Endocrine and Gastrointestinal Disorders, Exams of Nursing

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PRN1178/ PRN 1178 Final Exam (New 2024/

2025 Update) Client-Centered Care II

Review| Questions and Verified Answers|

100% Correct| A Grade - Rasmussen

QUESTION

Addison's Disease (Adrenal Gland Hypofunction) Answer: •Adrenal insufficiency

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findings in Addison's Disease Answer: •hypotension, hyponatremia, hyperkalemia, hyperpigmentation

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Addisonian crisis Answer: life-threatening event, need for cortisol and aldosterone is greater than available supply; usually occurs in response to stressful event; severe hypotension

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Cushing's (Hypercortisolism) Answer: •Excess secretion of cortisol from adrenal cortex

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s/s of Cushing's Answer: •S/S: facial swelling, hypertension, large abdomen

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Laboratory tests for Cushing's Answer: blood, salivary, urine cortisol levels

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HYPERTHYROIDISM

Answer: •Thyrotoxicosis

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S/S of hyperthyroidism Answer: unexpected weight loss, rapid or irregular heartbeat, insomnia, nervousness, sweating, irritability

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hyperthyroidism Lab tests: Answer: : Thyroid panel, Thyroid scan, Ultrasonography, ECG

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hyperthyroidism Treatment: Answer: Nonsurgical or Surgical

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hypothyroidism s/s Answer: •Signs and symptoms are widespread and reflect overall decreased metabolism from low levels of thyroid hormones: course features, edema around face, eyes; blank expression, thick tongue, slow muscle movement

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hypothyroidism untreated can cause Answer: •Hypothyroidism that is untreated can lead to myxedema coma which can cause shock, organ damage, or death

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Treatment for hypothyroidism Answer: levothyroxine

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GOITER

Answer: •Abnormal enlargement of the thyroid gland

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goiter develops by Answer: •Commonly develops as a result of iodine deficiency

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Prevention of goiter Answer: sufficient intake of iodine found in foods grown near the ocean and seafood

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major source of iodine Answer: •Iodized salt is the major source for most people

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DIABETES MELLITUS

Answer: •Glucose regulation maintains blood glucose levels within a relatively normal range. Several organs play a role and insulin plays a pivotal role.

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type 1 diabetes

Answer: •Type I: does not produce adequate insulin because the immune system has destroyed the beta cells of the pancreas; patients are insulin dependent; weight loss due to absence of sufficient insulin and body fluid loss

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risk factors for type 1 diabetes Answer: •genetic, metabolic, microbiologic, immunologic

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Type II diabetes Answer: •non-insulin dependent, adult onset diabetes; insulin resistant

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S/S: of type II diabetes Answer: •S/S: polydipsia, polyphagia, polyuria, excessive weight gain, poor healing, itching, blurred vision, drowsiness, increased fatigue

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Gestational diabetes Answer: diagnosed during pregnancy

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Insulin glargine Answer: long acting

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Insulin aspart Answer: rapid acting

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HA1C: range Answer: 4%-6%

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Oral glucose tolerance test (OGTT): range Answer: <140mg/d

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Fasting plasma glucose (FPG): range Answer: 100mg/dL

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Diet and exercise for diabetes Answer: •Diet and exercise: Monitor food and fluid intake; achieve metabolic control before activity; monitor blood glucose before and after physical activity; food distribution must be adjusted to activities

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Diabetic Ketoacidosis (DKA): Answer: •Diabetic Ketoacidosis (DKA): absence of insulin and generation of ketoacids

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s/s of diabetic ketoacidosis Answer: •Fruity breath odor, altered mental status, Kussmaul respirations

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Hyperglycemia Answer: •Warm, dry skin; dehydration; Kussmaul respirations; changes in mental status; >160 blood glucose

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Hypoglycemia Answer:

•Cool, clammy, sweaty skin; anxious, nervous, irritable, mental confusion; weak, double vision, blurred vision, hunger, tachycardia, palpitation; <70 blood glucose; no ketones

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Insulin therapy Goal Answer: closely mimic basal insulin

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Crohn's Disease: Answer: •chronic inflammatory disease of small intestine, colon, or both. Can affect GI tract from the mouth to the anus

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where is Crohn's disease pain located Answer: •Localized lower abdominal pain usually in the left lower quadrant

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history of what in Crohn's disease Answer: •History of constipation

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Treatment of Crohn's Disease Answer: •Treatment includes stool softeners to prevent constipation; drug and nutritional therapy, increase fiber

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Colostomy Answer: connects part of the colon to an opening in the abdominal wall

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Patient education ostomy care Answer: psychosocial implications diet, eat yogurt to decrease stool odor, avoid popcorn, celery, and shrimp which can increase the risk of obstruction

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what to eat to decrease odor in colostomy Answer: eat yogurt to decrease stool odor

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what can increase the risk of obstruction in colostomy Answer: avoid popcorn, celery, and shrimp

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Ileostomy Answer: : a surgery that makes a temporary or permanent opening called a stoma

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Patient education on ileostomy Answer: emotional support, peristomal skin care, avoid high residue foods

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what is purplish stoma Answer: •purplish stoma is emergency because the stoma is not getting the blood it needs

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Diabetes Insipidus Answer: •Water metabolism problem caused by an ADH deficiency

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Diabetes Insipidus symptoms Answer: •Symptoms of dehydration, increase of urination and excessive thirst, hypotension, decrease in urine specific gravity; profuse diaphoresis

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Treatment of Diabetes Insipidus Answer: •Oral chlopropamide, Desmopressin acetate, early detection of dehydration and maintenance of adequate hydration, lifelong vasopressin therapy; monitor intake and output

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SIADH

Answer: •Vasopressin secretes even when plasma osmolarity is low or normal and feedback mechanisms do not function properly

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what is retained in SIADH Answer: •Water is retained which results in hyponatremia; monitor fluid balance

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findings in SIADH Answer: •Findings include recent head trauma, cerebrovascular disease, TB, Cancer, drug use

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PITUITARY GLAND

Answer:

Pea sized gland that plays a major role in regulating vital body functions and general well being

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what is the pituitary referred to as Answer: "master gland" because it controls the activity of most other hormone secreting glands

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pituitary gland hormones Answer:

• Adrenocorticotropic hormone
• Growth hormone
• Follicle stimulating hormone
• Prolactin
• Melanocyte stimulating hormone
• Thyroid stimulating hormone
• Luteinizing hormone

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major endocrine glands Answer: hypothalamus, pituitary, thyroid, parathyroid, adrenal, pineal

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endocrine sys function 1 Answer: release hormones into the bloodstream that help control mood, growth and development

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endocrine sys function 2 Answer: regulation of how much of each hormone is released

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endocrine sys function 3 Answer: Alter chemical reactions and control the rates at which chemical activities take place within cells (target cells)

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endocrine sys function 4 Answer: Change the permeability of cell membranes and select the substances that can be transported across cell membranes

QUESTION

After administering prescribed insulin to a client with diabetes mellitus. The nurse monitors for hyperglycemia. Which of the following are signs and symptoms of hypoglycemia? SELECT ALL THAT APPLY Answer: Anixety Tremors Tachycradia Hunger

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to receive IV vancomycin 1 g in 200 ml D5W at a rate of 10 mg/ min. At what rate will you set the IV infusion pump? Answer: 120 mL/hr

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The ED nurse is caring for a client with the right lower quadrant pain and muscle guarding. The clients temperature is 100.5 degrees, and they report nausea and vomiting. Which of the following does the nurse suspect? Answer: Appen- dicitis

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A client with type 1 diabetes mellitus is preparing for a moderate 30 minute exercise period. Which action best indicates that the client understands con- dition management? Answer: The client consumes a simple carbohydrate snack after 30 minutes of activity.

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A client is being evaluated by the healthcare provider for possible hyper- thyroidism. The nurse notes which of the following symptoms that support a diagnosis of hyperthyroidism? SELECT ALL THAT APPLY Answer: Nervousness Weightloss Insomnia

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When discussing exercise programs with a diabetic client, which instruc- tion is important for the nurse to include? SELECT ALL THAT APPLY Answer:

Delay exercise until glucose is controlled. Keep a quick source of glucose readily available. Begin slowly and build up to 30-45 minutes.

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A client comes to the ED complaining of abdominal pain. The nurse ob- serves dry hot skin, fruity breaths, and deep respiration. Which of the following does the nurse support? Answer: Ketoacidosis.

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A client has ordered 500mg IV every 6 hours of a medication. Which is available in 25 mg/ml. How many mL will be administered 24 hours? Answer: 80 mL

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The nurse is preparing to administer an enema. After positioning the client and putting on gloves. Which action should the nurse take next? Answer: Expel air from the tubing.

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A client with weakness and malaise is diagnosed with Addison disease. The nurse understands that Addison disease is due to which of the follow- ing? Answer: Adrenal insuffciency

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Which of the following hormones are secreted by the pituitary gland? SELECT ALL THAT APPLY Answer: Adrenocorticotroic hormone Thyroid stimulating hormone Growth hormone

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A client is prescribed cephalexin 250 mg by mouth every 6 hours for 10 days. The medication is available in 250 mg capsules. How many capsules will the client need for the 10 day course of therapy? Answer: 60 capsules

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The nurse administering insulin glargine to a client knows that the duration of this insulin is how long? Answer: 24 hours

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The nurse working at gastroenterology practice knows that colonoscopies may be indicated for the following reasons. SELECT ALL THAT APPLY Answer: Rule out inflammatory bowel disease. Screen for colon cancer. Remove pre cancerous colon polyps.

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The nurse is caring for a client with IBS which teaching points should the nurse reinforce?

Answer: Keep a diary to identify foods that cause symptoms

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The nurse is reinforcing teaching to a client with a colostomy. Which food should the nurse recommend to help decrease stool Oder? Answer: Yogurt

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The provider has order a 100 mg/ a day IM divided into two doses. The medication is available in 50 mg/mL. How many mL will you administer per dose? Answer: 1 mL

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The nurse is caring for a hospitalized client who is ordered sodium to prevent constipation. When reinforcing teaching about the medication. Which instruction should the nurse include? Answer: Take with a full glass of water

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The nurse is caring for a client with diabetes insipidus. Which of the follow- ing manifestations does the nurse anticipate the client will have? Answer: Profound diuresis

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The nurse is reviewing the medical hx of a client prescribed metformin. The nurse would question the order for metformin if the clients hx contained which of the following? Answer: Renal failure.

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The nurse is caring for a client with type 1 diabetes who is diaphoretic and clammy. The client complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next? Answer: Give 6 oz of OJ

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A client with chronic constipation asks about high fiber dietary selections. Which menu selection should the nurse recommend? Answer: Turkey sand which on whole wheat toast, pears and tea

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The nurse is reinforcing teaching to a client with a colostomy. Which of the following foods will increase the risk of obstruction? Answer: Shrimp Popcorn Celery

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The nurse is caring for a client admitted into med-surgical unit for intestinal obstruction. The client complains of 10/100pain despite administration of pain medication. Which action should the nurse take?

Answer: Notify MD immediately

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Which of the following statement explain a reason for weight and type 1 diabetes? SELECT ALL THAT APPLY Answer: Absence of sufficient insulin Stressful lifestyle Loss of body fluid

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The nurse is reinforcing teaching to a client with diverticulitis. Which state- ment by the client indicates that teaching was successful? Answer: "If left untreated, the inflamed bowel can perforate and cause peritonitis.

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The nurse caring for a client with hypothyroidism anticipates. Which med- ication to be prescribed? Answer: Levothyroxine

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The nurse is caring for a client with syndrome of inappropriate anti diuretic hormone. (SIADH) Which of the following is a priority for the nurse to moni- tor? Answer: Fluid balance

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Cells that are affected by endocrine hormones are called which of the following? Answer: Target cells

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The nurse is reinforcing teaching about peristomal skin care. Which infor- mation should the nurse include? Answer: Apply a skin barrier to the peristomal area.

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The following nurses receives a report on the following clients. Which client should the nurse see first? Answer: A client with a gastric ulcer who complains of severe abdominal pain and distention.

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What is the correct term for enlarged thyroid gland? Answer: Goiter

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Which of the following is term for diabetes that develops during pregnan- cy? Answer: Gestational disbetes

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Which nurse is explaining the underlying pathophysiology of type 1 dia- betes to a newly diagnosed client. Which information accurately explains why the type 1 diabetic does not produce adequate insulin? Answer: The immune system destroys beta cells of the pancreas.

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The nurse is caring for the client who is immediately postoperative with a new ileostomy. What intervention is most important for the nurse to implement at this time? Answer: Provide emotional support.

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A 36 year old client who had an ascending colostomy angrily stated. "I don't want this thing on my body. This bag I have now is not me" Which response is most appropriate for the nurse to make? Answer: What about this colostomy concerns you the most?

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The nurse is providing pre operative care to a client who will undergo osto- my creation. Which of the following is most regarding ostomies? Answer: A colostomy connects part of the colon to an opening in the abdominal wall.

QUESTION

Type 1 and type 2 diabetes differ in that type 1 diabetes is associated with which of the following? Answer: Insulin dependence

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A nurse is caring for a client one day postoperative after a transverse colostomy. When observing the stoma. Which finding requires the nurses immediate action? Answer: A purplish colored stoma.

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The nurse is caring for a client who is recovering from a flare up of crowns disease. Which of the following should the nurse reinforce? Answer: Increase fiber intake as tolerated.

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The nurse is helping discharge a client diagnosed with diverticulitis. Which instruction should the nurse reinforce? Answer: Eat a high fiber diet

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Which of the following gastrointestinal disorders is characterized by hyper- sensitivy of the bowel wall? Answer: IBS Irritable bowel syndrome

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Excessive secretion of growth hormones or gigantism. Symptoms? Answer:

Enlarge feet

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Which type of insulin is considered rapid acting? Answer: insulin aspart

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A client on prolonged steroid therapy presents to the clinic with facial swelling. Enlarged abdomen and hypertension. Which condition does the nurse suspect? Answer: Cushing syndrome

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Which of the following is the most appropriate nursing intervention for a client diagnosed with diabetes insipidus? Answer: Monitor intake and output

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The nurse notes that the HBA1c level of an assigned client demonstrated a drop from 9.4% to 5.4%. What do those findings indicate? Answer: The clients blood glucose control has improved over the past few months

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Intestinal Obstruction

Answer: •Intestinal contents accumulate at and above the area of obstruction » abdominal distention » intestines unable to absorb contents and move waste » increased peristalsis, increased secretions » additional distention (increasing pain = emergency)

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Nonmechanical Obstruction (paralytic ileus or functional obstruction) Answer: •Does not involve a physical obstruction •Slowing of movement or backup of intestinal contents •Peristalsis decreased or absent, hypoactive or absent bowel sounds

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Mechanical Obstruction Answer: •Bowel physically blocked by problems outside the intestine (adhesions); in the bowel wall (Crohn's); in the intestinal lumen (tumors)

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Irritable Bowel Syndrome Answer: •Functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating (spastic colon, mucous colon, nervous colon); hypersensitivity of bowel wall

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History of Irritable bowel syndrome Answer: •History includes fatigue, malaise, abdominal pain, changes in bowel pattern, GI infections, medications, history of food intolerance

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educate patient on IBS Answer: •Educate patient on keeping a food diary, reducing stress, modifying diet, and adhering to medications

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Appendicitis Answer: acute inflammation of the vermiform appendix that occurs most often among young adults

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appendicitis symptoms Answer: •Abdominal pain followed by nausea and vomiting; Cramping pain in the epigastric or periumbilical area; Anorexia; Right lower quadrant pain between anterior iliac crest and umbilicus (McBurney's point); Muscle rigidity, guarding on palpation of the abdomen

QUESTION

treatment of appendicitis Answer: Treatment includes: administration of IV fluids to maintain fluid and electrolyte balance, maintain patient in semi-fowler's position, administer opioid analgesic and antibiotics to patients having emergency surgery; do not administer laxatives or enemas which could cause perforation of the appendix