Thyroid, Cushings, Addisons
The nurse is assessing a client with chronic Cushing’s disease. Which of the following clinical manifestations should the nurse expect to find? (Select all that apply.)
A. Truncal obesity with a "buffalo hump"
B. Purple striae on the abdomen
C. Orthostatic hypotension
D. Hyperglycemia
E. Hyperpigmentation of the skin
A,B,D
A Med-Surg nurse is providing "sick-day rules" discharge teaching to a client with Type 1 Diabetes who has acute gastroenteritis. Which instruction should the nurse include?
A. "Stop taking your insulin if you are vomiting and unable to eat solid meals."
B. "Check your blood glucose levels at least every 3 to 4 hours."
C. "Only check your urine for ketones if your blood glucose drops below 70"
"D. "Restrict your fluid intake to prevent fluid overload while resting."
B; remember, when a diabetic is sick they often have high blood sugar levels. we want them to check their sugar more often
A nurse is caring for an 82-year-old client admitted to a Med-Surg unit who is continent of urine cognitively but has severe rheumatoid arthritis in both hands, making it difficult to manipulate clothing fasteners quickly, along with unsteady mobility. The client experiences accidental urine leakage before reaching the commode. What type of incontinence is this?
A. Functional incontinence
B. Reflex incontinence
C. Stress incontinence
D. Total incontinence
A; for functional incontinence we want to modify their environment
A nurse is designing a care plan to prevent pressure injuries for a client with complete lower-extremity paralysis. Which of the following interventions should the nurse include? (Select all that apply.)
A. Reposition the client in bed at least every 2 hours.
B. Massage bony prominences vigorously during every shift change.
C. Elevate the head of the bed to 45 degrees or higher continuously to promote comfort.
D. Use pillows or foam wedges to keep bony prominences (such as knees and ankles) from direct contact with each other.
E. Clean skin promptly when soiled with incontinence and apply a moisture barrier ointment.
A,D,E
A Med-Surg client taking oral Metformin for Type 2 Diabetes is scheduled for an elective Computed Tomography (CT) scan with intravenous iodinated contrast dye at 14:00 today. Which nursing action is essential prior to sending the client for the procedure?
A. Administer double the scheduled dose of Metformin with breakfast.
B. Verify that Metformin has been held prior to the test and confirm orders to hold it for 48 hours post-procedure.
C. Instruct the client to double their fluid intake during the 2 hours immediately preceding the scan.
D. Switch the client to subcutaneous insulin glargine (Lantus) right before the procedure.
B; remember, we want to hold metformin with IV contrast because it can fry the kidneys
A client suspected of having Graves' disease has blood drawn for a thyroid panel. Which laboratory result pattern confirms a diagnosis of primary hyperthyroidism?
A. Increased T3 & T4 & decreased TSH
B. Decreased T3 & T4 with increased TSH
C. Normal T3 & T4 with an increased TSH
D. Elevated T3 & T4 with an increased TSH
A; remember they have HIGH THYROID HORMONE LEVELS (T3 & T4)
A nurse in the emergency department is assessing two clients with extreme hyperglycemia. Client A is diagnosed with Diabetic Ketoacidosis (DKA) and Client B is diagnosed with Hyperglycemic Hyperosmolar State (HHS). Which clinical feature is unique to Client B (HHS) and helps distinguish it from Client A?
A. Kussmaul respirations and a fruity breath odor
B. Serum glucose level significantly greater than 600 without significant ketosis
C. Arterial blood pH less than 7.30 and serum bicarbonate less than 18 mEq/L
D. Presence of moderate-to-large ketones in the urine
B; remember, HHS does not have the acidosis state (no Kussmauls or ketones)
A nurse is providing discharge instructions to a female client who is experiencing stress urinary incontinence following a vaginal delivery. Which of the following statements by the client indicates an understanding of the teaching?
A. "I will restrict my total daily fluid intake to less than 1,000 mL so my bladder doesn't fill up too fast."
B. "I will perform pelvic floor muscle training exercises, such as Kegel exercises, regularly every day."
C. "I should expect to wear an indwelling urinary catheter permanently to manage this condition."
D. "Sudden, uncontrollable urges to void mean I need to take anticholinergic medications immediately."
B; remember, for stress the 'treatment' is Kegel exercises
A nurse is admitting a client to the post-anesthesia care unit (PACU) following a subtotal thyroidectomy. Which of the following items is most critical for the nurse to have immediately available at the bedside?
A. A programmed patient-controlled analgesia (PCA) pump with morphine
B. An incentive spirometer and nasal cannula
C. A tracheostomy insertion tray and oxygen suction equipment
D. A bottle of saturated solution of potassium iodide (SSKI)
C; remember, your priority problem is always ABCs
A nurse is preparing to administer scheduled subcutaneous insulin lispro (Humalog) to a client with Type 1 Diabetes Mellitus. Which nursing action is essential prior to injecting this medication?
A. Ensure the client's meal tray is delivered and present on the unit before administration.
B. Administer the injection 45 to 60 minutes before the client begins eating.
C. Mix the insulin lispro with insulin glargine (Lantus) in the same syringe to reduce injection frequency.
D. Hold the dose if the client’s pre-meal blood glucose is greater than180
A; remember, we want to ensure that they have food so we don't drop their blood sugar due to the quick onset
Remember: the onset of rapid acting is 0-15 minutes, so we want to give them their insulin when their tray arrives!!!
A Med-Surg nurse is creating a plan of care for a client with myxedema coma who is being transferred from the ICU. Which interventions should be included in the care plan? (Select all that apply.)
A. Maintain the client on continuous cardiac telemetry monitoring.
B. Place electric heating pads on the client's upper and lower extremities.
C. Assess for signs of hypoglycemia and hyponatremia.
D. Monitor respiratory status and keep emergency airway supplies at the bedside.
E. Administer prescribed sedatives at bedtime for severe restlessness.
A,C,D
A is correct: Severe bradycardia, hypotension, and delayed cardiac conduction require continuous ECG monitoring.
C is correct: Slowed metabolic rate reduces gluconeogenesis (risk for hypoglycemia) and impairs renal free-water clearance (risk for hyponatremia).
D is correct: Hypoventilation and central nervous system depression are common; maintaining airway patency is critical.
A client is admitted to the emergency department with a diagnosis of Diabetic Ketoacidosis (DKA). The client's initial laboratory results include: Blood Glucose 480\text,Arterial Blood Gas (ABG): pH 7.24, Serum Bicarbonate 14, and Serum Potassium 5.2Which prescription order should the nurse implement first?
A. Administer regular insulin 10 units IV bolus followed by a continuous infusion.
B. Initiate an intravenous infusion of 0.9% Normal Saline at 500 mL/hr
C. Administer sodium bicarbonate 50 mmol IV over 30 minutes.
D. Administer a sliding-scale dose of subcutaneous regular insulin.
B: REMEMBER ALWAYS DO FLUID RESUSCITATION FIRST!! normally normal saline (0.9%)
A nurse is caring for an adult client who has been experiencing acute, severe watery diarrhea for the past 3 days. Which of the following laboratory and assessment findings should the nurse expect to observe?
A. Serum potassium level of 5.6 and a blood pressure of 140/90
B. Dry mucous membranes, poor skin turgor, lethargy, and a serum potassium level of 3.0
C. Periorbital edema, crackles in lung bases, and bounding peripheral pulses
D. A metabolic alkalosis arterial blood gas profile with an elevated pH 7.48
B; remember, they are likely to be dehydrated, have low potassium and be in a metabolic acidosis state
remember drop the base!
A nurse is providing discharge instructions to a client with Graves' disease who has just received a therapeutic dose of Radioactive Iodine (${}^{131}\text{I}$). Which of the following instructions is most important for the nurse to include in the client's safety plan?
A. "You should wear lead-lined gloves whenever you prepare food for family members for the next 2 weeks."
B. "Maintain a distance of at least 6 feet from pregnant women and infants, and use a separate toilet and flush twice."
C. "Discontinue all of your prescribed antithyroid medications immediately after taking the radioactive iodine dose."
D. "Expect to experience permanent weight gain and severe heat intolerance starting within 48 hours of treatment."
B: remember these patients are radioactive, and can be harmful to those around them
A nurse administers insulin glargine (Lantus) subcutaneously to a client at bedtime (21:00). At what time should the nurse monitor most closely for a peak hypoglycemic reaction caused by this specific insulin?
A. Between 22:00 and 23:00 (1 to 2 hours after injection)
B. Between 01:00 and 05:00 (4 to 8 hours after injection)
C. Between 07:00 and 09:00 (10 to 12 hours after injection)
D. Peak monitoring is not necessary because insulin glargine has no distinct peak.
D; it's long acting so there is no peak
The nurse is providing nutritional counseling to a client with active thyrotoxicosis. Which dietary recommendation should the nurse include in the teaching plan?
A. Restrict total daily caloric intake to 1,500 calories.
B. Consume high-calorie, high-protein meals with frequent snacks.
C. Increase intake of highly caffeinated beverages to maintain alertness.
D. Eliminate all dietary protein and rely solely on simple carbohydrates
B; remember these people have an increased metabolism, and will eat a ton but still lose weight
A nurse is caring for an awake and alert client with Type 1 Diabetes whose bedtime blood glucose reading is 54 mg/dLThe client is asymptomatic. According to the "Rule of 15," which action should the nurse take first?
A. Administer 1 mg of Glucagon intramuscularly (IM).
B. Administer 15 g of simple, fast-acting carbohydrates orally (e.g., 4 oz of juice).
C. Administer 50 mL of 50% Dextrose (D50W) IV push over 2 minutes.
D. Provide a high-protein snack, such as peanut butter crackers, immediately.
B; they are awake and alert, so we want to do an oral intake
A client admitted to the Med-Surg unit develops frequent, foul-smelling watery diarrhea after completing a 10-day course of broad-spectrum antibiotics. Laboratory tests confirm Clostridium difficile infection. Which infection control measure is mandatory for the nurse to implement?
A. Place the client on Airborne Precautions in a negative-pressure airflow room.
B. Place the client on Contact Precautions and wash hands with soap and water after care.
C. Place the client on Droplet Precautions and wear a surgical mask upon entering the room.
D. Use alcohol-based hand sanitizer immediately upon exiting the room after glove removal.
B; remember soap and water for c diff!!
contact: gown and gloves!
(though I would wear a mask too, for the book tho it's just gown and gloves)
A nurse in the emergency department is reviewing triage charts for four clients. Which client should the nurse prioritize for immediate, emergent medical evaluation and intervention?
A. A client with Graves' disease who has fine, silky hair, warm skin, and a resting heart rate of 110 bpm.
B. A client with Cushing’s disease who exhibits truncal obesity, purple striae, and a blood glucose of 185
C. A client with Addison’s disease who abruptly stopped taking daily hydrocortisone 3 days ago and presents with confusion, severe hypotension 78/48 and vomiting.
D. A client with Type 2 Diabetes who has a blood glucose reading of 210 prior to lunch.
C; they are having severe complications currently
A nurse is caring for a client newly diagnosed with Graves' disease who is in her first trimester of pregnancy. The healthcare provider prescribes an antithyroid medication. Which medication should the nurse expect to administer?
A. levothyroxine
B. Propylthiouracil (PTU)
C. Radioactive Iodine
D. Lugol's solution (Strong Iodine Solution)
B; remember, we do not want to do radioactive iodine for pregnant patients
A nurse is providing discharge education to a client newly prescribed long-term daily oral prednisolone. Which statement by the client indicates a need for further nursing teaching?
A. "I should take my steroid dose every morning with food or milk to prevent stomach upset."
B. "I will watch for signs of infection like a sore throat or fever, and report them right away."
C. "If I start feeling stressed or catch a mild cold, I should stop taking my pills immediately until I feel better."
D. "I need to schedule regular bone density scans to monitor for potential osteoporosis."
C; REMEMBER, STEROIDS, THAT END IN -SONE, YOU CANNOT STOP ABRUPTLY!!
A nurse is reviewing the laboratory results of a client admitted to the emergency department with suspected Diabetic Ketoacidosis (DKA). Which of the following laboratory findings should the nurse expect to see? (Select all that apply.)
A. Serum blood glucose level of 420
B. Arterial blood gas pH of 7.48
C. Serum bicarbonate level of 14
D. Presence of moderate-to-large ketones in the urine
E. Serum potassium level of 2.2
A,C,D
A is correct: DKA is characterized by uncontrolled hyperglycemia, typically with blood glucose levels > 300
C is correct: The breakdown of fats into acidic ketone bodies consumes the body's buffer system, leading to metabolic acidosis characterized by a low serum bicarbonate level 18
D is correct: ketones are present due to acidosis
pH will be acidic, and potassium will be high
A nurse is providing discharge instruction to an older adult client who suffers from chronic constipation. Which of the following statements by the client indicates an understanding of dietary and lifestyle modifications?
A. "I will eliminate all dietary fiber from my meals to prevent my bowel from becoming blocked."
B. "I should drink at least 2 to 3 liters of fluids each day and include high-fiber foods like beans and whole grains."
C. "I will take a strong stimulant laxative every night before bed for the rest of my life to stay regular."
D. "I should avoid all physical activity and rest in bed so my bowels can relax."
B; Management of chronic constipation relies on increasing dietary fiber (which adds bulk and stimulates peristalsis) combined with adequate fluid intake (2–3 L/day)
** life long laxatives are contraindicated because you will gain dependence on them **
A client is admitted to the ICU with a diagnosis of Diabetic Ketoacidosis (DKA). Initial lab results show: Blood Glucose 540, pH 7.15, Serum Bicarbonate 12, and Serum Potassium 3.0. Which order must the nurse execute prior to initiating the continuous regular insulin infusion?
A. Administer 50 mmol of sodium bicarbonate IV push over 30 minutes.
B. Administer intravenous potassium chloride replacement until serum potassium is above 3.3
C. Administer an oral dose of potassium supplement.
D. Discontinue all intravenous fluid infusions.
B; the IV is going to work more rapidly than oral dose, and this patient has a critically low potassium
A Med-Surg nurse is reviewing the charts of four different clients on an endocrine unit. Which of the following client clinical presentations or nursing actions requires immediate intervention by the nurse?A. A client with Addison's disease who is scheduled for a minor dental procedure and has a physician's prescription to double their daily oral hydrocortisone dose today.
B. A client with iatrogenic Cushing's syndrome who states, "I'm feeling much better today, so I stopped taking my daily prednisone dose abruptly this morning."
C. A client with Cushing's disease who has a blood glucose reading of 190 and 2+ peripheral pitting edema in the lower extremities.
D. A client receiving intravenous hydrocortisone replacement for an Addisonian crisis who has a blood pressure reading of 118/76 and is alert and oriented.
B; NEVER ABRUPTLY STOP STEROIDS OR YOU CAN GO INTO ADDISONIAN CRISIS