Endocrinology/Oncology

An 80 year old female arrives to the ED with a temperature of 94, BP of 88/60, HR of 52, RR of 40, and O2 of 84%. She has a history of hypothyroidism but lives alone and does not remember taking her medication in the past 4 weeks. She appears lethargic. Which of the following is the appropriate initial nursing action?

prepare to endotracheal intubation

A nurse is providing discharge teaching for a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include in the teaching?

- eat a high fiber diet - notify your provider of any sweet tasting drainage

A nurse is caring for a child who has oral mucositis. Which of the following interventions should the nurse implement?

- offer the child a straw for drinking fluids - provide a soft, disposable toothbrush for oral care - encourage gargling with a warm saline mouthwash

A nurse is providing instructions to a client who is scheduled for an ACTH stimulation test. Which of the following information should the nurse include in the teaching?

ACTH is a hormone produced by the pituitary gland

The nurse is performing an assessment on a client with gastic carcinoma where the fundus is mainly affected. At what mark on the drawing is the fundus located?

B

A nurse is caring for a client with type 1 diabetes who has prescriptions for NPH insulin and regular insulin. At 0700, the breakfast tray has arrived, and the client has a blood glucose of 280. Which of the following is the most appropriate action by the nurse?

administer NPH insulin and regular insulin in the same syringe, drawing regular first

A nurse is caring for a 26 year old male client who asks about testicular self exams. Which of the following will the nurse advise the client is the best time for a man to perform a testicular self exam?

after a warm shower

Select the chemotherapy agent that is accurately paired with it's complication or side effect.

alkylating therapy: acute leukemia

A nurse is caring for a client with inoperable brain cancer. The client says, "There is nothing I can do. I feel so powerless." Which of the following interventions by the nurse will be most helpful?

allow the client to make decisions when possible

The nurse is caring for a client who has been diagnosed with terminal cancer. The PCP had a brief visit with the family while the client was present but sleeping intermittently. The PCP has indicated in the past the client's likely diagnosis is cancer. The nurse is approached by the family in the hallway who asked the nurse to keep the diagnosis from the client as they did not want them distressed. When the nurse enters the room they are asked by the client if the PCP told them they had cancer. What is the appropriate response by the nurse?

answer the client's question in the affirmative that the PCP indicated they do have cancer

A nurse is updating the plan of care for a client who has cancer and is near death. Which of the following interventions should the nurse plan to include?

ask the client about personal preference for a light or dark room

A nurse has administered the wrong type of insulin to a client with diabetes. The nurse recognizes that she gave the wrong kind as soon as she looks at the medication record for the next client. Which of the following is the most appropriate initial response?

assess the client

A nurse in a provider's office is reviewing the lab reports of a client who is being evaluated for Grave's disease. Which of the following lab results is an indication of Graves's disease?

decreased TSH

A nurse is providing education to a client who is preparing to undergo radiation therapy for treatment of head and neck cancer. Which of the following complications of radiation therapy will the nurse include in the teaching?

jaw stiffness, nausea, and lymphedema

A nurse is caring for a client who has a serum Ca of 11.8. Which complication is the client at highest risk for?

kidney stones

A nurse is caring for a child who has retinoblastoma. Which of the following findings should the nurse expect?

leukocoria

A nurse prepares to administer medications at the onset of her shift. Which of the following is the priority for the nurse to administer?

pre prandial regular insulin for a client who has just received a breakfast tray

A nurse is providing teaching to a client who has been prescribed for a six week taper of prednisone after a flare of Crohn's disease. The nurse advises the client not to discontinue the prednisone suddenly for which of the following reasons?

prednisone induces the body to stop producing natural steroids and the patient might have a crisis

A nurse is preparing discharge education for a client with type 2 diabetes and RA with a new prescription for prednisone. Which of the following will the nurse include in the teaching?

prednisone suppresses the inflammatory process but doesn't cure the disease

A nurse is caring for a client with a tumor of the anterior pituitary gland. Which of the following hormones secreted by the anterior pituitary gland may exhibit abnormal levels?

prolactin

A nurse is reviewing the medication administration record of a client with type 2 diabetes mellitus at 1900. Which of the following interventions is most appropriate for the nurse to implement?

provide a bedtime snack for the client

A nurse is preparing to remove a client's PICC line. Which of the following best describes the process of removing the catheter?

put on sterile gloves, remove exterior dressing, withdraw the cath, apply pressure for 5 mins

The infusion rate of TPN is tapered before being discontinued. This is done to prevent which of the following complications?

rebound hypoglycemia

A nurse is caring for a client with Addison's disease who has the following results on complete metabolic profile: sodium 128, K 3.8, Ca 10, HCO3 22, BUN 18, creat 1.0. Which of the following conditions does this client have?

hyponatremia

A nurse in a primary care clinic is caring for a client who is 65 years old with a BMI of 31. What information should the nurse provide the client concerning his fast blood glucose level of 147?

"The HCP will want to repeat testing on another day, because your fasting blood glucose was higher than it should be"

An adolescent is to receive radioactive iodine for Graves' disease. Which statement by the client reflects the need for further teaching?

"The advantage of radioactive iodine is that I will not need medication for my disease"

A nurse is teaching the parent of a child who has growth hormone deficiency. Which of the following statements should the nurse make?

"This disorder will not affect your child's ability to gain weight"

Select the screen mechanism that is accurately paired with its recommendation.

Cervical cancer screening: beginning at age 21 and then every 3 years until age 65

A nurse is caring for a client who has an order for a fasting blood glucose test for diagnosis of suspected diabetes. The client tells the nurse that his last meal was 3 hours ago. Which response from the nurse is correct ?

I'll check with the HCP first before performing the test

A nurse is providing palliative care at home for a dying client. There is no sign of impending death. Which of the following interventions does not represent palliative care for this client?

IV administration of chemotherapeutic agents

A nurse is caring for a client who was admitted early in the shift with pancreatitis. When evaluating the client's lab results, which is the immediate priority for intervention?

Na 118

Which of the following clients should receive follow up education from the nurse?

a diabetic client with neuropathy who walk barefoot outside and inside

A nurse is discharging a client with RA who has a new prescription for prednisone. The nurse knows that which of the following is a side effect of prolonged use?

loss of bone mass

A nurse is caring for a client who is in perimenopause. Which of the following is an example of long term change that may develop after menopause?

loss of bone tissue

A nurse is teaching a group of adults about diabetes. She provides them with all of the following facts except:

being caucasian increases one's risk of developing diabetes

A nurse in a clinic is caring for a client who has suspected uterine cancer. For which of the following procedures should the nurse prepare the client?

bimanual pelvic examination

A nurse is caring for an 8 year old child diagnosed with DKA who is receiving an insulin infusion and infusion of normal saline. Which of the following findings does the nurse consider most concerning?

changes in T waves on the cardiac monitor

A nurse is administering prescribed vasopressin to a client with DI. The nurse will monitor the client for which of the following adverse effects?

chest pain

A nurse is asked to speak to a group of women at a community health day about osteoporosis. Which of the following should the she include when discussing the risk factors for osteoporosis?

cig smoking

A nurse is caring for a client with cancer who has a prescription for an analgesic for bone pain caused be metastatic disease. The client states that his pain remains 9/10 despite analgesic administration. Which of the following intervention is appropriate?

convey belief in the extent of pain expressed by the client

The lab results from a male hospice with cancer metastasized to the spine and long bones have arrive. Lab values include the following: total protein 4.8, albumin 2.6m and Hgb 10.8. Which of the following interventions will be included in the client's care plan?

coordinate with anesthesiologist for pain control

A nurse in an outpatient clinic is assessing a client with type 1 diabetes mellitus. Which of the following lab results should the nurse prioritize for report to the HCP?

creat 2.2

A client is undergoing a massive blood transfusion and complains of muscle cramps. The nurse knows to assess Chvostek's sign because of which of the following possible effect of a large volume blood transfusion?

hypocalcemia

A nurse is caring for a client with SIADH. Which of the following is a common manifestation of this disorder?

decrease Na level

A client with type 2 diabetes is managed with 2 injections of NPH/regular insulin daily, before breakfast and before dinner. He recently lost 10 kg by dieting and exercising but has has multiple episodes of hypoglycemia manifested by diaphoresis and tachycardia every afternoon about 1-2 hours before dinner. Which of the following changes should the nurse discuss with the client's primary care provider?

decrease the morning NPH insulin dose

A nurse is caring for a client with type 2 diabetes who take metformin. The client has a cardiac cath scheduled. Which of the following should the nurse advise?

discontinue the medication prior to the procedure

A nurse is preparing to teaching a client who has a new prescription of methylprednisolone for RA. Which of the following will the nurse include when instructing this client about the new medication?

do not discontinue the medication suddenly

A nurse is positioning a client to promote drainage from the lower lung lobes. Which of the following bed positions is the most appropriate?

feet elevated

A nurse is assessing a client who has hypothyroidism and is receiving thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse the need for a decrease in the medication dosage?

hand tremors

A patient diagnosed with AIDS asks about the possibility of using hospice. In order to be eligible for hospice care, the patient must:

have a life expectancy of less than 6 months

A nurse is caring for a client who has returned to the unit after subtotal thyroidectomy. Which of the following does the nurse know to monitor for signs of laryngeal nerve damage?

hoarseness

A nurse is caring for a woman who has undergone a radical mastectomy for breast cancer. She tells the nurse "I'm worried because my spouse won't touch me since my breast was removed." Which of the following is the most appropriate response by the nurse?

how do you feel about your mastectomy

A nurse is teaching a class to young women on contraception. When instructing the class about oral estrogen progestin contraceptives, the nurse stresses to the participants that which of the following findings should be reported to an MD?

hypertension, tenderness in the calf, and breast nodules

A nurse is assessing a client who has terminal cancer, is unresponsive, and has a RR of 5. The client's family member requests the client to receive morphine for pain. Which of the following ethical principles should the nurse use to support the decision to withhold the medication?

nonmaleficence

The nurse is giving a talk about diabetes to a group of 8th grade students. Which of the following does the nurse know is the greatest risk factor for development of type 2 diabetes?

obesity

A nurse is caring for a client who has excess production of growth hormone with manifestations of acromegaly and is scheduled for a trans sphenoidal hypophysectomy. Which of the following interventions should the nurse include in the client's postop care plan?

observe dressing drainage for the presence of glucose

A nurse is caring for a client with diabetes who is scheduled to have abdominal surgery. The client has been on NPO status since 10pm the previous evening. The nurse notices that the client's morning insulin dose has not been ordered. The first action the nurse should take it to:

obtain a bedside glucose level

A client is newly diagnosed with insulin dependent diabetes. The HCP prescribes 6 units of regular insulin each morning before breakfast. Which of the following does the nurse expect?

onset of 30-60 mins with 2-4 hour peak action and duration of 6-8 hrs

Which of the following measures provides the best assessment of diabetic autonomic neuropathy in a client with type 2 diabetes mellitus?

orthostatic BP

A nurse in an outpatient clinic is assessing a 25 year old woman at 30 weeks gestation. Which of the following findings could indicate a possible complication?

positive urine test for glucose and ketones

A nurse knows that which of the following is most likely to be associated with central DI?

posterior pituitary gland

A nurse offers a snack of crackers at midafternoon to a client with a prescription for 25 units of NPH insulin before breakfast each day. This snack is prescribed for which of the following reasons?

regulation of carb metabolism

The nurse is developing a care plan for a client with hypocalcemia. The client's calcium level is below 8.5. Which of the following nursing diagnoses is appropriate?

risk for injury

A nurse is caring for a client who had a parathyroidectomy a day ago. When making an assessment, which of the following findings should the nurse prioritize for action?

stridor

Which client is at least risk for a bone marrow transplant rejection?

the client who received an autologous transplant

A nurse is teaching a wellness class to middle age women. She instructs the women who are present that their risk of developing osteoporosis is increased if:

they have a history of long term steroid use

A 70 year old Spanish speaking male is discharged home with an infected diabetic foot ulcer. He and his wife, who will be providing care for him at home, have a limited understanding of English. When providing instructions for home care, what is the most appropriate way for the nurse to explain the necessary monitoring and dressing changes for the client's continuing care?

use an interpreter from a fee pain agency or a telephone interpretation service

A nurse is caring for a client with newly diagnosed diabetes mellitus type 1. Which of the following signs would not be expected in a client with new onset type 1 diabetes?

weight gain

A client diagnosed with BRCA-positive breast cancer asks the nurse for advice about her treatment options. Which of the following is the most appropriate nursing response?

which treatment options have you discussed with your MD

A nurse is caring for an elderly client who is taking metformin for diabetes and is scheduled for cardiac cath. Which of the following is important for the MD to order?

withhold the metformin prior to the cardiac cath

A client who is receiving radiation therapy of the head and neck asks the nurse if there will be any side effects associated with the process. Which response from the nurse is accurate?

you may have a dry mouth and the mucous membranes in your mouth can become inflamed. that should go away with time

A nurse is teaching the parent of a child who has stage IV-S neuroblastoma. Which of the following statements should the nurse include in the teaching?

your child's tumor might not need any treatment

A nurse is providing foot care instructions to a client who has diabetes mellitus. Which of the following instructions should the nurse include?

- perform nail care after bathing - trim toenails straight across - wear closed toe shoes

A nurse is providing nutrition teaching to a group of clients who are at risk for developing type 2 diabetes mellitus. Which of the following statements should the nurse make?

- eat less red meat and processed food - decrease your intake of saturated fats - increase your daily fiber intake - include foods that are high in omega 3 fatty acids in your diet

A client with small cell carcinoma of the lung is diagnosed with SIADH. Which of the following is an appropriate intervention?

- fluid restriction - oral salt tabs - neuo checks

A nurse is providing care to a client who has DKA. The nurse should expect which of the following manifestations?

- fruity breath odor - abdominal discomfort - Kussmaul respirations - metabolic acidosis

A nurse is providing education for a client undergoing chemotherapy. What are the potential side effects of administering this class of medication?

- hair loss - nausea - vomiting - stomatitis

A nurse is providing teaching to a client about the manifestations of hyperthyroidism. Which of the following manifestations should the nurse include?

- heat intolerance - goiter formation - weight loss

A nurse is preparing to provide care to a client who has HHS. The nurse should identify that which of the following findings are risk factors for this diagnosis?

- history of recent MI - BUN 35 - take CCB - age 65 years

A nurse is assigned care of a client who has been diagnosed with Addison's disease. Signs of Addison's disease that may be evident on assessment include which of the following?

- hyperpigmentation - fatigue

A nurse is reviewing the medical history of a client who has Cushing's disease. The nurse should identify that clients who have Cushing's disease are at an increased risk for which of the following conditoins?

- infection - gastric ulcer - neprholithiasis - bone fractures

A charge nurse is providing in service education about insulin preparations to nursing staff on a med surg unit. Which of the following is true about the different types of insulin preparations?

- insulin glargine has an onset of 1.5-2 hrs - NPH insulin has a peak effect at 4-6 hrs

The nurse is administering prednisolone to an older adult client. Which of the following are true about this drug?

- it can cause edema - it can cause euphoria - it can cause peptic ulcer

A nurse is completing the admission assessment on a client who has suspected lung cancer. Which of the following manifestation should the nurse expect?

- dysphagia - frothy sputum

A nurse is providing dietary discharge instructions to a client who has type 2 diabetes mellitus. Which of the following statements should the nurse include in the teaching?

- carbs should comprise 45-60% of your daily caloric intake - if you drink alcohol, it should be with a meal or food - it is important to have your meals spaced through the day

A nurse is caring for a client who has breast cancer and asks why she is receiving a combination of chemotherapy of cyclophosphamide, methotrexate, and fluorouracil. Which of the following responses should the nurse make?

- combination chemo is used to decrease medication resistance - combination chemo is used to attack cancer cells at different stages of cell growth - combination chemo is used to reduce the risk of injury. to normal body cells

A nurse is reviewing the medical record of a client with SIADH. Which of the following findings should the nurse expect?

- decrease serum sodium - decreased serum osmolality - decreased temperature

A nurse is caring for a client who has received a new prescription for levothyroxine. Which of the following should the nurse include in teaching this client about the new medication?

- do not discontinue the medication without discussing with the HCP - a follow up blood test for serum TSH level will be necessary

A man is admitted to the hospital with complains of lethargy, ployuria, and fever for over one week. During your health history interview, it is revealed that he has a history of diabetes and has been non compliant with his diet. You proceed to the physical assessment and find a non stageable ulceration to the bottom of his right foot. When you question him, he says, "Oh, I stepped on a sharp rock when I went swimming in the lake a couple of weeks ago and forgot about it." What points would be important to include in the client education part of your nursing care plan?

- regularly check blood glucose levels - daily check skin integrity - remove concentrated sweets from the diet

After administering an oral dose of radioactive iodine to a client with Graves' disease, which of the following precautions should the nurse instruct the client to observe at home for the first 3-7 days after administration?

- the client should use separate toilet and flush 2-3 times after each use - do not breastfeed

A nurse in a provider's office is planning teaching for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following information should the nurse include in the teaching plan?

- the medication can increase the risk for infection - monitor of T3 levels will be required - take the medication at the same time every day

A nurse is caring for a client with Addison's disease. Which of the following symptoms does the nurse expect?

- weakness - postural hypotension - constipation - diarrhea - muscle wasting

A 55 year old man with breast cancer is receiving doxorubicin 60 mg per square meter of body surface area, as part of his cancer therapy. He is 5 ft 6 in tall and weighs 145 lbs. His body surface area is 1.75 m. What is the correct dose that the nurse should administer?

105 mg

Which client is at greatest risk for hyperparathyroidism?

65 year old female client

A nurse is providing information to a couple who want to delay starting a family about various types of family planning. The couple decides to use the basal body temperature method to avoid pregnancy. The nurse should explain that the length of the fertility period surrounding ovulation lasts for which of the following periods of time?

72 hrs before and 24 hrs after ovulation

A client who has been newly diagnosed with metastatic cancer has a prescription for morphine sulfate for analgesia but is concerned about the possible side effects of nausea and vomiting. Which of the following should the nurse tell the client in response to this concern?

Persistence of nausea is rare since most people develop a rapid tolerance to those side effects

A nurse is receiving a report on a client who received a unit of granulocytes the previous evening. Which of the following daily lab studies will the nurse assess to determine the effectiveness of the client's transfusion?

WBC count

A client with metastatic lung cancer has been prescribed hydromorphone per rectum as needed for analgesia. The rectal route of administration is contraindicated in which of the following circumstances?

if the client has thrombocytopenia

A nurse is caring for a client newly admitted with DKA who has a K of 3.8, pH of 7.1. The client's glucose is 400. Which of the following actions is most likely in the first 24 hrs of care?

initial infusion of isotonic crystalloids

A nurse is assessing a client with type 2 diabetes and kidney disease. When the nurse asks the client about dietary intake are carbs, the client becomes angry and tells the nurse, "I will eat what I want to eat, and I'm tired of people asking me about it!" How should the nurse respond?

you seem very angry. can you tell me why you are feeling so upset?