HURST QUESTIONS [ENDOCRINE]

A client with Cushing's disease occupies one bed in a semi-private room. When considering room assignments, which client would be the safest choice to occupy the other bed in this room? 1. Status asthmaticus receiving respiratory therapy. 2. Newly admitted young adult with acute bronchitis. 3. Elderly client with 50% burn of both arms. 4. Young adult post appendectomy.

1. Correct: Status asthmaticus is not infectious and would be the best roommate for the client with Cushing's syndrome who is immunosuppressed due to excessive secretion of glucocorticoids. 2. Incorrect: Don't even consider this client because bronchitis is always infectious. 3. Incorrect: Burns are always contaminated wounds, and the elderly client has a poor immune system, so a high probability for an infected burn would make this client a poor choice to occupy a room with the Cushing's client who is immunosuppressed. 4. Incorrect: A client post appendectomy is prone to peritonitis or wound infection and not the best client choice.

A nurse is caring for a poorly controlled Type 2 diabetic who is having difficulty following the prescribed diet. For the past 3 months the HbA1c has been 8%. Todays blood sugar is 218 mg/dL. The client is currently taking metformin and exenatide and is at the clinic today to discuss insulin therapy with the PCP. Based on this history, what should the nurse anticipate will be the first strategy implemented to improve glucose control for this client? 1. Nutritional counseling to help improve diet compliance. 2. Addition of the Alpha-Glucosidase inhibitor, Acarbose to current medications. 3. Client teaching for a new prescription of insulin using the Basal/Bolus dosing method. 4. A prescription for Detemir, once daily SubQ.

1. Nutritional counseling to help improve diet compliance.

What information should a community health nurse include while planning an educational program on prevention of deep vein thrombus formation for a group of people who attend a senior citizens center? Select all that apply. 1. Exercise legs by raising and lowering heels while toes are on floor when traveling by plane. 2. Stop smoking 3. Lose weight 4. Stop every 4 hours to walk when traveling by car 5. Exercise daily

1., 2., 3., & 5. Correct: If on a plane, try to stand or walk occasionally. If unable to do that, at least try to exercise lower legs. Try raising and lowering your heels while keeping your toes on the floor, then raising your toes while your heels are on the floor. Make lifestyle changes. Lose weight and quit smoking. Obesity and smoking increase your risk of deep vein thrombosis. Get regular exercise. Exercise lowers a person's risk of blood clots, which is especially important for people who have to sit a lot or travel frequently, 4. Incorrect: If traveling long distances by car, stop every hour or so and walk around.

A nurse is caring for a client who has a prescription for 20 U of NPH insulin every morning, and a sliding scale insulin AC and HS according to this scale: BLOOD GLUCOSE: </ 200 mg/dL = 0 U. 201-250 mg/dL = 2 U. 251-300 mg/dL = 4 U. 301-350 mg/dL = 6 U. 351-400 mg/dL = 8 U. > 400 mg/dL = call. When the nurse check's the client's glucose at 7 AM, it is 258 mg/dL. Based on this information, what action should the nurse implement? 1. Hold the NPH insulin and regular insulin. 2. Give 8 units of regular insulin and hold the NPH insulin. 3. Give the NPH insulin and hold the rapid-acting insulin. 4. Give the NPH insulin and 4 units of regular insulin.

4. Give the NPH insulin and 4 units of regular insulin.

A nurse is reviewing serum laboratory data for four male clients. Which client would require the most immediate assessment? A: Thyroid-stimulating hormone [TSH] 12 mU/L [normal: 2-10 mU/L] B: Free T4 [Thyroxine] 7.0 ng/dL [normal: 0.8-2.8 ng/dL] C: Growth hormone 8 ng/mL [normal: 0-6 ng/mL] D: Glucose 130 mg/dL [normal: 70-110 mg/dL] 1. Client A 2. Client B 3. Client C 4. Client D

2. Correct: An excess of thyroid hormone is the most life-threatening of the findings listed due to its effects on the cardiovascular system of hypertension and tachycardia. The client should be assessed for impending thyroid storm. 1. Incorrect: An elevated TSH level occurs in hypothyroidism. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones which are essential for life. Not life-threatening. 3. Incorrect: An elevated growth hormone produces acromegaly with resulting bone and soft tissue deformities and enlarged viscera. But this is not life threatening. 4. Incorrect: Though the glucose level is elevated, a level of 130 mg/dL (7.2 mmol/L) does not require immediate assessment or intervention.

A client has been prescribed levothyroxine sodium. What should the nurse teach the client about this medication? Select all that apply. 1. Therapy will last six month to one year. 2. Notify the primary healthcare provider for heart rate less than 60/minute. 3. Take medication ½ hour before breakfast. 4. Do not take medication with calcium supplements. 5. Improvement of symptoms will occur within days.

3. & 4. Correct: YES! It is preferable to take medication on an empty stomach, ½ - 1 hr before breakfast. Should not be administered within 4 hours of these meds. 1. Incorrect: No, therapy is for a lifetime. 2. Incorrect: This is done for digoxin. 5. Incorrect: It may take several weeks for symptoms to improve.

The nurse is caring for a client with Addison's disease that is taking fludrocortisone 0.1mg/day. What assessment data by the nurse would suggest that the client's dose is too high? Select all that apply. 1. Weight loss of 2 lbs (0.907 kg)/24 hours 2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure

2., 3., 4., & 5. Correct: Now, remember that with Addison's disease the client does not have enough steroids, so we have to ADD steroids. All of these options indicate the client is holding onto fluid, and we would expect the client to hold onto fluid when their steroid dose is too high. 1. Incorrect: We would expect weight gain with this client, and what is the amount of weight gain we worry about? That's right, anything over 2-3 lbs (0.907 - 1.360 kg) in 24 hours.

What medications would the nurse anticipate for the treatment of hyperthyroidism? Select all that apply. 1. levothyroxine 2. methimazole 3. propranolol 4. iodine compounds 5. calcitonin

2., 3., & 4. Correct: Methimazole (Tapazole®) is correct because it decreases the production of thyroid hormones. It is an antithyroid drug and it is used to "stun" the thyroid pre-operatively. It makes the thyroid "freak out" and stop producing hormones temporarily. Propanolol (Inderal®) is correct because it is a beta blocker and beta blockers decrease the heart rate and decrease anxiety. Why is this important? Because the heart rate and anxiety are going to be increased in the hyperthyroid client. Iodine compounds like Lugol's solution® are correct because these decrease the size and vascularity of the thyroid gland. Do you think this might be important pre-operatively?YES, to decrease the likelihood of bleeding/hemorrhage. And we also, just learned that pharmacologic doses of iodine will also do what? That's right, large doses will decrease thyroid hormone production for a few weeks. So that's two reasons we might use an Iodine compound for Hyperthyroidism. 1. Incorrect: We are not going to give levothyroxine (Synthroid®), that's just going to make the problem worse! Because what is levothyroxine? That's right it's the synthetic form of T4. 5. Incorrect: What about calcitonin? It is a thyroid hormone too! They don't need more! They are hyperthyroid! So False.

What teaching points should the nurse include when educating a client how to prevent a venous stasis ulcer? Select all that apply. 1. Dangle legs for 30 minutes, three times a day. 2. Perform leg exercises regularly. 3. Wear graduated compression stockings. 4. Treat itching with prescribed topical corticosteroids. 5. Minimize stationary standing.

2., 3., 4., & 5. Correct: Regular leg exercises improve calf muscle function. Wearing graduated compression stockings will help prevent dilation of lower extremity veins, pain, and a heavy sensation in the legs. Itching can cause the client to scratch, which leads to skin breakdown. Topical corticosteroids can decrease itching. Minimize stationary standing as much as possible to decrease pooling of blood in the lower extremities. 1. Incorrect: Elevating legs above the heart for 30 minutes, three times a day will minimize edema and reduce intra-abdominal pressure.

What is the priority assessment for a client post-op thyroidectomy? 1. Mental status changes. 2. Carpal spasm. 3. Patency of airway. 4. Pain at incision site.

3. Patency of airway.

A client returns to the surgical unit following a thyroidectomy. What is the priority lab value for the nurse to monitor when caring for this post-op client? 1. Serum sodium level. 2. Serum T4 level. 3. Serum calcium level. 4. Serum iodine level.

3. Serum calcium level.

What is the priority electrolyte imbalance for the nurse to monitor when caring for a client post op thyroidectomy? 1. Hypophosphatemia 2. Hyperphosphatemia 3. Hypocalcemia 4. Hypercalcemia

3. Correct: Why is hypocalcemia the correct answer? Because if they removed the thyroid gland, where are the parathyroids? They could be GONE! No parathyroid glands means no calcium!! 1. Incorrect: Phosphorus is not the priority electrolyte to monitor post thyroidectmy. 2. Incorrect: Phosphorus is not the priority electrolyte to monitor post thyroidectmy. 4. Incorrect: No, the complication from removal of the thyroid is possible injury or removal of parathyroid glands. This produces a disturbance in calcium levels. The calcium levels fall resulting in hypocalcemia.

The nurse is caring for a poorly controlled type 2 diabetic client. Lab results include a BUN of 22mg/dL (7.85 mmol/L) and a creatinine of 1.9 mg/dL (0.67 mmol/L). The nurse checks the client's blood sugar and it is 218mg/dL (12.09 mmol/L). Current medications include metformin and exenatide. What is the priority concern with this client taking metformin? 1. The metformin is not controlling his blood sugar. 2. Metformin can cause GI complaints. 3. Metformin can cause a decrease in appetite. 4. Metformin is contraindicated with an elevated creatinine level.

4. Correct: This is the priority response. Why? Because metformin is eliminated primarily by the kidneys, and if the kidneys are not working properly, administration of metformin can lead to toxicity and increased lactic acidosis risk. Lactic acidosis is a rare SE of metformin administration. 1. Incorrect: Now that's a lot to know about metformin, and I'm a brand new nurse! But look at #1, #2, and #3. Are those killer responses? No, a blood sugar of 218 mg/dL is NOT going to kill me and I'm not going to die from a little diarrhea or decrease in appetite! So the only answer left is #4. It's the answer to pick if I can only pick one, because the others aren't killers! See how you can take what you do know and apply it to pick the correct answer? 2. Incorrect: Now that's a lot to know about metformin, and I'm a brand new nurse!!! But look at #1 #2 and #3, are those killer responses? No a blood sugar of 218mg/dl is NOT going to kill me and I'm not going to die from a little diarrhea or decrease in appetite! So, the only answer left is #4. It's the answer to pick if I can only pick one, because the others aren't killers! See how you can take what you do know and apply it to pick the correct answer!! 3. Incorrect: Now that's a lot to know about metformin, and I'm a brand new nurse! But look at #1, #2, and #3. Are those killer responses? No a blood sugar of 218 mg/dL (12.09 mmol/L) is NOT going to kill me and I'm not going to die from a little diarrhea or decrease in appetite! So the only answer left is #4. It's the answer to pick if I can only pick one, because the others aren't killers! See how you can take what you do know and apply it to pick the correct answer?

A nurse is caring for a client who is diagnosed with diabetic ketoacidosis (DKA). Which primary healthcare provider prescriptions should a nurse question during the first 24 hours of treatment for this client? Select all that apply. 1. 0.9% saline solution at 50 mL/hr 2. 3% saline solution at 125 mL/hr 3. 0.9% saline solution at 1,000 mL/hr × 2 4. Dextrose 5% in 0.45% saline solution at 125 mL/hr when blood glucose reaches 250 mg/dL 5. Dextrose 5% in lactated Ringer's solution at 125 mL/hr when blood glucose reaches 500 mg/dL

1., 2. & 5. Correct: 0.9% saline would not be administered at 50 mL/hr because the first goal of fluid therapy in DKA is to restore volume in a severely volume depleted client, thus 50 mL/hr would be an inappropriate rate. 3% saline solution would be contraindicated in this client because it is a hypertonic solution that would worsen the client's dehydration. Dextrose 5% in lactated Ringer's solution at 125 mL/hr when blood glucose reaches 500 mg/dL is inappropriate because the blood sugar is still too high for infusion of a dextrose containing solution. 3. Incorrect: 0.9% saline solution should be infused at a rate of at 1,000 mL/hr times 2, up to a total of 10 L in the first 24 hours of treatment. 4. Incorrect: Administration of a dextrose-containing solution is recommended to begin when the client's blood glucose reaches 250 mg/dL.

The nurse is preparing discharge teaching for a client diagnosed with peripheral vascular disease. Which teaching points should the nurse include about foot and leg care? Select all that apply. 1. Wear clean, loose, soft cotton socks 2. Avoid whirlpools 3. Rub feet dry 4. Wash feet every other day 5. Clear pathways in house

1., 2. & 5. Correct: These are correct teaching points to avoid injury to feet. 3. Incorrect: Feet should be patted rather than rubbed dry to prevent tissue injury. 4. Incorrect: Feet should be washed and dried daily.

The nurse is caring for a client who is receiving enoxaparin after a diagnosis of deep vein thrombosis of the left leg. Which nursing interventions would be appropriate for this client? Select all that apply. 1. Monitor PT and aPTT 2. Initiate bedrest 3. Apply cool, moist packs to left leg 4. Elevate left leg 5. Monitor closely for bleeding 6. Monitor complete blood count

1., 2., 4., 5. & 6. Correct: The main complication of anticoagulant therapy is bleeding. Blood studies such as CBC should be monitored. Bedrest will reduce the risk of a clot dislodging. Elevate left leg to decrease swelling and promote venous return. 3. Incorrect: Warm, moist packs reduce discomfort. Never put cold on a vein.

A client who has been diagnosed with chronic venous insufficiency has received teaching regarding how to prevent venous stasis ulcerations. Which statements by the client indicate to the nurse that teaching has been effective? Select all that apply. 1. "Stationary standing should be kept to a minimum." 2. "It is important to avoid wearing constricting clothes longer than 2 hours." 3. "Elevation of my legs should be done for 15 minutes every 4-6 hours." 4. "Protecting my legs from trauma is very important." 5. "I will wear compression stockings every day." 6. "I will elevate the foot of my bed 6 inches (15.24 cm) when I sleep."

1., 4., 5., & 6. Correct: Minimize stationary standing as much as possible. Protect legs from trauma as this can lead to ulcerations. Elastic compression stockings are recommended for clients with chronic venous insufficiency to prevent pooling and promote venous return. Leg elevation decreases edema, promotes venous return, and provides symptomatic relief. Legs should be elevated frequently throughout the day (for at least 15-30 minutes every 2 hours). During the night, the client should sleep with the foot elevated approximately 6 inches (15.24 cm). 2. Incorrect: The client should avoid wearing any constricting clothing, even for short periods of time. This will decrease blood flow. 3. Incorrect: Leg elevation decreases edema, promotes venous return, and provides symptomatic relief. Legs should be elevated frequently throughout the day (at least 15 to 30 minutes every 2 hours).

A 13 year old found unresponsive in the park is brought into the emergency department (ED). The nurse sees a medical alert bracelet stating "Diabetic", and notes a fruity smell to the breath. There are no family members available to obtain consent for treatment and attempts to call them have been unsuccessful. What action should the nurse take? 1. Obtain consent from the social worker on duty in the emergency department. 2. Begin treatment by inserting two large bore IVs for administration of normal saline. 3. Give Glucagon IM and then wait for the arrival of a parent to consent to further treatment. 4. Notify the pirmary healthcare provider.

2. Correct: Consent for a minor is not needed in the event of an emergency. Begin treatment for Diabetic Ketoacidosis (DKA). 1. Incorrect: Consent for a minor is not needed in the event of an emergency. The social worker does not give consent in this situation. 3. Incorrect: This client is exhibiting signs of DKA, so glucagon is not needed. Emergency treatment can be provided without parental consent for a minor. 4, Incorrect: The primary healthcare provider cannot give consent or treatment in the ED. The ED physician and nurses can provide treatment in an emergency.

What is the primary electrolyte imbalance that the nurse should monitor for in a client who is receiving an insulin infusion? 1. Hypernatremia 2. Hypokalemia 3. Hypocalcemia 4. hypophosphatemia

2. Correct: Insulin causes movement of potassium into the cells, which can lead to a severe reduction in serum potassium if not regulated appropriately. A severe decrease in serum potassium could be fatal. 1. Incorrect: Although insulin has been shown to increase sodium reabsorption in the kidneys, the change is not as rapid and not as life threatening as the change in potassium. 3. Incorrect: A significant change in the calcium level is not anticipated with the insulin infusion. 4. Incorrect: A significant change in the phosphorus level is not anticipated with the insulin infusion.