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Diabetes
Adrenal
Pituitary
Thyroid
I'm Feeling Lucky (Random)
100

A nurse is educating a new diagnosed diabetic client on the 3 P's.  The nurse would explain the P's are

Polyuria- excessive urination; polydipsia-excessive thirst and polyphagia- excessive hunger

100
An ACTH stimulation test is commonly used to diagnose: a. Grave's disease b. Adrenal insufficiency and Addison's disease c. Cystic fibrosis d. Hashimoto's disease
b. Adrenal insufficiency and Addison's disease The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic adrenal insufficiency or Addison's disease generally do not respond with the expected increase in cortisol levels. An abnormal ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.
100
A patient is admitted to the hospital with probable SIADH. Which lab would be most concerning to you? A.) Serum sodium level of 140 mEq/L B.) Serum ADH of 5.5 ph/mL C.) Urine potassium of 40 mEq/day D.) Urine osmolality of 400 mOsm/L
B.) Serum ADH of 5.5 ph/mL A serum level of over 4.7 ph/ML can be indicative of SIADH
100
Symptoms of Grave's ophthalmopathy include all of the following except: a. Bulging eyeballs b. Dry, irritated eyes and puffy eyelids c. Cataracts d. Light sensitivity
c. Cataracts Grave's ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-mentioned symptoms, Grave's ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the eyes. About one-quarter of persons with Grave's disease develop Grave's ophthalmopathy. The condition is frequently self-limiting, resolving without treatment over the course of a year or two.
100

A client is caring for a client who has a thyroidectomy with the removal of the parathyroid. After observing a positive Trousseau and Chvostek sign, which medication should the nurse prepare to administer. 

Calcium gluconate

200

Occurs when hypoglycemia is followed by a rebound period of hyperglycemia as the body attempts to correct the initial problem by increasing blood glucose levels and normally occurs late at night or early in the morning.

Somogyi Phenomenon

200
All of the following are symptoms of Cushing's syndrome except: a. Severe fatigue and weakness b. Hypertension and elevated blood glucose c. A protruding hump between the shoulders d. Hair loss
d. Hair loss Cushing's syndrome (hyyperadrenocorticism) also may cause fragile, thin skin prone to bruises and stretch marks on the abdomen and thighs as well as excessive thirst and urination and mood changes such as depression and anxiety. Women who suffer from high levels of cortisol often have irregular menstrual cycles or amenorrhea and present with hair on their faces, necks, chests, abdomens, and thighs.
200
Acromegaly is most frequently diagnosed in: a. Middle-aged adults b. Newborns c. Children ages 2 to 5 d. Adults age 65 and older
a. Middle-aged adults Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone. Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences of acromegaly include type 2 diabetes, hypertension and increased risk of cardiovascular disease, arthritis and colon polyps.
200
Hashimoto's disease is: a. Chronic inflammation of the thyroid gland b. Diagnosed most frequently in Asian-Americans and Pacific Islanders c. A form of hyperthyroidism d. A rare form of hypothyroidism
a. Chronic inflammation of the thyroid gland Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60. When treatment is indicated, synthetic T4 is administered.
200
All of the following statements about Hashimoto's disease are true except: a. Many patients are entirely asymptomatic b. Not all patients become hypothyroid c. Most cases of obesity are attributable to Hashimoto's disease d. Hypothyroidism may be subclinical
c. Most cases of obesity are attributable to Hashimoto's disease Although weight gain may be a symptom of Hashimoto's disease, the majority of obese people have normal thyroid function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto's disease include fatigue, cold intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.
300

A client comes into the clinic voicing they are feeling weak, thirst, and have been vomiting.  While assessing the client, the nurse notes a rapid pulse and client is breathing heavily but the BP is low.  The nurse notes the client smells a fruity smell.  The nurse knows the following are a sign of

Ketoacidosis

300
Which of the following nursing implications is most important in a client being medicated for Addison’s disease? a) Administer oral forms of the drug one hour before eating. b) Monitor capillary blood glucose for hypoglycemia in the diabetic client. c) Instruct the client to never abruptly discontinue the medication. d) Teach the client to consume a diet that is high in potassium, low in sodium, and high in protein.
c) Instruct the client to never abruptly discontinue the medication. The primary medical treatment of Addison’s disease is replacement of corticosteroids and mineralcorticoids, accompanied by increased sodium in the diet. The client needs to know the importance of maintaining a diet high is sodium and low in potassium. Medications should never be discontinued abruptly because crisis can ensue. Oral forms of the drug are given with food in Cushing’s disease.
300
The most common benign tumor of the pituitary gland is a: a. Glioma b Prolactinoma c. Carcinoid tumor d. Islet cell tumor
b Prolactinoma Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into the blood or mechanically by pressing on surrounding tissues. In women, symptoms may include menstrual irregularities and infertility; in men erectile dysfunction and libido may be impaired.
300
A nurse on a surgical floor is caring for a post-operative client who has just had a subtotal thyroidectomy. Which of the following assessments should be completed first on the client? a) Assess for signs of tetany by checking for Chvostek’s and Trousseau’s signs. b) Assess dressing (if present) and the area under the client’s neck and shoulders for drainage. c) Administer analgesic pain medications as ordered, and monitor their effectiveness. d) Assess respiratory rate, rhythm, depth, and effort.
d) Assess respiratory rate, rhythm, depth, and effort. All of the above assessments have importance, but airway and breathing in a client should always be addressed first when prioritizing care. Assess for signs of latent tetany due to calcium deficiency, including tingling of toes, fingers, and lips; muscular twitches; positive Chvostek’s and Trousseau’s signs; and decreased serum calcium levels. However, tetany may occur in 1 to 7 days after thyroidectomy so # 1 is not the highest priority. Assessing for hemorrhage is always important, but the danger of hemorrhage is greatest in the first 12 to 24 hours after surgery, and as this client is immediately post operative it is not the main concern at this time. Pain medication is important but according to Maslow, pain is a psychosocial need to be addressed after a physiologic need.
300
Nurse Ronn is assessing a client with possible Cushing's syndrome, the nurse would expect to find: A.) Hypotension B.) Thick, coarse skin. C.) Deposits of adipose tissue in the trunk and dorsocervical area. D.) Weight gain in arms and legs
C.) Deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
400

This is one of the leading causes of blindness which occurs from the loss of function in the retinal tissues causing microvascular damage. 

Retinopathy

400
A client newly diagnosed with Addison’s disease is giving a return explanation of teaching done by the primary nurse. Which of the following statements indicates that further teaching is necessary? a) "I need to increase how much I drink each day." b) “I need to weigh myself if I think I am losing or gaining weight.” c) “I need to maintain a diet high in sodium and low in potassium.” d) “I need to take my medications each day.”
b) “I need to weigh myself if I think I am losing or gaining weight.” Clients with Addison’s disease must learn to provide lifelong self-care that involves varied components: medications, diet, and recognizing and responding to stress. The client needs to take the medications on a daily basis. The client needs to perform daily weights to monitor for signs of dehydration. The client needs to maintain a diet high in sodium and low in potassium, as well as maintain an increased fluid intake. # 2 is incorrect because daily weights need to be performed instead of weighing when a problem is suspected.
400

A patient with SIADH is treated with water restriction and administration of IV fluids. The nurse evaluates that treatment has been effective when the patient experiences a. increased urine output, decreased serum sodium, and increased urine specific gravity. b. increased urine output, increased serum sodium, and decreased urine specific gravity. c. decreased urine output, increased serum sodium, and decreased urine specific gravity. d. decreased urine output, decreased serum sodium, and increased urine specific gravity.

B.) increased urine output, increased serum sodium, and decreased urine specific gravity. Rationale: The patient with SIADH has water retention with hyponatremia, decreased urine output and with high specific gravity. Improvement in the patient's condition is reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.

400

A client is starting a new medication, levothyroxine, know that this medication should be taken_____

Taken early in the morning on an empty stomach with a full glass of water.

400
A female adult client with history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? A.) Related to bone demineralization resulting in pathologic fractures. B.) Related to exhaustion secondary to accelerated metabolic rate. C.) Related to edema and dry skin secondary to fluid infiltration into interstitial spaces. D.) Related to tetany secondary to decreased serum calcium level.
A.) Related to bone dimineralization resulting in pathologic fractures. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn’t accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn’t associated with tetany.
500

A nurse is teaching about foot care.  Name 5 practices that she would include

Inspect feet daily, wash feet daily and do not soak, dry feet thoroughly, cut nails straight across, do not walk barefoot, well fitting shoes, wear new shoes for only a short period, avoid using heating pads and hot water bottles, place lambs wool between over lapping toes to prevent fricition

500
The nurse is caring for a client with pheochromocytoma. Which of the following must be included in planning the nursing care for this client? a) Monitor blood pressure frequently, assessing for HTN. b) Assess only for physical stressors present. c) Collect a random urine sample. d) Prepare the client for chemotherapy to shrink the tumor.
a) Monitor blood pressure frequently, assessing for HTN. Pheochromocytomas are usually benign tumors in the adrenal medulla that produce catecholamines (epinephrine and norepinephrine). Many organs are affected but the most dangerous effects are peripheral vasoconstriction and increased cardiac rate and contractility with resultant paroxysmal hypertension. Attacks are often precipitated by physical, emotional, or environmental stimuli, so # 2 is incorrect because more than physical stressors are considered. # 3 is incorrect because catecholamine secretion is episodic, a 24-hour urine is a better surveillance method than random urine sample. # 4 is incorrect because surgical removal of the tumor(s) by adrenalectomy is the treatment of choice.
500
A patient is admitted to the hospital with a diagnosis of diabetes insipidus (DI). The nurse should be aware of what primary characteristics of DI? a.) Decreased urinary output and decreased plasma osmolality b.) Excretion of large quantities of urine with very low specific gravity and urine osmolality c.) Hypertension, weight gain, and bradycardia d.) Irritability and mental dullness
b.) Excretion of large quantities of urine with very low specific gravity and urine osmolality. Rationale: DI is associated with a deficiency of production of or secretion of of ADH or a decreased renal response to ADH. The decrease in ADH results in fluid and electrolyte imbalances caused by increased urinary output and increased plasma osmolality.
500

True or False

A nursing consideration for a client following a thyroidectomy should be the client is up and walking after surgery.  The nurse should encourage the client to be active and assisting with ADL care. They should have adequate Vit D and Calcium, and adequate caloric intake.

FALSE:  The client should be resting and avoiding excessive physical activity.
500
A nurse is monitoring a client with Graves' disease for signs of thyrotoxicosis (thyroid storm). Which of the following signs and symptoms, if noted in the client, will alert the nurse to the presence of this crisis? Select all that apply. A.) Bradycardia B.) Fever C.) Sweating D.) Agitation E.) Pallor
B.) Fever C.) Sweating D.) Agiation Rationale: Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever greater than 100° F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.