Evolve Endocrine NCLEX-PN
A nurse is caring for a client who is recovering from injuries sustained in a motor vehicle accident (MVA) 5 days ago. The client has a past medical history of hyperlipidemia, hypothyroidism, and depression. When obtaining the client's vital signs, the nurse notes that the client's temperature is 95°F (35°C), the heart rate is 54, and respirations are 10. Which of the following complications does the nurse suspect the client is experiencing?
Myxedema coma
The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the practical nurse implement from the plan of care?
Observe for nausea and vomiting and weigh daily
Hypernatremia
high sodium
Hypoglycemia symptoms
hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin
hyperparathyroidism
hypersecretion of the parathyroid glands, usually caused by a tumor
Which teaching technique(s) would be most useful for an older adult patient with diabetes? (Select all that apply.)
. Set a time for the teaching session that is agreeable to the patient. Allow time for the patient to jot down important points. Repeat key concepts frequently; if the patient does not understand, try rephrasing the concept.
A 30-year-old woman is admitted for urinary tract infection with sepsis. A urinalysis reveals presence of ketones, glucose, and nitrates. Which question would the nurse ask to further assess possible diabetes mellitus?
3. "Have you been thirstier than usual? Do you find you urinate more now?"
The nurse answers the call light for a patient with diabetes. The patient states she feels shaky and weak. The nurse notes pallor and moist skin. List in priority order the actions of the nurse. 1. Give patient 6 oz of juice. 2. Document interventions. 3. Check fingerstick glucose. 4. Assess level of consciousness.
4,3,1,2
Target preprandial glucose
80-130 mg/dl
Which manifestation indicates to the practical nurse the client is experiencing hypoparathyroidism?
A positive Chvostek's sign
Addison's disease
A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones.
The nursing assistant tells you that a patient with diabetes has a blood glucose level of 60 mg/dL. What symptoms would the nurse be most likely to observe with this glucose level?
Confusion, tremulousness, pallor, sweating, and weakness
A nurse is caring for a client with Cushing's syndrome with multiple skin tears. Which of the following nursing interventions best promotes maintaining the client's skin integrity?
Consulting a dietitian, as ordered, if the client's nutrition is poor
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. Which intervention would be appropriate to decrease the client's anxiety?
Convey empathy, trust, and respect toward the client
A nurse is caring for a client with diabetes insipidus secondary to a primary pituitary tumor. The nurse notes that the client's blood pressure is low and urine output is high. Which of the following conditions is of primary concern for the nurse regarding this client?
Dehydration
.The practical nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the practical nurse implement?
Ensure the client eats the bedtime snack
S/S of Cushing's Syndrome?
Fragile, thin skin, prone to bruises, and stretch marks on the abdomen, excessive thirst and urination
. The practical nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the registered nurse for review?
Serum sodium of 112 mEq/L and a headache
The nurse is caring for a client with type 1 diabetes mellitus who is hyperglycemic. Which problem should the nurse consider first, when planning care for this client?
Signs of dehydration
A client who returned to the nursing unit 8 hours ago after hypophysectomy has clear drainage saturating the nasal dressing. The nurse should take which action?
Test the drainage for glucose
A young adult female weighing 113 kg (250lbs) comes to the clinic for a non-healing wound on her lower leg, which has been present for two (2) weeks. Which disease process should the practical nurse suspect the client has developed?
Type 2 DM
tetany
condition affecting nerves causing muscle spasms as a result of low amounts of calcium in the blood caused by a deficiency of the parathyroid hormone
diabetes insipidus (DI)
condition caused by insufficient antidiuretic hormone secreted by posterior lobe of pituitary gland; symptoms include polyuria and polydipsia
necrotic
dead tissue
Myxedema coma
defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs.
acromegaly
enlargement of the extremities; caused by A disorder in adults in which the pituitary gland produces too much growth hormone.
Humlin N
insulin NPH
Hypoglycemia
low blood sugar
Hyponatremia
low sodium in the blood
Serum creatinine levels
normal is between 0.6 and 1.3
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
overproduction of the antidiuretic hormone ADH, leading to bloating, water retention, and electrolyte imbalance
Very short acting insulin
i.e. Humalog (lispro), Novolog (aspart), Apidra (glulisine) ONSET: 10-20 minutes PEAK: 1-2 hours DURATION: 4-5 hours ROUTE: SQ injection, IV, insulin pump
Endocrine disorders
primary: defect in the cells that secrete the hormone secondary: too much or too little tropic hormone
albuminuria
protein in the urine
hypophysectomy
removal of the pituitary gland
Chvostek's sign
spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia
Hypoparathyroidism
the state of decreased secretion or activity of parathyroid hormone (PTH)
Levothyroxine
thyroid replacement, thyroid hormone
Hypothyroidism
underactivity of the thyroid gland
The practical nurse is caring for a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the practical nurse expect to observe?
Bronze pigmentation, hypotension, and anorexia
The client is diagnosed with hypothyroidism. Which manifestations should the practical nurse expect the client to exhibit?
Complaints of extreme fatigue and hair loss
The practical nurse is reviewing discharge teaching for a client diagnosed with Cushing's disease. Which statement by the client demonstrates an understanding of the instructions?
I will notify my doctor if i start to run a fever
A nurse is caring for an adult female with acromegaly. The nurse notes that the client has enlarged facial features and large hands and feet. Which additional clinical findings will the nurse expect to find in this client? Select all that apply.
Increased subcutaneous tissue Enlarged spleen Hyperglycemia Fleshy appearance
The nurse is monitoring the results of periodic serum laboratory studies drawn on a client with diabetic ketoacidosis (DKA) receiving an insulin infusion. The nurse determines that which value needs to be reported?
Potassium 3.1 mEq/L
The registered nurse is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the practical nurse, who is attending the class, expect in the discussion
Take diabetic medication even if unable to eat the client's normal diabetic diet If unable to eat, drink liquids equal to the client's normal caloric intake Call the health care provider if glucose levels are higher than 180 mg/dL
A nurse is caring for a client with diabetes insipidus (DI). The client asks the nurse, "What causes this condition?" Which of the following is the best response from the nurse?
"A deficiency of a hormone called antidiuretic hormone (ADH)."
A client with type 2 diabetes mellitus had hip replacement surgery. At 7 a.m. on the day after surgery, the nurse prepares to administer regular insulin subcutaneously. The client tells the nurse, "You're giving me the wrong medication. I don't take anything with needles." Which of the following is the nurse's best response to this client?
"This medication was ordered because the stress of the surgery has made your blood sugar higher than normal."
Which statement, made by the client with type 2 diabetes mellitus, indicates that the client understands the glycosylated hemoglobin test?
"This test gives an average of my blood sugar levels for the past 3 months."
Vasopressin
(antidiuretic hormone) hormone released by posterior pituitary; raises blood pressure and enables kidneys to conserve water
Serum Sodium (Na+) normal level
135-145 mEq/L
Urine Specific Gravity Normal Range
1.010-1.025
glycosylated hemoglobin (A1c level) normal range
4-6%
Which measure should the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves' disease?
A restful environment
Which laboratory data would make the practical nurse suspect the client with primary hyperparathyroidism is experiencing a complication?
A serum creatinine level of 2.8 mg/dL
. A nurse determines the fingerstick blood glucose reading for a patient with diabetes is 750 mg/dL. What is the nurse's priority action?
Assess the vital signs of the patient.
Hashimoto's disease
Autoimmune disease that produces chronic inflammation of the thyroid gland, more women are affected than men; diagnosed in persons ages 40 to 60.
Synthroid
Brand name for levothyroxine
The nurse participating in a free health screening at the local mall obtains a random blood glucose level of 200 mg/dL on an otherwise healthy client. The nurse tells the client to do which as a next step?
Call the health care provider to have the value rechecked as soon as possible
The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pulse and respiratory rate are elevated from the client's baseline. Which action should the nurse implement?
Check the client's capillary blood glucose
. Which manifestations indicate the client with hypothyroidism is not taking enough thyroid hormone?
Complaints of constipation and being cold
A nurse is caring for an adult client who presents to the primary care clinic with the complaint of insomnia due to severe polyuria and nocturia. The nurse reviews the client's laboratory results and notes that the client's urine specific gravity is decreased, while the serum osmolality is increased. Which of the following conditions does the nurse suspect?
Diabetes insipidus (DI)
Kidney disease
During a routine checkup, the health care provider tells a patient with diabetes that test results reveal albuminuria. Which long-term complication is specific to this test result?
Acromegaly S/S
Enlarged hands and feet. Coarsened, enlarged facial features. Coarse, oily, thickened skin. Excessive sweating and body odor. Small outgrowths of skin tissue (skin tags) Fatigue and muscle weakness.
hypermetabolic state
Excessive metabolism that occurs with severe infections and cachexic patients
A client scheduled for a thyroidectomy says to the nurse, "I am so scared to get cut in my neck." Based on the client's statement, the nurse determines that the client is experiencing which problem?
Fear about impending surgery
The client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the unlicensed assistive personnel (UAP) tells the practical nurse the client has a headache and is really acting "funny." Which intervention should the practical nurse implement first?
Go to the client's room and observe for signs of hypoglycemia
A client newly diagnosed with diabetes mellitus takes NPH insulin every day at 7:00 am. The nurse has taught the client how to recognize the signs of hypoglycemia. The nurse determines that the client understands the information presented if the client watches for which signs and symptoms in the late afternoon?
Hunger; shakiness; and cool, clammy skin
A nurse is caring for a client with Cushing's syndrome after taking prednisone for years for an autoimmune disease. The client appears obese with a large "buffalo hump" noted. In addition to the client's physical appearance, which of the following clinical manifestations will the nurse observe in this client?
Hypernatremia ; Hyperglycemia
Which manifestations should make the practical nurse suspect the client is experiencing a thyroid storm?
Hyperpyrexia and extreme tachycardia
A nurse is caring for a client with hyperthyroidism and is taking the client's vital signs. The nurse notes that the client's temperature is elevated. Which of the following is the nurse's best understanding regarding the reason for the client's elevated temperature?
Hyperthyroidism causes a hypermetabolic state, elevating the client's temperature
A client has an endocrine system dysfunction of the pancreas. The nurse anticipates that the client will exhibit impaired secretion of which substance?
Insulin
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who is being treated for hyponatremia. Which of the following health-care provider orders will the nurse anticipate in the collaborative care of this client?
Intravenous hypertonic saline solution
A client recently diagnosed with diabetes mellitus requiring insulin tells the clinic nurse that he is traveling by air throughout the next week. The client asks the nurse for any suggestions about managing the disorder while traveling. Which action should the nurse tell the client to do?
Keep snacks in carry-on luggage to prevent hypoglycemia during the flight.
The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia?
Less than 50 mg/dl
Target HbA1c
Less than 7%
A 50-year-old woman was recently diagnosed with type 2 diabetes mellitus and desires to start a healthy lifestyle to control her disease. What is the initial recommendation that the nurse should make?
Maintain adequate glucose control.
Intermediate acting insulin
NPH (Humulin N, Novolin N) Onset 1-2hr Peak 6-12hr Duration 18-24 hr
Diabetes Type 1
No insulin is produced. Either born with it or developed at a young age ; lean body, at risk for DKA, must have insulin to survive
The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which action should the practical nurse implement as a priority?
Notify the RN
Insulin injection sites
Outer arm, abdomen, thigh, upper buttocks
The home health nurse is visiting an older adult patient who has successfully managed her type 2 diabetes for years. During the visit, the nurse notes that the patient has severe arthritis; poor vision; and several dry, red areas on the lower extremities. What is the priority patient problem?
Potential for ineffective self-health management due to aging.
The practical nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the practical nurse review about diabetes
Preform warm up and cool down exercises
The anticipated intended effect of fludrocortisone acetate (Florinef) for the treatment of Addison's disease is which?
Promote electrolyte balance
Short acting insulin
Regular (Humulin R, Novolin R) onset 30 minutes Peak 2-5hr Duration 5-8 hr
A client is in metabolic acidosis caused by diabetic ketoacidosis (DKA). The nurse prepares for the administration of which medication as a primary treatment for this problem?
Regular Insulin
The practical nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions would the practical nurse implement from the pan of care?
Restrict fluids per health-care provider order; Monitor urine and serum osmolality
Which laboratory value should be monitored by the practical nurse for the client diagnosed with diabetes insipidus?
Serum sodium
The practical nurse is reviewing information about type 2 diabetes mellitus with a client.. Which explanation explains the development of type 2 diabetes?
The cells become resistant to the circulating insulin
The practical nurse is inspecting the feet of a client with long-term type 2 diabetes. Which information warrants immediate intervention by the registered nurse?
The client has a necrotic big toe
The client diagnosed with hypothyroidism is prescribed the thyroid hormone levothyroxine (Synthroid). Which assessment data indicate the medication has been effective?
The client's temperature is within baseline
The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the practical nurse make based on this result?
This result is above recommended levels
The practical nurse is caring for the client diagnosed with type 2 diabetes mellitus. Which diet selection indicates the client understands nutritional teaching?
Turkey sandwich, unsweetened tea, celery sticks
A patient who works as a personal trainer is diagnosed with insulin-dependent diabetes. What should the nurse teach regarding self-administration of regular insulin?
Use the abdomen as an insulin injection site.
A client with diabetes mellitus is scheduled to have a fasting blood glucose level determined in the morning. The nurse tells the client not to eat or drink after midnight. When the client asks for further information, the nurse clarifies by stating that which should be acceptable to take before the test?
Water
The client diagnosed with a pituitary tumor has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which intervention should the practical nurse expect to implement from the plan of care?
Weigh the client daily at the same time
diabete ketoacidosis
a condition that occurs as the result of high blood sugar, characterized by dehydration, altered mental status, and shock
Diabetes type 2
adult onset diabetes, noninsulin dependent, body produces insulin but no enough, is more common, can be controlled by diet and exercise,
Primary adrenal cortex insufficiency
Addison's disease
The nurse working on an endocrine nursing unit understands that which correct concept is used in planning care?
Clients who have hyperparathyroidism should be protected against falls.
hyperpyrexia
an extremely high fever
Which information indicates the client diagnosed with diabetic ketoacidosis (DKA) is responding to the medical treatment?
PT is alert to date, time, and place
polyphagia
excessive hunger
polydipsia
excessive thirst
polyuria
excessive urination
A patient newly diagnosed with diabetes is given diet instructions. What should the nurse do to effectively motivate the patient to comply with dietary recommendations? (Select all that apply.)
1. Emphasize good food choices. 2. Apply diet prescriptions to patient-preferred foods. 4. Focus on the benefits of diet compliance. 5. Involve meal preparers in diet teaching.
The practical nurse reviews the client problem "risk for imbalanced body temperature" for the client diagnosed with hypothyroidism. Which intervention should the practical implement from the plan of care?
Discourage the use of an electric blanket
Cushing's syndrome symptoms
Obesity, wasted extremities, buffalo hump, acne, hirsutism, amenorrhea, proximal muscle weakness, striae, HTN
polycystic ovary syndrome
a condition caused by a hormonal imbalance in which the ovaries are enlarged by the presence of many cysts formed by incompletely developed follicles
Cushing's syndrome
a condition caused by prolonged exposure to high levels of cortisol
Graves disease
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos
ACTH stimulation test
blood analysis for cortisol levels after administration of synthetic adrenocorticotropic hormone
Hyperthyroidism
excessive activity of the thyroid gland
