Endocrine

A multidisciplinary team has been assembled to treat the patient who is hospitalized for a diabetic foot ulcer. Adherence to treatment, lifestyle, and dietary strategies has been an ongoing issue. The team includes an endocrinologist, primary care physician, a podiatrist, a registered nurse, and a dietitian. The addition of which provider to the multidisciplinary team will most positively impact outcomes for this patient?

The LPN/LVN informs the supervising RN, “I didn’t realize until after administering the medication, but I was supposed to give the patient a half tablet of levothyroxine; I gave him a whole tablet.” Which action does the nurse take first?

The gravida 3 para 2 pregnant woman is being screened for gestational diabetes. Which characteristics increase the woman's risk? Select all that apply.

The drowning victim is admitted to the intensive care unit (ICU) after being without oxygen for 10 minutes. When he was found, he did not have a pulse and was resuscitated at the site. Once return of spontaneous circulation (ROSC) occurred, he was transported to the hospital. He was found to be profoundly hypotensive and was fluid resuscitated in the ambulance. In the ICU, his Glasgow coma score is found to be 7. He is intubated and has a central line and a peripheral arterial catheter in place. Which constellation of symptoms concern the nurse the most?

The nurse is concerned the patient is experiencing hypocalcemia following the removal of the thyroid. In which location does the nurse assess for the Chvostek’s sign?

The patient with poorly controlled type II diabetes mellitus reports burning pain in the feet and legs that keep him up at night. The nurse passes this report along the provider and advocates for which medication for the patient?

The nurse anticipates which symptom in the patient newly diagnosed with Graves' disease?

The patient receiving sliding scale insulin requests the subcutaneous insulin to be injected into the abdomen. Immediately prior to administration, the nurse notes the site is stringy, slightly indurated, and has several fat masses. Which action by the nurse is appropriate?

The patient with diabetes insipidus has been prescribed vasopressin. The nurse instructs the student nurse about which characteristic of the medication?

The nurse is preparing to discharge the patient following surgical creation of an arteriovenous fistula. For which complication is this patient most at risk?

The nurse anticipates which laboratory results in the patient with end stage liver disease? Select all that apply.

The nurse is vigilant for Candida albicans infections in patients with which conditions? Select all that apply.

Which instruction does the nurse give to the patient who is prescribed short-acting insulin? 

The nurse assesses the patient for which signs of complications of a parathyroidectomy?

A patient tells the nurse in an outpatient endocrinology clinic that he is unhappy with his diabetes care and wants to see another physician. The nurse provides which advice?

Which statement describes the nurse's legal responsibility in administering regular insulin to the mentally competent adult patient? 

The nurse notes these heart sounds on auscultation of a 65-year-old man: The nurse reviews the patient’s medical record for history of which conditions associated with these heart sounds? Select all that apply.

During a well-child visit for the 4-month-old child, the nurse palpates hard nodules where each rib joins the sternum. The nurse reports this finding to the provider and requests which lab studies for this patient? Select all that apply.

The nurse is creating a presentation on rickets in the community. The nurse focuses on which group of individuals for this teaching?

The nurse is reviewing the chart of a patient recently admitted to the hospital. The patient’s medication review includes bosentan, glyburide, praziquantel, and ergotamine. The nurse expects to observe which symptom in the patient?

Which report from the ophthalmologist indicates the patient with type 2 diabetes mellitus is experiencing early signs of poor glycemic control?

The patient with type 2 diabetes mellitus complains of worsening vision. Retinal changes are noted on ophthalmoscopic examination. The nurse prepares the patient for which test for diagnostic confirmation?

The patient presents to the emergency department (ED) complaining of sudden onset loss of vision in the right eye. The patient denies recent trauma or other symptoms. The nurse anticipates which report from the ophthalmoscopic exam of the retina?

Which evening meal choice is appropriate for this patient? Look at the patient’s chart to make a selection.

The patient receiving tube feeding experiences confusion, diaphoresis, pallor, and tremors two hours after receiving a bolus tube feeding. The nurse requests an order for which test?

A mass casualty incident has occurred and the charge nurse must make beds available in the intensive care unit for incoming victims. Which patients can be safely downgraded to the floor? Select all that apply.

Following a major natural disaster, the charge nurse receives instruction from superiors to pair patients as roommates to increase the number of available rooms. The first patient to be paired is a 42-year-old patient with cellulitis who has a 103°C fever and tachycardia. The charge nurse places her in a room with which patient?

The nurse receives report of four issues at 0800. Which situation is addressed first?

The patient receiving which medication is most likely to also require a prescription for miconazole?

The 32-year-old female patient (60 kg) is brought via ambulance to the emergency department following a water drinking competition. The patient has a Glasgow Coma score of 6, oxygen saturation of 94% on room air, heart rate of 62 bpm, and respiratory rate of 16 breaths per minute. The nurse anticipates administering which medication?

The nurse more closely assesses patients with which conditions for signs of pernicious anemia? Select all that apply.  

In the postoperative period following a Whipple procedure, the nurse includes which interventions in the care plan? 

The nurse informs the patient beginning pharmacological therapy for prostate cancer to anticipate which additional changes? Select all that apply.

The nurse is helping to recruit patients for a study about the effectiveness of a new delivery system for somatropin. The nurse filters the records for patients with which conditions? Select all that apply.

The 21-year-old patient with a body mass index of 10.1 undergoes placement of a peripherally inserted central catheter (PICC) at 1000 and total parenteral nutrition (TPN) is initiated at 1200. At 1600, 160 mL have infused and the patient is noted to be breathing shallowly, there is blood oozing from the PICC insertion site, and the patient is exhibiting confusion. Which action does the nurse perform first? 

The patient with chronic alcoholism begins parenteral nutrition (PN) at a rate of 50 mL/h for treatment of severe malnutrition. Four hours after the infusion begins, the patient’s urine output increases from 40 mL/h to 200 mL/h. The nurse contacts the provider to request which order?  

The patient is receiving parenteral nutrition while NPO for a bowel obstruction. Review the patient’s lab results and decide which change to the parenteral nutrition the nurse clarifies with the provider.   Blood urea nitrogen = 34 mg/dL   Serum Creatinine = 2.1 mg/dL  Potassium = 6.1 mEq/dL  Sodium = 131 mEq/dL  Chloride = 100 mEq/dL  Bicarbonate = 18 mEq/dL

At the beginning of the shift, the nurse assesses the patient receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter and notes a crack in the tubing with TPN leaking. The nurse notifies the provider and anticipates receiving which order first? 

The patient receiving total parenteral nutrition (TPN) is found to have received 24 hours’ worth of TPN in 4 hours. Which intervention does the nurse perform first? 

Which interventions does the nurse include in care for the patient who underwent a total pelvic exenteration for a cancer diagnosis one day ago? Select all that apply.  

The patient presents to the emergency department with severe, unrelenting abdominal pain. Which findings prompt the nurse to suspect the patient will require a Whipple procedure? Select all that apply.  

The patient presents to the emergency department complaining of severe gastrointestinal distress after meals that has persisted for 36 hours. He reports that these symptoms have occurred off and on for a few years now, but he is seeking care now because they are interrupting his ability to sleep. Which additional assessment indicates the poorest prognosis for this patient?  

During a routine physical, the 58-year-old patient reports aching chest pain that occurs only when doing yardwork or heavy cleaning. However, it does not occur every time he is performing these chores. He denies regular exercise and reports a sedentary lifestyle. The nurse anticipates providing which instruction to the patient related to the patient's new prescription for this condition?   

The 15-year-old patient attempted suicide by ingesting an entire bottle of her father’s metoprolol. She is found unresponsive by emergency medical services and is intubated due to an inability to manage her own airway. Upon arrival to the emergency department, her blood pressure is 49/32 mmHg, heart rate is 24 bpm, and the pulse oximeter reads 82%. An 18-gauge peripheral IV is placed in the left antecubital vein and a 22-gauge IV is placed in the right antecubital vein. Which interventions are included in care? Select all that apply.  

The nurse is evaluating the patient’s response to therapy with 1-deamino-8-ᴅ-arginine vasopressin (DDAVP) for treatment of mild bleeding caused by hemophilia A. Which assessment indicates the patient is experiencing an adverse effect to therapy?  

The 3-week-old neonate of the mother who desires to formula feed is noted to have musty urine and excessive vomiting. Which initial intervention is most appropriate?  

The 18-day-old neonate has musty-smelling urine and vomits with almost every feeding. The patient, who was born after an uncomplicated pregnancy and delivery, had a normal newborn screening that was drawn in the hospital after birth. Which action by the nurse is most appropriate?   

The 13-year-old girl is brought to the clinic for treatment of vaginal candidiasis for the 2nd time in 6 months. Which question is most helpful by the nurse?  

The home health nurse is planning care for the 14-year-old with type 2 diabetes mellitus. Which intervention will best decrease the patient’s risk for long-term complications?  

The nurse is providing discharge teaching to the parents of the 3-year-old patient who was recently diagnosed with type 1 diabetes mellitus. Which item, if identified by the parents as the most important item to carry at all times, indicates effective teaching?