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.
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.
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. _____________________________________________________________________________________________________________________________.