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endocrine disorder

SITUATION I

A physician prescribes  Levothyroxine (Synthroid), 25 mcg P.O. daily for a female patient with hypothyroidism.see answer

 

Question 1:

The patient should take this medication at what time of the day and why?

1. _____________________________________________________________________________________________________________________________.

 

Question 2:

For how long will the patient be taking her Levothyroxine (Synthroid)?

1. _____________________________________________________________________________________________________________________________.

 

Question 3:

In the administration of a drug such as Levothyroxine, you would like to teach the patient to report what?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

Question 4:

The patient states, "I'm worried about taking this medication because it can cause osteoporosis". What will be your response to alleviate her fear? Identify two.

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

SITUATION II

A patient is taking Beta Blockers for hyperthyroidism and would like to know why Beta Blockers are used in hyperthyroid patients.see answer

 

Question 1:

What is your best response?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION III

Included in the care for the patient who will have a subtotal thyroidectomy is the administration of prophylthiouracil (Propyl-Tyracil) and strong iodine solution (Lugol's solution).see answer

 

Question 1:

What does this medication do for hyperthyroid patients after taking this in 1-2 weeks?

1. _____________________________________________________________________________________________________________________________.

 

Question 2:

How will you give the Lugol's solution properly apart from giving it with juice and why?

1. _____________________________________________________________________________________________________________________________.

 

Question 3:

You should advise the patient to notify the physician if what problem occurs regarding her medication?

1. _____________________________________________________________________________________________________________________________.

 

Question 4:

What laboratory data should you evaluate for this patient?

1. _____________________________________________________________________________________________________________________________.

 

Today the patient has had a subtotal thyroidectomy.

 

Question 5:

After a thyroidectomy, how should bleeding be checked for? What position should the patient be placed in?

1. _____________________________________________________________________________________________________________________________.

 

Question 6:

Why is it important to assess the patient's voice post thyroidectomy?

1. _____________________________________________________________________________________________________________________________.

 

During evening rounds, you assess the patient who now has nausea, a temperature of 40.5˚C, tachycardia, and extreme restlessness.

 

Question 7:

What is most likely the cause of these symptoms and what are your interventions apart from notifying the doctor?

1. _____________________________________________________________________________________________________________________________.

 

Interventions:

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

SITUATION IV

You're the nurse caring for a patient following thyroidectomy and is monitoring for complications. Your patient assessments are; Surgical pain in the neck area, mild hoarseness and weakness of voice, numbness and tingling around the mouth, and Temperature of 37.6°C. see answer

Medical orders:

Synthroid 50mcg

Panadol 1000mg PRN for pain

Calcium gluconate 650mg PRN

Tylenol 650 mg for fever PRN

 

Question 1:

Which of the following assessment you have noted in the patient that needs you to notify the physician and why?

1. _____________________________________________________________________________________________________________________________.

 

Question 2:

What is your initial intervention?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION V

A nurse is instructing a patient with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder.

 see answer

Question 1:

The nurse should state that the physician probably will order daily supplements of calcium and what?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION VI

A hospitalized patient with type 1 diabetes mellitus received NPH and regular insulin 2 hours ago. The patient calls you and reports that he is feeling hungry, shaky and weak.see answer

 

Question 1:

What is your initial intervention?

1. _____________________________________________________________________________________________________________________________.

 

Question 2:

What could be the possible cause of the patient's symptoms (hypoglycemia)?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION VII

Patient B told you that he has been working hard for the past three months to control her diabetes with diet and exercise.

see answer

Question 1:

To determine the effectiveness of the patient's effort, what test should be done and why?

1. _____________________________________________________________________________________________________________________________.

 

The patient is receiving 12 units of NPH and 6 units of Humalog insulin each morning and you would like to reinforce her knowledge on how to properly mix his insulin.

 

Question 2:      

Place the following actions in a chronological order of how you would demonstrate how to mix insulin. Put a number for your answers.

___Withdraw 12 units of NPH insulin

___Inject 12 units of air into the  NPH vial

___Withdraw 6 units of Humalog insulin

___Inject 6 units of air into the Humalog vial

___Wipe off the vials with an alcohol swab

 

SITUATION VIII

After a three month of dietary therapy and exercise, Mr. C with type 2 diabetes still has a glucose level above 180 mg/dL. Apart from his insulin, the physician adds glyburide (Diabeta) 2.5 mg P.O once a day to the treatment regimen.see answer

 

Question 1:

You would instruct Mr. C that it is best to take his glyburide at what time?

1. _____________________________________________________________________________________________________________________________.

 

Mr. C told you that he loves to play badminton to keep his blood sugar well-controlled.

 

Question 2:

What are your teachings to him on how to prevent hypoglycemia whenever he does his activity? Identify two (2).

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

SITUATION IX

A 56-year-old man with type 2 diabetes who had been fasting during Ramadan was admitted yesterday to the emergency department due to hypoglycemia. Today's vital signs: BP: 110/80 mmHg, R: 19/min P: 82/min, O2 sat.: 92% R/A, T: 36.7˚C, CBG: 2.8 mmol/L.see answer

 

Question 1:

What is your intervention according to the patient's condition?

1. _____________________________________________________________________________________________________________________________.

 

Fifteen minutes later, you retake his blood glucose level. CBG: 4.2 mmol/L

 

Question 2:

What is your next intervention?

1. _____________________________________________________________________________________________________________________________.

 

Upon his discharge, you discussed with the patient that it is highly advisable not to fast because of his condition.

 

Question 3:

Give three (3) other discharge teachings to the patient on how to control his diabetes?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

SITUATION X

A patient with hyperthyroidism is about to receive radioactive iodine as an outpatient.see answer

 

Question 1:

What safety measures should the nurse teach the client to protect his family while he undergoes treatment? 

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

SITUATION XI

Mr. D is a 55-year-old retired white American went to the clinic for his regular check-up today. He is overweight with a waist/hip ratio >1, fasting blood glucose of 5.1 mmol/L, have a consistent HDL level above 40 mg/dl (40-59 mg/dl), maintaining a sedentary lifestyle, and a blood pressure of 140/90 mmHg. His physician advises him that he might develop metabolic syndrome, which is a group of conditions that put people at higher risk of developing type II diabetes and heart diseases.see answer  

 

Question 1:

Identify three (3) reasons the patient has that are leading to his diagnosis of metabolic syndrome?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

Question 2:

Identify two (2) ways  the patient can do to prevent complications in the future due to his current condition.

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

SITUATION XII

A patient newly diagnosed with Type I DM is being seen by the home health nurse. The doctor's orders include; 1200 calorie ADA (American Diabetes Association) diet, 15 units NPH insulin before breakfast, and check blood sugar QID.see answer

 

Question 1:

When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 2.2 mmol/L. The nurse would expect the patient to be:

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

After intervening, the nurse is having difficulty obtaining a capillary blood sample from a client's finger to measure blood glucose using a blood glucose monitor. 

 

Question 2:

What procedure will help increase the blood flow to the area to ensure an adequate specimen?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

SITUATION XIII

A nurse cares for a client following a liver biopsy.see answer

 

Question 1:

What interventions or instructions you will do to the patient?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

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