Labs/ FL
BUN/ Creat:
Na:
Cl:
K:
Mg:
Ca:
Phos:
BUN/ Creat: 8-20, 0.4-1.2
Na: 135-145
Cl: 96-106
K: 3.5-4.5
Mg: 1.8- 2.6
Ca: 8.2- 10.2
Phos: 2.5-4.5
The nurse should question which order?
a. implementing a fall risk for the Cushing's client
b. a diet high in carbs, high in protein, high in sodium for Addison's
c. strict bedrest for a client who is being treated for Addisonian crisis
d. restrict sodium in aldosteronism, administer spironolactone plus potassium supplements and prepare client for adrenalectomy
b. a diet high in carbs, high in protein, high in sodium for Addison's
... adequate sodium
A patient is recovery from a parathyroidectomy. Which of the following findings causes concern and requires nursing intervention?
A. The patient is in Semi-Fowler's position.
B. The patient's calcium level is 8.9 mg/dL.
C. The patient’s voice is very hoarse.
D. The patient is drowsy but arouses to name.
C. The patient’s voice is very hoarse.
Patients who've had a parathyroidectomy are at risk for laryngeal nerve damage. Therefore, the nurse should monitor the patient for signs and symptoms of this which would include a hoarse voice, difficulty swallowing, or speaking. The nurse should intervene by notifying the physician.
From your own mind fill in the blank!
Excessive _____ causes ____ in kids, and ______ in adults
Excessive growth hormone causes giantism in kids, and acromegaly in adults.
A patient taking IV levothyroxine starts to complain of feeling hot and chest pain. On assessment, you find that the heart rate is 125 bpm and blood pressure is 200/103. You immediately notify the physician of the patient’s condition and receive orders for lab work. Based on the patient's signs and symptoms, what is the MOST important lab result at this time to determine the cause of the patient’s symptoms?
A. Potassium level
B. Thyroid levels
C. Calcium level
D. Sodium level
B. Thyroid levels
BONUS: what do you suspect the client is experiencing?
Hypo solutions:
Iso solutions:
Hyper solution:
a. 0.25% NS b. D5 0.9% NS C. LR D. 0.45% NS
Hypo solutions: A. 0.25% NS D. 0.45% NS
Iso solutions: C. LR
Hyper solution: B. D5 0.9% NS
What are important teaching points for a client with Addison's ? SATA
a. hormone replacement during stress for life
b. wear medic alert bracelet
c. if increased sweating use salt tablet or eat salty food
d. vigorous exercise in moderation
e. teach s/s of hypo/hyper adrenocortical hormones to request dose adjustment
b. wear medic alert bracelet
c. if increased sweating use salt tablet or eat salty food
e. teach s/s of hypo/hyper adrenocortical hormones to request dose adjustment
BUT...
a- hormone replacement is for life even without stress
d- vigorous exercise should be avoided, but general exercises with alternate resting periods is ok
A patient hospitalized with hypoparathyroidism is about to order lunch. Which food selection is best for this patient based on their dietary needs at this time?
A. Baked chicken, green beans, and boiled potatoes
B. Broccoli salad, cottage cheese, and peaches
C. Roast beef, carrots, and pinto beans
D. Hamburger, fries, and sorbet
B. Broccoli salad, cottage cheese, and peaches
S/S of a pituitary tumor... SATA
a. unilateral hemianopia
b. headaches
c. vomiting
d. swelling around optic disc
e. heat intolerance
b. headaches
c. vomiting
d. swelling around optic disc
This medication is used to treat hyperparathyroidism in patients with chronic renal failure. It works by mimicking the role of calcium in the blood and tricks the parathyroid gland into stop secreting PTH (parathyroid hormone). Which of the following medications does this describe below?
A. Calcitonin
B. Fosamax
C. Lasix
D. Cinacalcet
D. Cinacalcet
aka: Calcimimetic
Serum Osmolality...
Normal Range:
a. 150-250 b. 275-290 c. 300-375
Critically Low:
a. <275 b. <300 C. <250
Critically High:
a. >300 b. >600 c. >250
Normal Range: b. 275-290
Critically Low: C. <250
Critically High: a. >300
BONUS!!!: WHAT ARE NORMAL LEVELS FOR URINE SP GR?
1.005-1.030
DI= DILUTE SP GR SO <1.005
SIADH= CONCENTRATED SO >1.030
The nurse is assessing a client admitted with Addison’s Disease. Assessment findings consist of generalized muscular weakness, hypotension, irritability, and hyperpigmentation of skin. Which lab values would the nurse expect to find?
a. hyperkalemia, hypercalcemia
b. hypokalemia, hypocalcemia
c. elevated cortisol
d. elevated glucose
a. hyperkalemia, hypercalcemia
A patient is recovering from myxedema coma and will be discharged tomorrow. What will you include in their discharge teaching?
A. Avoiding green leafy vegetables.
B. Importance of taking Tapazole exactly as prescribed at the same time every day.
C. Limiting foods with Iodine such as kelp, dairy, and eggs.
D. Importance of taking levothyroxine in the morning without any food.
D. Importance of taking levothyroxine in the morning without any food.
levothyroxine should be taken in the morning without food so absorption is not affected. All the other options are incorrect discharge education for patients suffering from myxedema coma.
The nurse knows which is true for SIADH? SATA
a. hyponatremia
b. hypoosmolality
c. seizure precautions
d. Tx option is to replace ADH
e. FL restriction
f. hypertonic parenteral FL as ordered
a. hyponatremia
b. hypoosmolality
c. seizure precautions (due to hypoNa+)
e. FL restriction
f. hypertonic parenteral FL as ordered
A client has excessive catecholamines in the urine. Which of the following will the client NOT exhibit? SATA
a. tachycardia
b. anxiety
c. hypoglycemia
d. thermogenesis
e. decreased metabolic rate
c. hypoglycemia
e. decreased metabolic rate
see pheochromocytoma
ABG's:
pH
C02
hc03
Pa02
Sa02
pH (a) 7.35- 7.45 (b)
PaC02 (b) 35-45 (a)
HC03 (a) 22-26 (b)
Pa02 80-100
Sa02 95-100
In the scenario below, what medication do you expect the patient to be started on?
A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient’s family is with the patient and reports that before the patient became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the patient has not been taking any medications. The patient was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient’s blood pressure is 70/45.
A. IV Solu-Cortef
B. PO Prednisone
C. PO Declomycin
D. IV Insulin
A. IV Solu-Cortef
The patient needs cortisol immediately because they are experiencing Addisonian Crisis. IV Solu-Cortef is the best option because it is intravenous and a glucocorticoid. The patient is unconscious and can not take oral medications, therefore Prednisone is not the best option and all the other options are incorrect.
A patient is post-opt from a thyroidectomy for treatment of Grave's Disease. When you walk into the patient's room to perform an assessment, which of the following findings causes the MOST concern and needs nursing intervention?
A. The patient complains of a pain rating of 4 on 1-10 at the surgical site.
B. The patient is positioned in supine position.
C. The patient's Foley catheter is draining 50 cc of urine per hour.
D. The patient is splinting the neck while coughing and deep breathing.
B. The patient is positioned in supine position.
The nurse cares for a client diagnosed with DI being TX with vasopressin. Which action should the nurse include in the clients care plan? SATA
a. Record daily weight
b. Test urine for glycosuria
c. monitor for constipation
d. the ADH replacement therapy is temporary
a. Record daily weight
***I originally pulled this question from Kaplan and one of the choices was "restrict FL intake"... I'm not sure I understand that rationale... let me know if you do lol
A patient is scheduled for a bilateral adrenalectomy. Preoperatively, the patient is ordered by the doctor to take an alpha-adrenergic blocker. After administering a dose of this medication, what type of side effect will you monitor the patient for?
A. Bradypnea
B. Hyperglycemia
C. Reflex tachycardia
D. Hypertension
C. Reflex tachycardia
1. A temp of _____, _____cardia, and ____ are all s/s of Thyroid storming.
a. <100 degrees b. tachy c. brady d. <106 e. delirium
2.TRUE or FALSE... propranolol is used in the TX of thyroid storm
3. What is the TX for myxedma?
1. A temp of <106, tachycardia, and delirium are all s/s of Thyroid storming.
2.TRUE
3. IV Levothyroxine and hydrocortisone
TRUE OR FALSE
1. A hospitalized client with Cushing's is encouraged to have visitors to decrease the stress of their hospitalization.
2. Cushing's may be treated with an alteration in medication regime if they have a prolonged history of corticosteroid use.
3. A secondary cause of Cushing's is an ACTH secreting neoplasm that causes a drop in adrenal function.
4. During times of stress a client DX with Addison's should speak with HCP for a dose increase.
1. FALSE... at increased risk for infections so visitors should be limited
2. TRUE
3. FALSE.... the ACTH secreting neoplasm cuases the adrenals to make excessive amounts of cortisol.
4. TRUE...why doeee?
The nurse should question which order?
a. daily weights for a client with hyperthyroidism
b. teprotumumab/ TRBW for tx of TED
c. Radioactive Iodine for a postpartum mother aged 18
d. beta blockers and corticosteroids for a client experiencing thyroid storming
c. Radioactive Iodine for a postpartum mother aged 18
1.Which patient is most at risk for developing SIADH?
A. A PT DX w small cell lung cancer.
B. A PT whose kidneys are not reabsorb h20
C. A PT w a tumor on the anterior pituitary
2.
A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention?
A. Na+ of 136.
B. Patient reports urinating more frequently.
C. K+ of 5.0.
D. Assessment finding of crackles throughout the lung fields.
1= A. A PT DX w small cell lung cancer.
2= D. Assessment finding of crackles throughout the lung fields.
A physician orders Calcium Gluconate IV as treatment for a patient with hypoparathyroidism. The patient’s calcium level is 5 mg/dL. Which of the following finding causes you to question this order?
A. The patient is taking Digoxin.
B. The patient complains of muscle cramping and numbness in the face.
C. The patient is taking Aluminum Carbonate.
D. The patient’s phosphate level is 7 mg/dL.
A. The patient is taking Digoxin.
Calcium gluconate can increase Digoxin toxicity. Therefore, as the nurse you should clarify the order with the physician and make sure the physician is aware the patient is on Digoxin.