NCLEX PN - Endocrine
The nurse is teaching a client with diabetes about foot care. Which statement made by the client indicates understanding of which activities would help prevent infection? SATA
"I will apply lotion to my feet daily." "I will assess the skin on my feet for redness, abrasions, and open areas daily."
A client in thyroid storm tells the nurse, "I know I'm going to die. I'm very sick." Which response by the nurse is appropriate?
"You must feel very sick and frightened."
Which change would the nurse immediately communicate to the HCP when providing postoperative care for a client following a hypophysectomy? SATA
ALL Visual, Strength, Mental status, Profound diuresis, LOC
Which manifestation would a nurse assess for when providing care for a client with acromegaly? SATA
ALL Snoring, Joint pain; Hoarseness; HTN; Hyperglycemia; Enlarged hands
A client is injured in a motor vehicle accident and is admitted to the critical care unit. Twelve hours later, the client complains of abdominal pain in the LUQ. A ruptured spleen is diagnosed, and an emergency splenectomy is scheduled. Which point would the nurse emphasize when preparing the client for surgery?
Abdominal drains will be required for several days after the surgery.
Which manifestation would the nurse expect to find when caring for a client newly diagnosed with Cushing syndrome?
Adipose tissue deposits
A client is scheduled for an adrenalectomy. Which nursing intervention would the nurse anticipate will be prescribed for this client?
Administering IV steroids Steroid therapy usually is instituted preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery.
Which action describes the correct administration of levothyroxine to a client with hypothyroidism?
Advise client to take the medication upon rising on an empty stomach
Which manifestation would the nurse assess for in a client with hyperthyroidism? SATA
Amenorrhea; Flushed appearance; Short attention span
Which treatment plan would the nurse expect for a client with dysphagia caused by acute thyroiditis?
Antibiotics Acute thyroiditis is treated with antibiotics. Surgery is required if hormone suppression therapy does not work or thyroiditis is not treated.
Which action by the nurse is important when caring for a client with hyperthyroidism?
Arranging for sufficient rest periods Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism. With hyperthyroidism, glucose tolerance is decreased, and the client would be hyperglycemic.
Daily Humulin R insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8:00 am. Which time would the nurse monitor the client for a potential insulin reaction?
Before lunch Regular insulin is short acting, and it peaks in 2 to 4 hours, which in this case will be at or before lunch.
When taking the blood pressure of a client who has a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the HCP. Which substance would the nurse expect the HCP to prescribe?
Calcium
After a surgical thyroidectomy, a client exhibits carpopedal spasm and some tremors. The client reports tingling in the fingers and around the mouth. Which medication would the nurse expect the primary health care provider to prescribe after being notified of the client's manifestations?
Calcium gluconate The client is exhibiting s/s of hypocalcemia, which occurs with removal of the parathyroid glands.
The nurse is caring for a client who just returned after thyroidectomy. Which action would be implemented during the first 24 hours after surgery when the nurse is concerned about thyroid storm?
Checking vital signs Q2H after they stabilize
A nurse is assessing a client with hypothyroidism. Which clinical manifestation would the nurse expect the client to exhibit? SATA
Cool skin; Constipation; Periorbital edema; Decreased appetite
The primary HCP prescribed carbamazepine to a client with central diabetes insipidus. The serum osmolarity is 600 mOsm (mmol)/kg. Which finding would indicate an effective outcome of the drug?
Decreased thirst.
The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which intervention would the nurse include to decrease the risk for complications? SATA
Examining the feet daily; Wearing well-fitting shoes; Performing regular exercise Clients with diabetes often have peripheral neuropathy and are unaware of discomfort or pain in the feet requiring the feet to be examined every night for signs of trauma.
During a home visit to a client, the nurse identifies tremors of the hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Which assessment finding would concern the nurse and require urgent reporting to the provider?
Fluttering in the chest. Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure.
Which action would the nurse take with a client scheduled for surgical procedure whose morning blood glucose reading was 120?
Hold the dose and notify the HCP
While assessing a client with adrenal gland hypofunction receiving drug therapy, the nurse finds a round face, rapid weight gain, and swelling in the body. An adjustment in the dosage of which medication would the nurse expect the primary health care provider to make?
Hydrocortisone The administration of hydrocortisone can result in "round face," rapid weight gain, and swelling in the body, which are the symptoms of Cushing syndrome.
Postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication would the nurse suspect the client is experiencing?
Hypocalcemia
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. Which condition would the nurse suspect is causing these clinical findings?
Hypokalemia Cramping, SOB, and U waves are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose.
A client is admitted to the hospital with a diagnosis of excess antidiuretic hormone (ADH). Which clinical indicator would the nurse identify when assessing this client?
Hyponatremia ADH causes increase reabsorption of water by renal tubules, which dilutes sodium levels, causing hyponatremia. ADH will decrease urine volume.
Which action would the nurse take when a client with Addison disease develops adrenal crisis after abruptly stopping prescription steroids?
IV fluid replacement
A nurse concludes that a client has a hypoglycemic reaction to insulin. Which finding supports this conclusion? SATA
Irritability; Heart palpitations
The nurse is caring for a client diagnosed with Cushing syndrome. Which finding will the nurse expect to find upon assessment?
Lability of mood Excess adrenocorticoids cause emotional lability, euphoria, and psychosis.
A client with type 1 diabetes consistently has high glucose in the morning. Which instruction should the nurse give to the client to differentiate between the Somogyi effect and the dawn phenomenon?
Measure the blood glucose level between 2:00 am and 4:00 am
Which drug acts as an abortifacient in female clients?
Mifepristone An antiprogesterone that blocks the progesterone receptors and acts as an abortifacient (substance that induces abortion)
Which clinical manifestation is indicative of the fluid and electrolyte imbalance associated with parathyroidectomy?
Muscle spasms Removal of the parathyroid glands causes hypocalcemia and associated neuromuscular irritability
During a routine examination, an enlarged thyroid gland is discovered and hyperthyroidism is suspected. Which finding would the nurse expect to identify when completing a nursing admission history and physical for this client? SATA
Palpitations; Tachycardia
A client is scheduled for an adrenalectomy. Which prescription will the nurse expect to find in the client's plan of care?
Parenteral steroids Steroid therapy is usually given IV or IM preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample Protein and potassium.
Laboratory studies are being performed on a client with a potential diagnosis of hyperparathyroidism. Which serum blood level would the nurse expect to be decreased when reviewing the results?
Phosphorus Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorus levels decrease.
Which response indicates that a client receiving total parenteral nutrition is hyperglycemic? SATA
Polyuria, Polydipsia
Which laboratory result would the nurse monitor for in a client taking a corticosteroid for exacerbation of emphysema and furosemide for blood pressure management?
Potassium
A nurse is caring for a postoperative client who has diabetes. Which cause of diabetic ketoacidosis does the nurse need to consider when caring for this client?
Presence of infection Infection increases the body's metabolic rate, and insulin is not available for increased demands.
Which hormone level test is likely to be ordered by the health care provider for a client with a suspected pituitary adenoma who reports amenorrhea, galactorrhea, headache, and vision loss?
Prolocatin Prolocatin is a hormone released from the anterior pituitary gland that stimulates milk production after childbirth. Pituitary adenomas can cause the release of too much prolactin resulting in ameorrhea, galactorrhea, headache, and visual disturbances.
The nurse is providing postoperative care for a client after thyroidectomy. Which response would the nurse assess the client for when concerned about the potential risk for thyrotoxic crisis?
Rapid heartburn and tremors Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes tachycardia, tremors, pyrexia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition.
A client who has type 1 diabetes is admitted to the hospital for major surgery. Before surgery, the client's insulin requirements are elevated but well controlled. Which change in insulin requirement will the nurse anticipate postoperatively?
Remain elevated Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period.
A client is admitted to the hospital for a subtotal thyroidectomy. Which action would the nurse teach the client to take when discussing postoperative drug therapy?
Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone. Excessive TH replacement may leads to s/s of hyperthyroidism. Iodine may be administered before surgery, not after.
Which intervention would a nurse perform when caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH)?
Restricting fluids
The nurse is assessing a client with a suspected pituitary tumor. Which assessment finding is consistent with a pituitary tumor?
Seizures Seizures can occur in clients who have pituitary tumors.
A client who is on long-term corticosteroid therapy after an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. Which concern related to the client's history would be recognized by the nurse?
Steroid therapy will need to be increased to avert a life-threatening crisis.
A client is scheduled to have a thyroidectomy for cancer of the thyroid. Which specific instruction about postoperative care should the nurse provides during preoperative teaching?
Support the head with the hands when changing position. Supporting the head with the hands when changing position relieves tension on the incision and limits the risk for dehiscence
A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. Which response would the nurse instruct the client to monitor for in addition to nervousness and hunger?
Sweating When serum glucose decreases, the sympathetic nervous system is stimulated, resulting in a surge of epinephrine and norepinephrine.
A client reports a "funny, jittery feeling" on the third postoperative day after a subtotal thyroidectomy. Which action would the nurse take immediately?
Test for Chvostek's and Trousseau's signs and notify the health care provider These symptoms may indicate impending hypocalcemic tetany, which is a complication after removal of parathyroid tissue during a thyroidectomy. Physical assessment and notification of the HCP are the priorities.
A nurse is caring for a client who just had a thyroidectomy. Which manifestation would the nurse assess the client for when concerned about hypoparathyroidism from the surgery?
Tetany Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which normally increases the blood calcium level.
A client is recovering from a thyroidectomy. Which assessment would the nurse use to evaluate for nerve injury that may be the result of surgery-related trauma?
The client's ability to speak The laryngeal nerve is close to the operative site and can be damaged inadvertently.
A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. Which teaching will the nurse include in response to the client's knowledge deficit?
There may not be enough thyroid tissue to supply adequate thyroid hormone. After a subtotal thyroidectomy, the thyroxine output may be inadequate to maintain an appropriate metabolic rate.
A nurse is caring for a client with an underactive thyroid gland. Which response would the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T3) and thyroxine (T4)? SATA
Weight gain; Cold intolerance
