Medical-Surgical: Endocrine Disorders Flashcards

A patient is admitted with diabetic ketoacidosis (DKA). Which combination of lab findings confirms this diagnosis?

Answer: Blood glucose 380 mg/dL, pH 7.24, serum ketones positive, anion gap 18

DKA is defined by the triad: hyperglycemia (typically >250 mg/dL), metabolic acidosis (pH <7.35, bicarbonate <18 mEq/L), and positive serum ketones with elevated anion gap.

A patient with hypothyroidism is started on levothyroxine (Synthroid). Which instruction should the nurse include?

Answer: Take the medication 30–60 minutes before breakfast on an empty stomach for best absorption

Levothyroxine absorption is maximized on an empty stomach, 30–60 minutes before breakfast. Food, calcium, iron, and antacids significantly reduce absorption.

A patient is admitted in an Addisonian crisis. Which nursing intervention is the highest priority?

Answer: Administer IV hydrocortisone and IV normal saline immediately

Addisonian crisis (acute adrenal insufficiency) is life-threatening, with profound hypotension, hyponatremia, and hyperkalemia. Immediate IV hydrocortisone and aggressive IV fluid resuscitation are the priority.

A nurse is teaching a patient with type 2 diabetes about metformin. Which laboratory value requires immediate provider notification before administering metformin?

Answer: eGFR of 25 mL/min/1.73m²

Metformin is contraindicated with eGFR <30 mL/min/1.73m² due to risk of lactic acidosis from accumulation. An eGFR of 25 is below this threshold — metformin should be withheld and the provider notified.

A patient is admitted with a serum calcium level of 13.2 mg/dL (normal 8.5–10.5 mg/dL). Which set of symptoms would the nurse expect?

Answer: Bone pain, constipation, polyuria, confusion, and muscle weakness

Hypercalcemia causes 'bones, stones, groans, and moans': bone pain, kidney stones, constipation, nausea, polyuria, confusion, muscle weakness. Tetany and positive Chvostek's are signs of hypocalcemia.

A patient undergoes a total thyroidectomy. Postoperatively, which assessment is the priority?

Answer: Monitoring for hypocalcemia symptoms: perioral tingling, muscle cramps, positive Chvostek's sign

Total thyroidectomy can damage the parathyroid glands (located on the posterior thyroid), causing hypoparathyroidism and hypocalcemia. Perioral tingling, muscle cramps, tetany, and positive Chvostek's/Trousseau's signs are early indicators.

A patient with Cushing's syndrome is being assessed. Which cluster of findings is most consistent with this diagnosis?

Answer: Central obesity, moon face, buffalo hump, purple striae, and hyperglycemia

Cushing's syndrome results from excess cortisol causing central obesity, moon face, buffalo hump (cervical fat pad), purple striae (thin skin), hyperglycemia, hypertension, and osteoporosis.

A patient with type 1 diabetes has a blood glucose of 52 mg/dL and is conscious and able to swallow. What is the priority intervention?

Answer: Give 15 g of fast-acting carbohydrate orally and recheck glucose in 15 minutes (Rule of 15)

The 'Rule of 15' for conscious hypoglycemia: give 15 g of fast-acting carbohydrate (4 oz juice, glucose tabs), wait 15 minutes, recheck glucose. Repeat if still <70 mg/dL. Glucagon and IV dextrose are for unconscious patients.

A patient with SIADH (syndrome of inappropriate antidiuretic hormone) has a serum sodium of 118 mEq/L. Which intervention should the nurse anticipate?

Answer: Fluid restriction, monitoring neurological status, and possibly hypertonic saline (3% NaCl)

SIADH causes dilutional hyponatremia. With severe hyponatremia (Na < 120 mEq/L), neurological symptoms (confusion, seizures, coma) can occur. Treatment is fluid restriction and potentially hypertonic saline for severe/symptomatic cases.

A patient presents with pheochromocytoma. Which vital sign finding is most characteristic?

Answer: Severe paroxysmal hypertension (BP >200/120) with headache, diaphoresis, and palpitations

Pheochromocytoma is an adrenal medullary tumor secreting excess catecholamines. Classic triad: episodic severe hypertension, headache, and diaphoresis with palpitations. Paroxysmal episodes are triggered by tumor release of epinephrine/norepinephrine.

A patient with diabetes insipidus (DI) is being evaluated. Which laboratory findings would the nurse expect?

Answer: High serum sodium (hypernatremia), low urine specific gravity (<1.005), and polyuria

DI results from ADH deficiency (central) or kidney resistance to ADH (nephrogenic), causing inability to concentrate urine. This leads to massive dilute urine output, dehydration, and hypernatremia.

A nurse is monitoring a patient after subtotal parathyroidectomy for hyperparathyroidism. The patient reports tingling around the lips and in the hands 12 hours postoperatively. What is the priority action?

Answer: Assess for positive Chvostek's and Trousseau's signs and notify the provider for possible hypocalcemia

Perioral and extremity tingling are classic early signs of hypocalcemia ('hungry bone syndrome') following parathyroidectomy. Chvostek's and Trousseau's signs confirm tetany risk; IV calcium is the urgent treatment.

A patient with hyperthyroidism develops fever of 104°F, extreme agitation, tachycardia (HR 160), and hypertension after thyroid surgery. What condition does this represent?

Answer: Thyroid storm (thyrotoxic crisis)

Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized by extreme hyperthermia, tachycardia, hypertension, and altered mental status, triggered by surgical stress, infection, or non-compliance.

Which patient finding would suggest secondary rather than primary hypothyroidism?

Answer: Low TSH and low T4

Primary hypothyroidism (thyroid gland failure) causes low T4 with compensatory high TSH. Secondary hypothyroidism (pituitary failure) causes both low TSH and low T4 because the pituitary cannot produce TSH.

A nurse is administering insulin to a patient with type 1 diabetes. The prescription reads: 'Regular insulin 10 units IV push.' The insulin is available as 100 units/mL. How many milliliters should the nurse draw?

Answer: 0.1 mL

Dose = 10 units. Available: 100 units/mL. Volume = 10 units ÷ 100 units/mL = 0.1 mL. Use a tuberculin syringe for accuracy with such small volumes.

A patient is diagnosed with primary hyperaldosteronism (Conn's syndrome). Which electrolyte abnormality is most expected?

Answer: Hypokalemia and hypernatremia

Excess aldosterone causes sodium retention and potassium excretion by the kidneys, resulting in hypokalemia (low K+) and hypernatremia (or high normal Na+), along with hypertension and metabolic alkalosis.

A patient with type 2 diabetes asks about the purpose of their newly prescribed GLP-1 receptor agonist (semaglutide/Ozempic). The nurse correctly explains that this medication:

Answer: Stimulates glucose-dependent insulin release, suppresses glucagon, slows gastric emptying, and reduces appetite

GLP-1 receptor agonists mimic incretin hormones: they stimulate insulin release only when glucose is elevated, suppress glucagon, delay gastric emptying (reducing postprandial glucose), and reduce appetite — leading to weight loss.

A patient with myxedema coma is admitted to the ICU. Which interventions are the nursing priorities?

Answer: Administer IV thyroid hormone, maintain airway, rewarm slowly, and monitor hemodynamic status

Myxedema coma is severe hypothyroidism causing coma, hypothermia, bradycardia, and respiratory failure. Treatment includes IV levothyroxine, airway management, slow passive rewarming, and IV hydrocortisone (in case of concomitant adrenal insufficiency).

A patient with diabetes mellitus has a foot wound that is not healing. The nurse notes peripheral neuropathy and reduced pedal pulses. Which nursing intervention is most important?

Answer: Maintain strict glycemic control, inspect feet daily, provide wound care, and consult vascular surgery

Diabetic foot wounds require glycemic optimization (promotes healing), daily foot inspection, evidence-based wound care, and vascular surgery consultation to assess perfusion. Heating pads risk burns in neuropathic feet.