Endocrine Problems (Exam Mode) By Rnpedia.Com

Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with hyperthyroidism?  

• Increased and rapid heart rate

• Decrease systolic blood pressure

• Increased respiratory rate

• Decreased oral temperature

For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing assistant?  

• Instruct the patient to report palpitations, dyspnea, vertigo, pr chest pain.

• Check the apical pulse, blood pressure, and temperature every 4 hours.

• Draw blood for thyroid-stimulating hormone, T3, and T4 levels.

• Explain the side effects of propylthiouracil (PTU) to the patient.

 As the shift begins, you are assigned these patients. Which patient should you assess first?  

• A 38-year-old patient with Graves’ disease and a heart rate of 94/minute

• A 63-year-old patient with type 2 diabetes and fingerstick glucose of 137 mg/dL

• A 58-year-old patient with hypothyroidism and heart rate of 48/minute

• A 49-year-old patient with Cushing’s disease and +1 dependent edema

A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to the nursing assistant?  

• Remind patient to change positions slowly.

• Check the patient for muscle weakness

• Teach the patient how to collect 24-hour urine

• Plan nursing interventions to promote fluid balance

You assess a patient with Cushing’s disease. For which finding will you notify the physician immediately?  

• Purple striae present on abdomen and thighs

• Weight gain of 1 pound since the previous day

• +1 dependent edema in ankles and calves

• Crackles bilaterally in lower lobes of lungs

The patient with pheochromocytoma had surgery to remove his adrenal glands. Which nursing intervention should you delegate to the nursing assistant?  

• Add strategies to provide a calm and restful environment post-operatively to the care plan.

• Warm the patient to avoid smoking and drinking caffeinated beverages

• Monitor the patient’s skin and mucous membranes for signs of adequate hydration.

• Monitor lying and standing blood pressure every 4 hours with cuff placed on same arm

8. For the patient with pheochromocytoma, what physical assessment technique should you instruct the LPN/LVN to avoid?  ________________________________________________________ 

 The patient with adrenal insufficiency is to be discharged taking prednisone 10 mg orally each day. What will you be sure to teach the patient?  

• Report excessive weigh gain or swelling to the physician

• Rapid changes of position may cause hypotension.

• A diet with foods high in potassium may be beneficial.

• Signs of hypoglycemia may occur while taking this drug.

You are caring for a patient who is post-hypophysectomy for hyperpituitarism. Which post-operative finding requires immediate intervention?  

• Presence of glucose in nasal drainage

• Nasal packing present in nares

• Urine output of 40 – 50 mL per hour

• Patient complaints of thirst

Which patient’s nursing care would be most appropriate for the charge nurse to assign to the LPN, under the supervision of the RN team leader?  

• A 51-year-old patient with bilateral adrenalectomy just returned from the post-anesthesia care unit

• An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary disease

• A 38-year-old patient with myocardial infarction who is preparing for discharge

• A 72-year-old patient admitted from long-term care with mental status changes

You are providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring?  

• Calcium

• Sodium

• Potassium

• White blood cells

You are preparing to review a teaching plan for a patient with type 2 diabetes. What will you check to determine the patient’s level of compliance with his diabetic regimen?  

• Patient’s fasting glucose level

• Patient’s oral glucose tolerance test results

• Patient’s glycosylated hemoglobin assay

• Patient’s fingerstick glucose check for 24 hours

The patient has newly diagnosed type 2 diabetes. Which task should you delegate to the nursing assistant?  

• Arrange consult with the dietician for patient.

• Verify patient’s insulin injection technique.

• Teach patient to use glucometer for monitoring glucose at home.

• Remind patient to check glucose level prior to each meal.

A nursing diagnosis for the newly diagnosed diabetic patient is risk for Injury related to sensory alterations. Which key points should you include in the teaching plan for this patient? (Choose all that apply).  

• Clean and inspect your feet every day.

• Be sure that your shoes fit properly.

• Nylon socks are best to prevent friction between toes and shoes.

• Report any non-healing skin breaks to your doctor.

The diabetic patient has all of these assessment bindings. Which will you instruct the LPN/LVN to report immediately?  

• Fingerstick glucose of 185 mg/dL

• Numbness and tingling in both feet

• Profuse perspiration

• Bunion on left great toe

The plan of care for the diabetic patient includes all of the following interventions. Which intervention could you delegate to the nursing assistant?  

• Check to make sure that the patient’s bath water is not too hot.

• Discuss community resources for diabetic outpatient care.

• Instruct the patient to perform daily foot inspections.

• Check the patient’s technique for drawing insulin into a syringe.

You are precepting a nurse who has recently graduated and passes the NCLEX examination. The new nurse has been on the unit for only 2 days. Which patient should you assign to the new nurse?  

• A 68-year-old diabetic who is experiencing signs of hyperglycemia including rapid, deep breathing and mental status changes

• A 58-year-old diabetic with peripheral neuropathy and cellulitis of the left ankle.

• A 49-year-old diabetic who has just returned from post-anesthesia care unit (PACU) after a below-the-knee amputation (BKA)

• A 72-year-old diabetic with diabetic ketoacidosis (DKA) on an IV insulin drip

In the emergency department, during initial assessment of a new admission with diabetes, you discover all of the following. Which information should you immediately report to the physician?  

• Hammertoe of the left second metatarsophalangeal joint

• Rapid respiratory rate with deep inspirations

• Numbness and tingling bilaterally in the feet and hands

• Decreased sensitivity and swelling of the abdomen

You are caring for a diabetic patient who is developing DKA. Which delegated task is most appropriate?   

• Ask the unit clerk to page the physician to come to the unit.

• Ask the LPN/LVN to administer IV insulin according to the sliding scale.

• Ask the nursing assistant to check the patient’s level of consciousness.

• Ask the nursing assistant to get the patient a cup of orange juice.

A diabetic patient presents with hot and dry skin, rapid and deep respirations, and a fruity odor to his breath. As charge nurse, you observe the new graduate RN accomplishing all these patient tasks. Which one requires that you intervene immediately?  

• The RN encourages the patient to drink orange juice.

• The RN checks the patient’s order for sliding scale insulin.

• The RN assess the patient’s vital signs every 15 minutes

• The RN checks the patient’s fingerstick glucose.

You are preparing a 24-year-old patient with diabetes insipidus (DI) for discharge from the hospital. Which statement indicates that the patient needs additional teaching? 

• “I will drink fluids equal to the amount of my urine output.”

• “I will weigh myself every day using the same scale.”

• “I will wear my medical alert bracelet at all times.”

• “I will gradually wean myself off the vasopressin.”