Module 4- Endocrine & Oncology

Client has been prescribed Levothyroxine sodium. What should the nurse teach the client about this medication? 1. Therapy will last a lifetime. 2. Notify the healthcare provider of chest discomfort. 3. Take medication with breakfast. 4. Do not take medication with iron supplements. 5. Improvement of symptoms will occur within days.

1, 2, & 4 CORRECT: YES! Therapy is for a lifetime. The clients should seek medical help immediately if the side effect of chest discomfort or pain occurs. *It could be an MI.* The medication should not be administered within four hours of iron supplements 3. INCORRECT: it is preferable to take medication on an empty stomach, 1/2 -- 1 hr before breakfast do not take with food. 5. INCORRECT: it may take several weeks for symptoms to improve.

A client diagnosed with cancer has been losing weight. What should the nurse teach the client regarding methods for improving nutritional; needs to maintain weight? 1. Add butter to foods. 2. Spread peanut butter on toast. 3. Add powdered creamer to milkshake. 4. Use biscuits to make sandwiches. 5. Eat Caesar salads once per day. 6. Put honey on top of hot cereal.

1, 2, 3, 4, & 6 CORRECT: Butter and oil added to food will add calories. This client needs more calories and more protein. Spread peanut butter or other nut butters, which contain protein and healthy fats, on toast, bread, or crackers. Use croissants or biscuits to make sandwiches which provides more calories. Add powdered creamer or dry milk powder to hot cocoa, milkshakes, hot cereal, gravy, sauces, meatloaf, cream sounds, or puddings to add more calories. Top hot cereal with brown sugar, honey, dried fruit, cream or nut butter. 5. Incorrect: Choose meat salads, such as chicken, ham, turkey, or tuna.

The nurse recognizes which manifestation as a sign/symptoms of Hodgkin's lymphoma? 1. Drenching night sweats. 2. Dry, itchy skin. 3. Painless lymph nodes in the neck. 4. Weight loss of 2 kg in one week. 5. Pale skin. 6. Enlarged spleen.

1, 2, 3, 5 & 6. CORRECT: with this disease, the body switches back-and-forth from fever and chills too excessive sweating sweating is worse at night time; and many clients report waking up in the middle of the night to clothing and bedding that is completely drenched. As the lymphoma cells grow, they secrete a chemical that causes a generalized itchiness and irritation to the skin throughout the body. The skin becomes dry. The most common symptoms of Hodgkin lymphoma is one or more enlarged lymph nodes. The enlarged lymph node may be in the neck, upper chest, armpit, abdomen, or groin. The swollen lymph node is usually painless. Lymphoma lowers the bodies red blood cell count, leading to anemia and even greater fatigue. Skin will be pale. The spleen is part of the lymph system and works as a drainage networks that defend the body against infection. 4. INCORRECT: this is not a significant weight loss. A large decrease in weight is common in many types of cancers and is particularly noticeable in lymphoma cases.

What signs and symptoms of ovarian cancer should a nurse include when educating women? *SATA* 1. Menorrhagia. 2. Loss of appetite. 3. Urinary frequency. 4. Decreasing abdominal girth. 5. Pelvic pain. 6. Change in bowel habits.

1, 2, 3, 5, & 6 CORRECT: Signs and symptoms of ovarian cancer include irregular menses, increasing prementstual tension, menorrhagia with breast tenderness, early menopause, abdominal discomfort, dyspepsia, floss of appetite, pelvic pressure and urinary frequency. Indigestion, flatulence, and fullness after a light meal, and increasing abdominal girth are significant symptoms. Change in bowel habits such as constipation. 4. INCORRECT: Abdominal girth will increase, not decrease.

A client had diabetes calls the nurse hot-line reporting shakiness, nerviousness, and palpitations. Which questions would yield information that would help the nurse decide that this is a hypoglycemic episode? 1. What, and when, have you eaten today? 2. Do you feel sleepy? 3. Have you been extremely thirsty. 4. Can you check your current glucose level? 5. Does your skin feel sweaty? 6. Is your vision blurry?

1, 2, 4, 5, & 6. CORRECT: This question will give the nurse information about how much time has elapsed since the last meal and will indicate the amount of time has elapsed since the last meal and will indicate the amount of protein and carbohydrates consumed at the last meal. Even a minor delay in meal times may result in hypoglycemia. As hypoglycemia worsens, level of consciousness declines. So asking if the client is sleepy is a good question. if the client has a glucose monitor, and accurate reading would give the nurse valuable information about how much food the client should consume now. The skin gets cool and clammy with hypoglycemia. As the brain gets less glucose, the eyes are affected. 3. INCORRECT: polydipsia is a sign of hyperglycemia.

A client with type two diabetes, who is noncompliant, has an HB A1c of 8%. The finger-stick blood sugar is 218 mg/dL at 0900. The current medication as prescribed or Metformin and exenatide. Based on the data, what teaching should the nurse reinforced? 1. Nutritional counseling to help improve diet compliance. 2. The goal of therapy is to have a HbA1c less than 7.0%. 3. Blood glucose testing before meals and at bedtime. 4. Vigorous exercise plan to improve glucose control. 5. Without glycemic control, nerve damage can occur. 6. HbA1c measures glycemia control over a period of six months.

1, 2, 3, & 5. CORRECT: the goal of therapy is to have a HbA1c less than 7.0. nutritional teaching to promote diet compliance should be tried first because this clients HbA1c is 8% and blood sugar is 218 mg/dl. reinforce need to monitor glucose levels several times a day, before meals and at bedtime. have client keep results in a log. 4. INCORRECT: physical activity under the supervision of the primary healthcare provider is appropriate teaching. Vigorous exercise is gnocchi to improving blood sugar. Exercise does not have to be intense, a normal exercise plan is recommended based on the clients ability 6. INCORRECT: HB A1c measures glycemic control over a period of three months

A nurse is assigned to a client who is one day post thyroidectomy. While taking the blood pressure, the clients hand starts to tremble. What actions should the nurse take? 1. Pad the side rails. 2. Monitor potassium level. 3. Take blood pressure on opposite arm. 4. Play Trach kit at bedside. 5. Check for airway patency. 6. Assess heart rhythm.

1, 4, 5, & 6. CORRECT: during the thyroidectomy the parathyroids could've been removed causing a decrease in the calcium level and could progressed to a seizure and Laryngospasms. Padding the side rails as a safety precaution for seizures the nurse place is a trach set at the bedside in case of laryngospasms check for airway patency as the esophagus is a smooth muscle. Think muscles with calcium and with hypocalcemia equals not enough sedative. The heart is a smooth muscle. It is important to check for arrhythmias. 2. INCORRECT: you should be worried about calcium with parathyroid, not potassium. 3. INCORRECT: this action is not needed. This would only provide you with the same response and delay treatment.

What is *priority* for the client experiencing hyperparathyroid crisis? 1. Support for airway and breathing. 2. Continuous cardiac monitoring for arrhythmias. 3. Provide safety precautions. 4. Prepare for emergency tracheostomy.

1. CORRECT: always remember *ABC*, if it is relevant, and it is with hyperparathyroid crisis. 2. INCORRECT: circulation is important. But this priority comes after attention has been directed toward airway and breathing. 3. INCORRECT: muscle weakness, and risk for falls is a concern, but airway takes priority! 4. INCORRECT: trach would be more likely with hypoparathyroidism. Remember, and hypoparathyroidism, the client would have rigid and tight muscles which would cause laryngospasms.

A nurse is caring for a poorly controlled type two diabetic client. The client does not adhere to the diet and the latest HB A1c is 8%. The serum glucose at this visit is 218 mg/dL. The client is currently taking metformin and exenatide. 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. 2. Increased daily exercise regimen. 3. Education regarding insulin by basil/bolus dosing method. 4. More frequent self-monitoring of blood glucose.

1. CORRECT: nutritional teaching to promote diet compliance should be tried first because the clients HB A1c is 8% and his blood sugar is 218 mg/dL - not terribly bad for type 2 diabetic who is noncompliant. *Noncompliant* is your big hint with this question! 2. INCORRECT: this is not priority over at nutritional counseling. Appropriate, moderate exercise, like walking, can overtime lower blood glucose. Increasing the daily exercise regimen is not appropriate based on the information provided in the question stem. 3. INCORRECT: insulin is not indicated for HB A1c of 8%, unless diet and oral hypoglycemics have failed long-term. Insulin is generally prescribed for sustained HB A1c of 9% or greater . 4. INCORRECT: this is not priority over nutritional counseling. More frequent self monitoring will be important once insulin therapy has begun.

A client with a long-standing history of diabetes presents to the emergency department with a serum blood sugar of 400 mg/dL. What lab data for this client is consistent with diabetic keto acidosis? 1. Serum sodium 140 mEq per/liter. 2. Ketonuria. 3. Serum potassium 5.5mEq/L. 4. PaCO2 52. 6. pH 7.35.

2 & 3. CORRECT: normally, no ketones are found in the urine. ketonuria is associated with poorly controlled diabetes that results in hyperglycemia and breakdown of body fat and protein. Remember dilute makes numbers go down. The potassium will be elevated because insulin is needed to move potassium out of the blood and into the cell. 1. INCORRECT: sodium is essential for maintaining a stable blood pressure and fluid balance in the body. High blood sugar causes excessive urination with loss of body water and sodium. When the body needs to restore water to the bloodstream, it does so by pulling it from other tissues. This influx of water into the bloodstream because blood sodium to be further diluted insulin and intravenous fluids containing sodium chloride are used to treat the sodium deficit caused by DKA. 4. INCORRECT: the client will have an increased respiratory rate. So the PaCO2 will go down. This PaCO2 is high so that correlates with hypoventilation. 5. INCORRECT: with DKA, the client is in metabolic acidosis, so the pH will be low.

Which statements made by a client diagnosed with Addison's disease indicates to the nurse that the client understands fludrocortisone therapy? 1. "Taking my medicine at night will help me sleep." 2. "It is important to wear a medical alert bracelet all of the time." 3. "I can eat processed meats and canned foods." 4. "My medication dose will change based on my daily weight." 5. "I may need more medication if I feel fatigued."

2, 3, 4, & 5. CORRECT: *medical alert bracelets* are an excellent way of informing healthcare providers of a life-threatening condition if the client is unable to verbalize that information. This client needs a *high sodium diet* as they are losing sodium and retaining potassium. So the client *can* eat processed meats and canned foods, which are high in sodium. Steroid therapy is adjusted according to the clients weight and signs of fluid volume status. Signs of being under medicated include weakness, fatigue, and dizziness. The client will need to report the symptoms so more medication can be given to the client. 1. INCORRECT: steroids can cause insomnia so the client does not need to take the medication prior to going to bed.

An elderly client diagnosed with Stage 4 cancer is anxiously awaiting the primary healthcare provider to discuss care options. What is the appropriate way for the nurse to assist the client? 1. Provide client with all possible care options. 2. Assist client to make list of questions to ask prior to the discussion. 3. Offer to leave the room when the client speaks with the primary healthcare proveder. 4. Suggest the presence of a family member could be helpful to client. 5. Provide verbal information to client about cancer treatments.

2. & 4. CORRECT: Consider this client has been diagnosed with stage 4 cancer. Te thought of cancer can quickly overwhelm the client, making it difficult to hear and focus information. It will be very helpful for the nurse to assist the client to create a list of questions which may otherwise be forgotten when the primary healthcare provider arrives. It will also be useful to have the nurse present during the discussion since the client may need some clarification after the fact. Though there is no indication the client has family to be present during the discussion. The emotional support is often extremely positive to help the client cope with the information. 1. INCORRECT: It is the primary healthcare provider's responsiblility to provide all possible cancer treatments that exist. 3. INCORRECT: It will also be useful to have the nurse present during the discussion since the client may need some clarification after the fact. 5. INCORRECT: while some clients benefit from verbal or written information, handing brochures to an anxious client is not one of the most appropriate ways to assist the client. the nurse is not focusion directly on the client's emotional needs at the point.

A client with Cushing's disease is in a semi private room. when considering room assignments, which client would be the safest choice to assign to this room? 1. Newly admitted client with methicillin resistant staphylococcus aureus. 2. Client with chronic kidney disease. 3. Client who is post emergency cholecystectomy. 4. Client with full thickness burn of left leg.

2. CORRECT: chronic kidney disease is not infectious and would be the Best roommate for the client with Cushing's disease who is immunosuppressed due to excessive secretion of glucocorticoids. 1. INCORRECT: MES A is a contagious infectious disease and not the best choice to room with a client who has Cushing's disease. Remember, the client with Cushing's is immunosuppressed. 3. INCORRECT: client post emergency cholecystectomy is prone to peritonitis or wound infection and is not the best client choice. 4. INCORRECT: Burns are always contaminated wound, and the client has a decreased immune system, so a high probability for an infected burn would make this client a poor choice to occupy a room with a client who has Cushing's disease. This client is also immunosuppressed

Which client diagnosis would a prescription for an intravenous infusion of 1000 mL normal saline with 20 mEq potassium chloride be appropriate? 1. Major burn injury. 2. Kidney disease. 3. Abdominal cramping with diarrhea. 4. Diabetic ketoacidosis. 5. Hypokalemia.

3, 4, & 5 CORRECT: clients with abdominal cramping with diarrhea, diabetic ketoacidosis, and hypokalemia are safe to receive normal saline with potassium chloride. A primary electrolyte found in the lower G.I. tract is potassium. Therefore, diarrhea can result in excessive loss of potassium and associated hypokalemia can occur. When insulin is given to the client with DKA, it causes a transport of both glucose and potassium out of the blood and into the cell, resulting in hypokalemia. Finally, a client who has hypokalemia from other causes we need potassium replacement as well. 1. INCORRECT: tissue destruction from a major burn will cause the release of potassium from the cell into the blood. Thus, hyperkalemia occurs. An IV infusion with potassium will make the problem worse. 2. INCORRECT: with kidney disease and the resulting diminished renal function, the client is at risk for sodium and potassium retention.

A nurse is caring for a client who is diagnosed with diabetic ketoacidosis. Which primary healthcare provider prescription is appropriate during the first 24 hours of treatment for this client? 1. 0.45% saline solution (NaCl) @ 50 mL/hr. 2. 3% saline solution (NaCl) @ 1:25 mL/hr. 3. 0.9% saline solution (NaCl) @ 1000 mL/hr times 2. 4. Dextrose 5% in lactated ringer's solution at 150 mL/hr.

3. CORRECT: 0.9% saline solution should be infused at a rate of 1000 mL/hr times 2, up to a total of 10 L in the first 24 hours of treatment. This client will be in a fluid volume deficit or shock and fluid replacement is essential. 1. INCORRECT: 0.45% 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 we need normal saline at a faster rate to replace fluid volume 2. INCORRECT: 3% saline solution would be contraindicated in this client because it is a hypertonic solution that would worsen the clients dehydration. 4. INCORRECT: dextrose 5% and lactated ringer's solution at 150 mL/hr is inappropriate because the blood sugar is too high for infusion of a dextrose containing solution.

A nurse is conducting an initial admission history on a client who is reporting bone pain secondary to cancer with metastasis to the bone. What does the nurse determined is the *most* important information together during this initial screening? 1. The physical assessment of the client. 2. The hemoglobin and hematocrit levels. 3. The amount of pain medication the client is receiving. 4. The clients description of the pain.

4. CORRECT: pain is subjective, based on the clients perception. This is also the primary complaint of the client upon admission. 1. INCORRECT: the physical assessment is important but does not address the clients perception of their own pain. 2. INCORRECT: RBC's are produced in the bone marrow. The H & H might be affected but will not cause the pain and will assessed later with admission labs and diagnostics. 3. INCORRECT: the amount of pain medication is important, but is not the most important information to gather from a client who is reporting pain, particularly with cancer and metastatic bone pain.

What is the *priority* nursing assessment for a client postop thyroidectomy? 1. 5 mm dark red drainage. 2. Temperature 99 F (37.2 C). 3. Trouseau's sign negative. 4. Strider

4. CORRECT: laryngeal/vocal cord edema is the most common cause of strider within the first 24 hours after thyroidectomy. It is usually associated with difficulty breathing. *Remember a priority question on NCLEX is always concerned with what the nurse would do if they could only do one thing.* 1. INCORRECT: 5 mm of dark red drainage is normal after surgery. We worry about bright red blood. 2. INCORRECT: a slight fever after surgery is expected. 3. INCORRECT: This is a normal finding.