of-shift report about the following four clients, which client should the nurse attend to first?
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Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL Correct: A glucose level of 36 mg/dL is considered an emergency. This client needs to be assessed and treated immediately.
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The client has been diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor, and bromocriptine mesylate (Parlodel) has been prescribed. As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain?
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Inhibits the release of some pituitary hormones Correct: Parlodel inhibits the release of both prolactin and growth hormone.
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A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus secondary to lithium overdose. Which medication is used to treat the diabetes insipidus (DI)?
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Desmopressin (DDAVP) Correct: Desmopressin (DDAVP) is the drug of choice for treatment of severe DI. It may be administered orally, nasally, or by intramuscular or intravenous routes
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A client has been admitted to the medical-surgical unit with a diagnosis of diabetes insipidus. The physician has requested desmopressin (DDAVP). How does DDAVP decrease urine output?
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Works as an antidiuretic hormone (ADH) in the kidneys Correct: DDAVP is a synthetic form of ADH that binds to kidney receptors and enhances reabsorption of water, thus reducing urine output.
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A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na 130 mEq/L, K 5.6 mEq/L, and glucose 72 mg/dL. Which of the following is the first request that the nurse should anticipate?
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Administer insulin and dextrose in normal saline to shift potassium into cells. Correct: This client is hyperkalemic. Anticipate a request to administer 20 to 50 units of insulin with 20 to 50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells
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The client with diabetes insipidus has dry lips and mucous membranes and poor skin turgor. Which intervention does the nurse provide first?
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Forces fluids Correct: Dry lips and mucous membranes and poor skin turgor are indications of dehydration, which can occur with diabetes insipidus (DI). This is a serious condition that must be treated rapidly. Encouraging fluids is the initial step, provided the client is able to tolerate oral intake.
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The client with Cushing's disease says that she has lost 1 lb. What does the nurse do next?
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Weighs the client Correct: Fluid retention with weight gain is more of a problem than weight loss in clients with Cushing's disease. Weighing the client with Cushing's disease is part of the nurse's assessment.
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The nurse is caring for the client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do?
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Wears a facemask when caring for the client Correct: A client with hypercortisolism will be immune suppressed. Anyone with a suspected upper respiratory infection who must enter the client's room needs to wear a mask to prevent the spread of infection.
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A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment?
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Avoids palpating the abdomen Correct: The abdomen must not be palpated because this action could cause a sudden release of catecholamines and severe hypertension in the client.
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The client has undergone a trans-sphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client?
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Instructs the client not to strain during a bowel movement Correct: Straining during a bowel movement increases ICP and must be avoided. Laxatives may be given and fluid intake encouraged.
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The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug?
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Headache Correct: A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the client's blood pressure should be monitored
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The nurse is teaching the client about how to monitor therapy effectiveness for the syndrome of inappropriate antidiuretic hormone (SIADH). What will the nurse tell the client to look for?
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Daily weight gain of less than 2 lbs Correct: The client needs to monitor daily weights because this assesses the degree of fluid restriction needed. A weight gain of 2 lbs or more daily or a gradual increase over several days is cause for concern.
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The client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response?
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"The disease can sometimes affect emotional responses." Correct: The client may have neurotic or psychotic behavior as a result of high blood cortisol levels. Being honest with the family helps them understand what is happening
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The nurse is providing discharge instructions to the client on spironolactone therapy. Which comment by the client indicates a need for further teaching?
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"I should eat a banana every day." Correct: Spironolactone increases potassium levels, so potassium supplements and foods rich in potassium should be avoided to prevent hyperkalemia.
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Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)?
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Increased serum sodium Correct: Increased serum sodium due to fluid restriction indicates effective therapy.
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Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use?
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Client with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week Correct: Corticosteroids may be used to treat signs and symptoms of asthma. This places the client at risk for adrenal insufficiency.
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A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: HR 118, resp rate 18, BP 84/44, pulse oximetry 98%, and temp 98.8 oral. Which intervention does the nurse prioritize for this client?
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Providing isotonic fluids Correct: Providing isotonic fluid is the correct response. This client's vital signs indicate volume loss that may be caused by nausea and vomiting and may accompany acute adrenal insufficiency. Isotonic fluids will be needed to administer IV medications such as hydrocortisone.
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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?
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Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily Correct: The client with chronic hypothyroidism and dementia is the most stable of the clients described and would be most appropriate to assign to an inexperienced RN.
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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?
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Client with infiltrative ophthalmopathy who needs administration of high-dose prednisone (Deltasone) Correct: Medication administration is within the scope of practice of the LPN/LVN.
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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?
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Measure the client's intake and output hourly. Correct: Measuring intake and output is a commonly delegated nursing action.
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Which action should the postanesthesia care unit (PACU) nurse take first when caring for a client who has just arrived after a total thyroidectomy?
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Monitor oxygen saturation using pulse oximetry. Correct: 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.
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The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first?
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Client with parathyroidectomy yesterday who has muscle twitching Correct: 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.
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The client has been diagnosed with hypothyroidism. What medication is usually prescribed to treat this disease?
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Levothyroxine sodium (Synthroid) Correct: Levothyroxine is a synthetic form of T4 that is used to treat hypothyroidism.
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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?
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Hypertension and heart failure Correct: 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.
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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?
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"You should see some effects of this medication within 2 weeks." Correct: 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 some effects within 2 weeks; however, it may take several more weeks before metabolism returns to normal.
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The client is being discharged with hypothyroidism. Which environmental change may the client experience in the home?
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Increased thermostat setting Correct: Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary
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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. A. Calcium gluconate B. Emergency tracheotomy kit C. Furosemide (Lasix) D. Hypertonic saline E. Oxygen F. Suction
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A. Calcium gluconate B. Emergency tracheotomy kit E. Oxygen F. Suction Correct: Calcium gluconate should be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Assess the client for numbness, tingling, or muscle twitching. Correct: Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema should occlude the airway. Correct: Respiratory distress can result from swelling or damage to the laryngeal nerve leading to spasm. It is important that the nurse work with respiratory therapy to have oxygen ready at the bedside for the client on admission. Correct: Because of the potential for increased secretions, it is important that a working suction is present at the bedside for admission of the client from the operating room. Incorrect Feedback: Incorrect: Furosemide might be useful in the postoperative client to assist with urine output; however, this is not of added importance for this client. Incorrect: Hypertonic saline would not be of benefit to this client as he is not hyponatremic
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The client has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention?
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Unlicensed assistive personnel (UAP) pulling the client up in bed by the shoulders Correct: The client with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the client carefully. A lift sheet should be used to reposition the client.
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The client is being discharged with propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse?
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"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 does not, however, need to remain completely at home.
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The client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next?
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Encourages the client to rest Correct: 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.
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Family members of the client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's response?
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"The mood swings should diminish with treatment." Correct: The mood swings should diminish over time with treatment. This will provide information to the family, as well as reassurance.
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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?
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Assesses the client's cardiac status completely Correct: 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.
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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?
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Asks whether the client has increased cold sensitivity or weight gain Correct: Increased sensitivity to cold and 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.
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The client is 18 hours post parathyroidectomy. Which finding requires immediate attention?
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Hoarseness Correct: Hoarseness or stridor is an indication of respiratory distress and requires immediate attention.
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The nurse is teaching the client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching?
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"If I continue to lose weight, I may need an increased dose." Correct: Weight loss indicates a need for a decreased dose, not an increased dose
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The client recently admitted with hyperparathyroidism has a very high urine output. Of the following actions, what does the nurse do next?
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Monitors intake and output Correct: Diuretic and hydration therapies are used most often for reducing serum calcium levels in clients with hyperparathyroidism. Usually, a diuretic that increases kidney excretion of calcium is used together with IV saline in large volumes to promote renal calcium excretion.
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A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching?
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"I'm ready to hold my newborn grandson now." Correct: 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.
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Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II?
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Medullary Correct: Medullary carcinoma commonly occurs as part of multiple endocrine neoplasia (MEN) type II, which is a familial endocrine disorder.
