Endocrine
A nurse is caring for a client admitted with suspected Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which of the following laboratory findings should the nurse expect?
A. Serum sodium 152 mEq/L, urine specific gravity 1.002
B. Serum sodium 118 mEq/L, urine specific gravity 1.030
C. Serum osmolality 310 mOsm/kg, urine osmolality 200 mOsm/kg
D. Serum osmolality 275 mOsm/kg, urine specific gravity 1.005
What is B. Serum sodium 118 mEq/L, urine specific gravity 1.030.
Which of the following is the most sensitive and specific lab test for diagnosing acute pancreatitis?
A. Serum amylase
B. Serum lipase
C. AST
D. White blood cell count
What is B. Serum lipase
Rationale: Serum lipase rises earlier, stays elevated longer, and is more specific to pancreatic injury than amylase.
A nurse is assessing a client with liver failure. Which clinical finding is most consistent with the early stage of liver dysfunction?
A. Asterixis
B. Jaundice
C. Pruritus
D. Right upper quadrant tenderness
What is D Right upper quadrant tenderness
Rationale: RUQ tenderness is a common early finding due to hepatomegaly and inflammation. Asterixis and jaundiceindicate more advanced liver failure.
Which of the following best explains the pathophysiology of burn-induced hypovolemic shock?
A. Loss of skin barrier increases blood loss
B. Catecholamine release causes vasodilation
C. Intravascular fluid shifts into interstitial space
D. Decreased cardiac output increases intravascular pressure
What is C. Intravascular fluid shifts into interstitial space
Rationale: Burns trigger capillary permeability, causing fluid to shift into the interstitial space → hypovolemia, ↓ BP, ↑ HR.
This type of shock is caused by a loss of circulating blood volume, such as from trauma or dehydration.
What is hypovolemic shock?
A nurse is caring for a patient diagnosed with Diabetes Insipidus (DI). Which of the following findings should the nurse anticipate? (Select all that apply)
☐ A. Serum sodium 130 mEq/L
☐ B. Polyuria with dilute urine
☐ C. Low urine specific gravity
☐ D. Elevated serum osmolality
☐ E. Bradycardia
☐ F. Increased thirst
What is
☐B. Polyuria with dilute urine
☐ C. Low urine specific gravity
☐ D. Elevated serum osmolality
Which of the following clinical findings would indicate severe acute pancreatitis? (Select all that apply)
☐ A. Cullen’s sign
☐ B. Trousseau’s sign
☐ C. Mild abdominal tenderness
☐ D. Turner’s sign
☐ E. Hypotension
☐ F. Fever
What is
☐ A. Cullen’s sign
☐ B. Trousseau’s sign
☐ D. Turner’s sign
☐ E. Hypotension
☐ F. Fever.
Rationale: Cullen’s and Turner’s signs indicate retroperitoneal hemorrhage. Trousseau’s (and Chvostek’s) suggest hypocalcemia. Severe forms include hypotension, fever, and systemic signs. Mild tenderness is associated with mild disease.
Which laboratory results support a diagnosis of liver failure? (Select all that apply)
☐ A. Decreased albumin
☐ B. Increased ammonia
☐ C. Decreased AST/ALT
☐ D. Prolonged prothrombin time
☐ E. Decreased bilirubin
What is
☐ A. Decreased albumin
☐ B. Increased ammonia
☐ D. Prolonged prothrombin time
Rationale: In liver failure, albumin and protein production decrease, ammonia builds up, and clotting time increases. ALT/AST may be elevated early, then normalize as hepatocytes die. Bilirubin increases, not decreases.
Which findings are expected during the emergent (resuscitative) phase of a burn injury? (Select all that apply)
☐ A. Increased hematocrit
☐ B. Hyperkalemia
☐ C. Decreased urine output
☐ D. Increased albumin
☐ E. Hyponatremia
What is
☐ A. Increased hematocrit
☐ B. Hyperkalemia
☐ C. Decreased urine output
☐ E. Hyponatremia
Rationale:
Hematocrit ↑ due to hemoconcentration
K+ ↑ from damaged cells
Na+ ↓ from fluid shift and loss
UO ↓ due to hypoperfusion
Albumin is lost into interstitial spaces
This type of shock is caused by a blockage in blood flow, such as a pulmonary embolism or tension pneumothorax.
What is obstructive shock?
The nurse receives the following morning labs for a client with Addison’s disease. Which result is the priority to report to the provider?
A. Sodium: 128 mEq/L
B. Glucose: 70 mg/dL
C. Potassium: 6.3 mEq/L
D. BUN: 20 mg/dL
What is C. Potassium: 6.3 mEq/L
A client with acute pancreatitis has the following assessment data. Which finding requires immediate intervention?
A. Serum calcium 7.4 mg/dL
B. Serum amylase 650 U/L
C. Blood glucose 220 mg/dL
D. White blood cell count 17,000/mm³
What is A. Serum calcium 7.4 mg/dL
Rationale: Severe hypocalcemia (<8 mg/dL) can lead to seizures, cardiac arrhythmias, and death. It is a critical finding requiring urgent electrolyte replacement.
A client with liver cirrhosis reports confusion, slurred speech, and hand tremors. What is the priority nursing action?
A. Check blood glucose
B. Administer lactulose as ordered
C. Elevate HOB to 30 degrees
D. Start seizure precautions
What is B. Administer lactulose as ordered
Rationale: This patient is showing signs of hepatic encephalopathy from high ammonia. Lactulose reduces ammonia and is first-line treatment.
A patient presents with bright red, weeping burns that are extremely painful. What classification is most likely?
A. First-degree burn
B. Superficial partial-thickness
C. Deep partial-thickness
D. Full-thickness burn
What is B. Superficial partial-thickness
Rationale: Superficial partial-thickness burns affect the upper dermis, are bright red, moist, very painful, and heal in 1-3 weeks.
In rapid sequence intubation (RSI), which adjunct medication is commonly used to decrease the physiologic response to intubation, often administered during pre-oxygenation to minimize hemodynamic effects?
What is fentanyl?
A client presents to the ED with a diagnosis of thyroid storm. Which of the following interventions should the nurse anticipate administering first?
A. IV propranolol
B. Oral methimazole
C. IV hydrocortisone
D. Acetaminophen rectally
What is A. IV propranolol
rationale:Beta blockers (like propranolol) are given first to reduce cardiac workload and control HR. Methimazole and iodine address hormone synthesis/release but take longer. Acetaminophen helps fever but doesn't address the critical cardiovascular status.
A client with necrotizing pancreatitis has a distended abdomen, low urine output, and new onset respiratory failure. Abdominal pressure is 22 mmHg. What is the nurse's priority intervention?
A. Increase IV fluid rate
B. Prepare for surgical abdominal decompression
C. Place a nasogastric tube
D. Start vasopressors to support blood pressure
What is B. Prepare for surgical abdominal decompression
Rationale: Intra-abdominal pressure >20 mmHg with organ failure = abdominal compartment syndrome, which is a surgical emergency. Decompression is required to prevent multi-organ failure.
A nurse is caring for a patient with end-stage liver disease and ascites. Which of the following orders would the nurse question?
A. Daily weights
B. High sodium diet
C. Measure abdominal girth
D. Administer spironolactone
What is B. High sodium diet
Rationale: A low sodium diet is essential in managing ascites. Sodium promotes water retention, which worsens fluid buildup.
A nurse is caring for a burn patient in the acute phase of recovery. What priority assessment finding may indicate early development of paralytic ileus?
A. High serum potassium
B. Complaints of constipation
C. Absent bowel sounds
D. Elevated blood glucose
What is C. Absent bowel sounds
Rationale: Paralytic ileus = bowel not moving due to hypoperfusion in early burn shock. Absent bowel soundsindicate slowed motility.
This pressure, calculated by subtracting intracranial pressure from the mean arterial pressure, is necessary to ensure adequate brain perfusion. If this value falls below 60 mmHg, cerebral ischemia may occur.
What is Cerebral Perfusion Pressure (CPP)?
A nurse is reviewing lab results for a client with suspected primary hypothyroidism. Which of the following findings support this diagnosis? (Select all that apply)
☐ A. Elevated TSH
☐ B. Decreased T3 and T4
☐ C. Elevated TRH
☐ D. Decreased TSH
☐ E. Increased Free T4
☐ F. Decreased metabolic rate
☐ A. Elevated TSH
☐ B. Decreased T3 and T4
☐ C. Elevated TRH
☐ F. Decreased metabolic rate
Rationale: Primary hypothyroidism means the thyroid gland itself is not responsive, so T3 and T4 levels are low, which causes elevated TSH and TRH (feedback loop trying to compensate). Metabolic rate is decreased due to low thyroid hormone activity.
Which of the following best describes the pathophysiology and consequences of acute pancreatitis? (Select all that apply)
☐ A. Premature activation of trypsin within the pancreas causes autodigestion
☐ B. Acinar cells secrete excess insulin during pancreatitis
☐ C. Elastase contributes to vascular damage and hemorrhage
☐ D. Hypocalcemia results from fat necrosis
☐ E. Pancreatic inflammation decreases vascular permeability
☐ F. Bradykinin contributes to increased capillary leak and edema
What is
☐ A. Premature activation of trypsin within the pancreas causes autodigestion
C. Elastase contributes to vascular damage and hemorrhage
☐ D. Hypocalcemia results from fat necrosis
☐ F. Bradykinin contributes to increased capillary leak and edema
Rationale: In acute pancreatitis, trypsin activates early, causing autodigestion. Elastase damages vessels, leading to hemorrhage. Fat necrosis binds calcium, resulting in hypocalcemia. Bradykinin contributes to inflammation and increased permeability. Acinar cells secrete enzymes, not insulin.
Which interventions are appropriate for a client with esophageal varices and active GI bleeding? (Select all that apply)
☐ A. Prepare for balloon tamponade
☐ B. Administer lactulose
☐ C. Administer octreotide IV
☐ D. Keep scissors at bedside
☐ E. Encourage oral fluids
What is
☐ A. Prepare for balloon tamponade
☐ C. Administer octreotide IV
☐ D. Keep scissors at bedside
Rationale: During variceal bleeding, tamponade, octreotide (vasoconstrictor), and emergency tools like scissors are life-saving. Lactulose is not indicated unless encephalopathy is present. NPO status is essential with active bleeding.
You are calculating fluid resuscitation needs for a 70-kg client with burns over 30% TBSA. How much fluid should be administered in the first 8 hours?
A. 2100 mL
B. 4200 mL
C. 8400 mL
D. 10,500 mL
What is C. 8400 mL
Rationale:
Parkland Formula = 4 mL × 70 kg × 30 = 8400 mL total
½ in first 8 hours = 4200 mL in 8 hours
A patient with this type of herniation, caused by swelling in the temporal lobe, shows signs of irregular breathing patterns, abnormal posturing, and a fixed, dilated pupil on the same side of the injury.
What is Uncal Herniation?