Endocrine
A nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse anticipate?
A) Serum sodium 125 mEq/L
B) Hematocrit 48%
C) Urine specific gravity 1.001
D) Serum potassium 6.2 mEq/L
A) Serum sodium 125 mEq/L
Rationale: SIADH leads to water retention and dilutional hyponatremia. A sodium level of 125 mEq/L is a common finding. Hematocrit is often low due to hemodilution, and urine specific gravity is typically elevated due to concentrated urine.
A nurse is caring for a patient with diabetes who reports shakiness, irritability, and blurred vision. The patient's blood glucose level is 68 mg/dL. What is the nurse's priority action?
A) Administer 15 grams of a fast-acting carbohydrate
B) Administer the patient's scheduled insulin dose
C) Notify the healthcare provider immediately
D) Ask the patient to lie down to prevent falls
A) Administer 15 grams of a fast-acting carbohydrate
Rationale: According to the "Rule of 15," administering 15 grams of a fast-acting carbohydrate is the immediate treatment for mild hypoglycemia.
Which statement by a patient with gestational diabetes indicates further teaching is needed?
A) "I should monitor my blood sugar levels closely during pregnancy."
B) "I know I have an increased risk for developing type 2 diabetes later in life."
C) "I should avoid exercise during pregnancy to prevent low blood sugar."
D) "My healthcare provider may recommend insulin if diet alone doesn't control my glucose levels."
C) "I should avoid exercise during pregnancy to prevent low blood sugar."
Rationale: Exercise is encouraged in patients with gestational diabetes to improve insulin sensitivity and manage blood glucose levels.
The nurse suspects a neurovascular problem based on which assessment finding?
A) Exaggerated strength with movement
B) Increased redness and warmth below the injury
C) Decreased sensation distal to the fracture site
D) Purulent drainage at the site of the open fracture
C) Decreased sensation distal to the fracture site
Rationale: Decreased sensation indicates compromised blood flow or nerve injury, a potential sign of compartment syndrome that requires immediate intervention.
A nurse is preparing a client for a barium swallow to evaluate dysphagia. Which nursing intervention is most important before the procedure?
A) Administer a laxative the night before.
B) Encourage the client to drink plenty of fluids.
C) Keep the client NPO (nothing by mouth) for 8 hours before the test.
D) Explain that stool may appear clay-colored for up to 72 hours.
C) Keep the client NPO (nothing by mouth) for 8 hours before the test.
Rationale: The client should be NPO (no food or fluids) for at least 8 hours before a barium swallow to ensure the upper GI tract is clear for imaging. While fluids and laxatives are essential after the procedure to promote barium elimination, the priority before the test is ensuring the stomach is empty.
The nurse is preparing to administer levothyroxine to a patient with hypothyroidism. Which statement by the patient indicates a need for further teaching?
A) "I should take this medication first thing in the morning before breakfast."
B) "I will need to take this medication for the rest of my life."
C) "If I experience heart palpitations, I should take an extra dose of the medication."
D) "I should let my provider know if I experience chest pain or insomnia."
C) "If I experience heart palpitations, I should take an extra dose of the medication."
Rationale: Taking an extra dose of levothyroxine can result in thyrotoxicosis. Heart palpitations could indicate excessive dosing and should prompt the patient to contact their provider instead.
Which lab result requires further investigation for possible diabetes diagnosis?
A) A1C of 5.7%
B) Fasting blood glucose of 126 mg/dL
C) Random plasma glucose of 180 mg/dL
D) Oral glucose tolerance test result of 130 mg/dL after 2 hours
B) Fasting blood glucose of 126 mg/dL
Rationale: A fasting blood glucose ≥ 126 mg/dL on two separate occasions is diagnostic for diabetes. The other values are either normal or indicate prediabetes.
You are preparing your patient’s order for NPH insulin. When you look at the vial, you notice it is cloudy. What is the correct nursing action?
A) Discard the insulin and request a new vial
B) Administer the insulin as ordered after gently rolling the vial
C) Shake the vial vigorously to mix the particles
D) Hold the medication and contact the provider
B) Administer the insulin as ordered after gently rolling the vial
Rationale: NPH insulin is supposed to be cloudy and should be gently rolled between the hands to resuspend the particles. Shaking the vial can damage the insulin molecules.
A patient with a closed, complete, oblique fracture of the femur is scheduled for surgery. The primary purpose of applying Buck’s traction preoperatively is to:
A) Increase circulation to the area of injury
B) Promote healing of the fracture before surgery
C) Reduce muscle spasm and immobilize the fracture
D) Allow for early ambulation
C) Reduce muscle spasm and immobilize the fracture
Rationale: Buck’s traction is commonly used to reduce pain, decrease muscle spasms, and temporarily immobilize fractures before surgery.
A client with gastroesophageal reflux disease (GERD) is prescribed omeprazole. Which statement by the client indicates the need for further teaching?
A) "I should take this medication before breakfast."
B) "This medication will heal my esophagus overnight."
C) "I may need to take this medication for several weeks."
D) "I should notify my doctor if I develop persistent diarrhea."
B) "This medication will heal my esophagus overnight."
Rationale: Proton pump inhibitors (PPIs) like omeprazole reduce stomach acid but require several weeks to promote healing. GERD is a chronic condition that may need long-term treatment. Immediate results are not typical. Persistent diarrhea can indicate Clostridioides difficile (C. diff) infection, a potential side effect of PPIs.
A nurse is providing teaching to a patient newly diagnosed with Cushing’s syndrome. Which statement by the patient indicates understanding of the condition?
A) "I should increase my intake of sodium to manage my fatigue."
B) "I will need to monitor my blood glucose regularly."
C) "I should stop taking my corticosteroid medication immediately."
D) "I can skip my medication doses on days when I feel well."
B) "I will need to monitor my blood glucose regularly."
Rationale: Patients with Cushing’s syndrome often experience hyperglycemia, so regular blood glucose monitoring is essential. Abruptly stopping corticosteroids can trigger adrenal crisis, and sodium intake is typically restricted.
A nurse is caring for a patient diagnosed with DKA. Which intervention should the nurse prioritize?
A) Administer sodium bicarbonate to correct acidosis
B) Start an IV infusion of normal saline and insulin
C) Provide a high-calorie snack to improve energy
D) Administer IV potassium before starting insulin
B) Start an IV infusion of normal saline and insulin
Rationale: The immediate priority is fluid resuscitation with normal saline and initiating insulin therapy to reduce blood glucose levels. Potassium is administered later as insulin drives potassium into the cells.
Which statement by the patient with type 2 diabetes indicates an understanding of dietary management?
A) "I will limit my alcohol intake to one drink a day."
B) "I am not allowed to eat any sweets because of my diabetes."
C) "I cannot exercise vigorously because I take blood glucose-lowering medication."
D) "The amount of fat in my diet is not important; only carbohydrates raise my blood sugar."
A) "I will limit my alcohol intake to one drink a day."
Rationale: Moderate alcohol intake is permitted, but patients should be cautious since alcohol can cause severe hypoglycemia. The other options reflect incorrect dietary information.
A nurse caring for a patient with osteoarthritis scheduled for total hip arthroplasty should explain that the purpose of this procedure is to: (Select all that apply)
A) Fuse the joint
B) Replace the joint
C) Prevent further damage
D) Improve or maintain range of motion (ROM)
E) Decrease the amount of destruction in the joint
B) Replace the joint
D) Improve or maintain range of motion (ROM)
Rationale: Total hip arthroplasty replaces the damaged joint to improve mobility and decrease pain. It does not prevent future joint damage in other areas or fuse the joint.
A nurse is caring for a client who was recently diagnosed with peptic ulcer disease (PUD). The client suddenly reports severe abdominal pain, has a rigid and board-like abdomen, and exhibits shallow respirations. What is the priority nursing action?
A) Administer prescribed antacids.
B) Notify the healthcare provider immediately.
C) Place the client in a supine position with legs elevated.
D) Encourage the client to take deep breaths and relax.
B) Notify the healthcare provider immediately.
Rationale: The client’s symptoms (severe abdominal pain, rigid abdomen, shallow breathing) suggest perforation, a life-threatening complication of peptic ulcer disease. This requires immediate medical intervention to prevent peritonitis and septic shock. Administering antacids, adjusting the client’s position, or promoting relaxation will not address the emergency at hand.
A patient with Addison’s disease is admitted to the hospital with complaints of fatigue, nausea, and dizziness. Upon assessment, the nurse notes poor skin turgor, dry mucous membranes, and a blood pressure of 88/60 mmHg. Which of the following interventions should the nurse prioritize?
A) Administer IV 5% dextrose in 0.9% saline
B) Administer oral hydrocortisone
C) Encourage oral fluids and rest
D) Administer potassium chloride IV
A) Administer IV 5% dextrose in 0.9% saline
Rationale: The patient’s symptoms indicate an Addisonian crisis. The priority intervention is to restore fluid and electrolyte balance with IV fluids containing sodium and dextrose. Hydrocortisone may also be needed, but IV fluid resuscitation is the immediate priority.
A patient with diabetes has a serum glucose level of 824 mg/dL and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis (DKA) rather than hyperosmolar hyperglycemic syndrome (HHS) based on which finding?
A) Polyuria
B) Severe dehydration
C) Rapid, deep respirations
D) Decreased serum potassium
C) Rapid, deep respirations
Rationale: Kussmaul respirations (rapid, deep breathing) are a hallmark of DKA. While both conditions involve polyuria, dehydration, and electrolyte imbalance, respiratory distress is more typical in DKA.
Which statement by the patient using an insulin pump requires additional teaching?
A) "I will change my infusion site every 2-3 days."
B) "If my pump malfunctions, I will administer my insulin using a syringe."
C) "I should avoid taking my pump off, even during activities like swimming."
D) "I must monitor my blood glucose levels frequently to adjust my insulin doses."
C) "I should avoid taking my pump off, even during activities like swimming."
Rationale: Insulin pumps should be removed during activities such as swimming to prevent device damage. Blood glucose must be monitored carefully when the pump is removed to prevent hyperglycemia.
D.S. is a 45-year-old construction worker admitted to the emergency department after falling from a scaffold. He sustained a closed, comminuted fracture of the left tibia and is placed in Buck's traction. D.S. has a history of hypertension controlled with medication and no known allergies.
Subjective Data:
Reports severe pain in his left leg rated 8/10
States the pain worsens with movement
Complains of numbness and tingling in his left foot
Objective Data:
BP: 138/84 mmHg, HR: 90 bpm, RR: 18/min, Temp: 99.0°F
Left lower extremity is pale and cool to touch
Dorsalis pedis pulse is weak and difficult to palpate
Capillary refill in the left foot is greater than 4 seconds
Questions
The provider suspects compartment syndrome. Which additional assessment finding would support this diagnosis?
A) Increased pain with passive movement
B) Reduced pain with elevation of the limb
C) Decreased pain after administration of opioids
D) Red, warm skin with a palpable pulse
A) Increased pain with passive movement
Rationale: A hallmark sign of compartment syndrome is pain that worsens with passive stretching and is unrelieved by medication. This condition requires urgent intervention, often involving fasciotomy.
A nurse is providing dietary education for a client with diverticulosis. Which food should the nurse recommend?
A) Popcorn
B) Nuts and seeds
C) White bread
D) Whole-grain cereals
D) Whole-grain cereals
Rationale: Clients with diverticulosis should consume a high-fiber diet to promote bowel regularity and reduce the risk of diverticula inflammation. Whole grains, fruits, and vegetables are ideal. Foods like popcorn, nuts, and seeds were once thought to irritate diverticula, but recent guidelines no longer strictly advise against them. However, fiber remains the key dietary recommendation.
Mr. Thomas, a 45-year-old male, arrives at the emergency department with complaints of fatigue, muscle weakness, and significant weight loss over the past month. He reports frequent dizziness and nausea. Upon assessment, his blood pressure is 88/56 mmHg, heart rate is 108 bpm, and he appears confused. His skin appears bronze-colored, and he has poor skin turgor. Laboratory results reveal the following:
Sodium: 128 mEq/L (135-145 mEq/L)
Potassium: 5.9 mEq/L (3.5-5.0 mEq/L)
Glucose: 62 mg/dL (70-100 mg/dL)
Cortisol: 2 mcg/dL (normal morning range 5-23 mcg/dL)
Question:
Based on Mr. Thomas’s assessment findings and lab results, what is the priority nursing intervention?
A) Administer 5% dextrose in 0.9% saline intravenously.
B) Administer insulin and dextrose to lower potassium levels.
C) Prepare for emergent intubation.
D) Administer hydrocortisone IV as prescribed.
A) Administer 5% dextrose in 0.9% saline intravenously.
Rationale:
The patient is showing signs of an Addisonian crisis, a life-threatening complication of adrenal insufficiency. The priority intervention is to restore fluid volume and correct electrolyte imbalances. Administering 5% dextrose in 0.9% saline addresses both hypovolemia and hypoglycemia.
A 14-year-old patient with newly diagnosed type 1 diabetes is admitted to the hospital with symptoms of polyuria, polydipsia, and weight loss. Lab results reveal a blood glucose level of 450 mg/dL, pH 7.28, and presence of ketones in the urine. The patient appears lethargic, with dry mucous membranes and Kussmaul respirations.
Question 1: What is the priority nursing intervention for this patient?
A) Administer a fast-acting carbohydrate such as fruit juice
B) Provide a high-protein snack to improve energy levels
C) Administer IV fluids and initiate an insulin drip
D) Apply oxygen at 2L/min via nasal cannula
C) Administer IV fluids and initiate an insulin drip
Rationale: The patient is exhibiting signs of diabetic ketoacidosis (DKA). The priority is to restore fluid volume and administer insulin to reduce hyperglycemia and correct acidosis.
An 82-year-old patient with type 2 diabetes is admitted with pneumonia. The patient’s blood glucose level is 610 mg/dL, and there are no ketones present in the urine. The patient is confused and has dry skin and poor skin turgor.
Question: Based on these findings, what condition does the nurse suspect?
A) Diabetic ketoacidosis (DKA)
B) Hyperosmolar hyperglycemic syndrome (HHS)
C) Somogyi effect
D) Dawn phenomenon
B) Hyperosmolar hyperglycemic syndrome (HHS)
Rationale: The absence of ketones combined with extremely high blood glucose and neurological symptoms is consistent with HHS.
D.S. is a 45-year-old construction worker admitted to the emergency department after falling from a scaffold. He sustained a closed, comminuted fracture of the left tibia and is placed in Buck's traction. D.S. has a history of hypertension controlled with medication and no known allergies.
Subjective Data:
Reports severe pain in his left leg rated 8/10
States the pain worsens with movement
Complains of numbness and tingling in his left foot
Objective Data:
BP: 138/84 mmHg, HR: 90 bpm, RR: 18/min, Temp: 99.0°F
Left lower extremity is pale and cool to touch
Dorsalis pedis pulse is weak and difficult to palpate
Capillary refill in the left foot is greater than 4 seconds
Questions:
1. Based on D.S.'s assessment, what is the priority nursing action?
A) Administer prescribed pain medication
B) Apply warm compresses to improve circulation
C) Notify the healthcare provider immediately
D) Reposition the Buck's traction to improve alignment
C) Notify the healthcare provider immediately
Rationale: The pale, cool extremity with weak pulses and delayed capillary refill indicates potential compartment syndrome, a medical emergency that requires immediate intervention to prevent permanent damage.
A 52-year-old male patient presents to the emergency department with complaints of severe upper abdominal pain that radiates to his back. He describes the pain as sharp and constant. He reports nausea, vomiting, and a recent binge drinking episode. On assessment, his abdomen is tender to palpation, with hypoactive bowel sounds. His vital signs are as follows:
Temperature: 38.3°C (100.9°F)
Heart rate: 110 bpm
Respiratory rate: 24/min
Blood pressure: 98/60 mmHg
Oxygen saturation: 94% on room air
Laboratory results reveal:
Amylase: 650 U/L (Normal: 23-85 U/L)
Lipase: 1,200 U/L (Normal: 0-160 U/L)
WBC count: 16,000/mm³ (Normal: 4,500-11,000/mm³)
Glucose: 210 mg/dL (Normal: 70-110 mg/dL)
Question:
Based on the patient’s presentation and laboratory results, which nursing intervention is the priority?
A. Administer intravenous (IV) fluids and initiate NPO (nothing by mouth) status
B. Administer oral acetaminophen for pain management
C. Encourage the patient to drink clear fluids to stay hydrated
D. Provide a low-fat diet to reduce pancreatic stimulation
A. Administer intravenous (IV) fluids and initiate NPO (nothing by mouth) status
Rationale:
This patient’s symptoms and lab results are consistent with acute pancreatitis, a serious inflammatory condition of the pancreas. Priority nursing interventions focus on stabilizing the patient’s hemodynamic status and reducing pancreatic stimulation.