MSNCB Endocrine Nursing 5 — Questions and Answers
Question 1: A patient taking glucocorticoids long-term should be monitored for which common adverse effect related to glucose metabolism?
- Hypoglycemia due to increased insulin sensitivity
- Steroid-induced hyperglycemia or diabetes (Correct answer)
- Hypoglycemia due to suppressed glucagon secretion
- Improved glycemic control in existing diabetics
Correct answer: Steroid-induced hyperglycemia or diabetes
Glucocorticoids antagonize insulin action and stimulate hepatic gluconeogenesis, causing hyperglycemia and potentially steroid-induced diabetes.
Question 2: Which symptom cluster in a post-thyroidectomy patient should prompt the nurse to assess for laryngeal nerve damage?
- Perioral tingling and carpopedal spasm
- Hoarse voice, difficulty speaking, and stridor (Correct answer)
- Tachycardia, fever, and extreme agitation
- Neck swelling, pain, and difficulty swallowing
Correct answer: Hoarse voice, difficulty speaking, and stridor
Hoarseness, weak voice, and stridor after thyroidectomy suggest recurrent laryngeal nerve injury, which can compromise the airway.
Question 3: A patient with type 2 diabetes reports frequent hypoglycemic episodes before dinner. The nurse should recommend discussing which medication adjustment with the provider?
- Increasing the morning NPH insulin dose
- Adding a rapid-acting insulin before lunch
- Reducing the lunchtime rapid-acting insulin dose (Correct answer)
- Switching to a twice-daily glargine regimen
Correct answer: Reducing the lunchtime rapid-acting insulin dose
Pre-dinner hypoglycemia often indicates excessive lunchtime rapid-acting insulin; reducing that dose addresses the timing and prevents the pattern.
Question 4: Which nursing action is MOST appropriate for a patient with myxedema coma?
- Administer cooling blankets and acetaminophen for fever
- Provide IV thyroid hormone, keep warm, and monitor for respiratory failure (Correct answer)
- Restrict IV fluids to prevent cerebral edema
- Administer high-dose propranolol to control heart rate
Correct answer: Provide IV thyroid hormone, keep warm, and monitor for respiratory failure
Myxedema coma requires IV thyroid hormone replacement, external rewarming, airway support, and close monitoring for respiratory failure due to decreased respiratory drive.
Question 5: When teaching foot care to a patient with diabetes and peripheral neuropathy, which instruction is MOST important?
- Soak feet in hot water nightly to improve circulation
- Inspect feet daily and report any sores or changes immediately (Correct answer)
- Walk barefoot indoors to toughen skin and improve sensation
- Trim corns and calluses at home to reduce pressure points
Correct answer: Inspect feet daily and report any sores or changes immediately
Daily foot inspection is essential because neuropathy masks pain, allowing ulcers to progress undetected; early reporting prevents amputation.
Question 6: A patient with acromegaly would MOST likely present with which assessment findings?
- Short stature, delayed puberty, and small hands
- Coarsened facial features, enlarged hands and feet, and prognathism (Correct answer)
- Central obesity, moon face, and proximal muscle weakness
- Exophthalmos, heat intolerance, and weight loss
Correct answer: Coarsened facial features, enlarged hands and feet, and prognathism
Acromegaly results from excess GH in adults, causing coarsening of facial features, prognathism (jaw protrusion), and enlargement of hands and feet.
Question 7: A patient on long-term lithium therapy is at highest risk for which endocrine disorder?
- Adrenal insufficiency
- Hyperparathyroidism and hypothyroidism (Correct answer)
- Cushing's syndrome
- Pheochromocytoma
Correct answer: Hyperparathyroidism and hypothyroidism
Lithium commonly causes hypothyroidism by blocking thyroid hormone synthesis and release; it also raises PTH levels, leading to hypercalcemia and hyperparathyroidism.
MSNCB Endocrine Nursing 5
A patient taking glucocorticoids long-term should be monitored for which common adverse effect related to glucose metabolism?