NCLEX-RN - Medical-Surgical Nursing: Endocrine & Metabolic Disorders Flashcards

Question 1

Diagnostic Criteria & Lab Thresholds for Diabetes Mellitus

Accepted Answer

Diagnosis requires meeting any of the following parameters:
- Fasting Plasma Glucose: $\ge 126	ext{ mg/dL}$ (after 8-hour fast)
- 2-Hour Oral Glucose Tolerance Test (OGTT): $\ge 200	ext{ mg/dL}$
- Glycated Hemoglobin (HbA1c): $\ge 6.5\%$
- Random Plasma Glucose: $\ge 200	ext{ mg/dL}$ with classic hypersecretion symptoms (polyuria, polydipsia, unexplained weight loss)

Question 2

Clinical Distinctions: DKA vs. Hyperosmolar Hyperglycemic State (HHS)

Accepted Answer

**Diabetic Ketoacidosis (DKA)**: - Target Population: Primarily Type 1 DM (Rapid onset) - Blood Glucose: $> 250 ext{ mg/dL}$ - Arterial pH & Bicarbonate: $ ext{pH} < 7.30$, $ ext{HCO}_3^- < 18 ext{ mEq/L}$ - Ketones: Positive in urine and serum; Kussmaul respirations and fruity acetone breath present. **Hyperosmolar Hyperglycemic State (HHS)**: - Target Population: Primarily Type 2 DM (Gradual onset) - Blood Glucose: $> 600 ext{ mg/dL}$ - Arterial pH & Bicarbonate: $ ext{pH} > 7.30$, $ ext{HCO}_3^- > 18 ext{ mEq/L}$ - Ketones: Absent or minimal; profound dehydration and acute altered mental status present.

Question 3

Nursing Priority Sequence in DKA Management

Accepted Answer

1. **Fluid Resuscitation**: Infuse $0.9\%	ext{ Normal Saline}$ ($1	ext{--}1.5	ext{ L/hr}$) to restore tissue perfusion.
2. **Potassium Verification**: Check $K^+$ level before giving insulin. Ensure $K^+ \ge 3.3	ext{ mEq/L}$ to prevent fatal cardiac dysrhythmias.
3. **Continuous Regular IV Insulin**: Administer continuous IV Regular Insulin ($0.1	ext{ units/kg/hr}$).
4. **Glucose Addition**: Add $5\%	ext{ Dextrose}$ ($D_5W$) to IV fluids when blood glucose reaches $200	ext{--}250	ext{ mg/dL}$ to prevent rapid drops causing cerebral edema.

Question 4

The 'Rule of 15' for Acute Hypoglycemia

Accepted Answer

Indicated for conscious patients with Blood Glucose $< 70	ext{ mg/dL}$:
1. Administer $15	ext{ g}$ of fast-acting simple carbohydrates ($4	ext{ oz}$ fruit juice, $3	ext{--}4$ glucose tablets).
2. Recheck blood glucose after $15	ext{ minutes}$.
3. If blood glucose remains $< 70	ext{ mg/dL}$, repeat $15	ext{ g}$ of simple carbs.
4. Once glucose normalizes, give a complex carbohydrate + protein snack (e.g., peanut butter crackers).
*Unconscious Patient*: Administer IV $50\%	ext{ Dextrose}$ ($D_{50}W$) or IM Glucagon.

Question 5

Thyroid Storm (Thyrotoxic Crisis): Triad & Emergency Interventions

Accepted Answer

**Clinical Triad**: Extreme hyperthermia ($> 104^\circ	ext{F} / 40^\circ	ext{C}$), profound tachycardia/atrial fibrillation, and extreme agitation/delirium.

**Interventions**:
1. Antithyroid medications: Propylthiouracil (PTU) or Methimazole.
2. Beta-blockers: Propranolol to control cardiovascular hyperactivity.
3. Cooling blankets & Acetaminophen (avoid Aspirin as it displaces bound thyroid hormones).
4. IV Hydrocortisone to suppress T4-to-T3 conversion and prevent adrenal crisis.

Question 6

Myxedema Coma: Recognition & Critical Interventions

Accepted Answer

Severe, life-threatening decompensated hypothyroidism.

**Key Assessment Findings**: Hypothermia, severe bradycardia, hypoventilation, hyponatremia, hypoglycemia, and generalized non-pitting edema (periorbital).

**Emergency Nursing Actions**:
- Maintain patent airway (mechanical ventilation often required).
- Administer IV Levothyroxine ($T_4$) and IV Hydrocortisone.
- Implement passive rewarming (warm blankets); avoid active rapid rewarming due to risk of vasodilation and vascular collapse.

Question 7

Post-Thyroidectomy Nursing Care & Bedside Safety Equipment

Accepted Answer

**Bedside Safety Equipment (Must-Have)**:
1. Emergency **Tracheostomy Tray**
2. Oxygen and functioning suction equipment
3. IV **Calcium Gluconate**

**Priority Post-Op Complications**:
- *Airway Obstruction*: Monitor for stridor, noisy breathing, or neck swelling.
- *Hemorrhage*: Check surgical dressing and posterior neck/pillow.
- *Hypocalcemia*: Results from accidental parathyroid gland removal; monitor for neuromuscular excitability.

Question 8

Clinical Signs of Hypocalcemia ($Ca^{2+} < 8.5	ext{ mg/dL}$)

Accepted Answer

- **Chvostek's Sign**: Facial twitching produced by tapping the facial nerve over the parotid gland anterior to the ear lobe.
- **Trousseau's Sign**: Carpal spasm elicited by inflating a blood pressure cuff above systolic pressure for $3	ext{ minutes}$.
- **Other Manifestations**: Circumoral paresthesia, tetany, hyperactive deep tendon reflexes (DTRs), and prolonged QT interval on ECG.

Question 9

Cushing's Syndrome vs. Addison's Disease: Lab Profile Comparison

Accepted Answer

**Cushing's Syndrome (Excess Cortisol)**: - Serum Glucose: Increased (Hyperglycemia) - Serum Sodium ($Na^+$): Increased ($> 145 ext{ mEq/L}$) - Serum Potassium ($K^+$): Decreased ($< 3.5 ext{ mEq/L}$) - Calcium ($Ca^{2+}$): Decreased **Addison's Disease (Deficient Cortisol & Aldosterone)**: - Serum Glucose: Decreased (Hypoglycemia) - Serum Sodium ($Na^+$): Decreased ($< 135 ext{ mEq/L}$) - Serum Potassium ($K^+$): Increased ($> 5.0 ext{ mEq/L}$) - Calcium ($Ca^{2+}$): Increased

Question 10

Addisonian Crisis: Clinical Presentation & Emergency Interventions

Accepted Answer

Life-threatening acute glucocorticoid/mineralocorticoid insufficiency precipitated by stress, infection, trauma, or abrupt steroid withdrawal.

**Clinical Manifestations**: Severe hypotension (refractory shock), hyponatremia, hyperkalemia, and hypoglycemia.

**Emergency Actions**:
- Rapid IV fluid resuscitation ($0.9\%	ext{ Normal Saline}$).
- Immediate high-dose bolus of IV **Hydrocortisone**.
- Continuous cardiac monitoring for hyperkalemic dysrhythmias.

Question 11

Patient Education for Long-Term Glucocorticoid Therapy

Accepted Answer

1. **Tapering**: Never stop medication abruptly; gradual withdrawal is mandatory to prevent Addisonian crisis.
2. **Stress Management**: Double or triple dosage during physiological stress, fever, infection, or surgery ("Sick Day Rules").
3. **Infection Awareness**: Report low-grade fever immediately; steroids mask typical signs of infection.
4. **Administration**: Take in the morning with food to mitigate peptic ulcer risk.

Question 12

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Accepted Answer

**Pathophysiology**: Excessive ADH release $ightarrow$ fluid retention, dilutional hyponatremia, and serum hypoosmolality.

**Key Findings**: Fluid volume excess without peripheral edema, low urine output with high urine specific gravity ($> 1.030$), serum $Na^+ < 135	ext{ mEq/L}$.

**Interventions**:
- Strict fluid restriction ($500	ext{--}1000	ext{ mL/day}$).
- Administer Hypertonic Saline ($3\%	ext{ NaCl}$) slowly for severe hyponatremia ($Na^+ < 120	ext{ mEq/L}$) to prevent Central Pontine Myelinolysis.
- Administer oral loop diuretics or vasopressin receptor antagonists (conivaptan).

Question 13

Diabetes Insipidus (DI): Diagnostics & Management

Accepted Answer

**Pathophysiology**: ADH deficiency (neurogenic) or renal resistance to ADH (nephrogenic).

**Key Findings**: Polydipsia, massive polyuria ($4	ext{--}20	ext{ L/day}$), extremely dilute urine with low specific gravity ($< 1.005$), serum hypernatremia ($Na^+ > 145	ext{ mEq/L}$), high serum osmolality ($> 295	ext{ mOsm/kg}$).

**Interventions**:
- Administer **Desmopressin (DDAVP)** (synthetic ADH).
- Monitor hourly urine output, daily weights, and urine specific gravity.

Question 14

Pheochromocytoma: Classic Triad & Critical Contraindication

Accepted Answer

Catecholamine-secretion tumor located in the adrenal medulla.

**Classic Triad**: Episodic **headache**, **profuse diaphoresis**, and **tachycardia** (accompanied by severe hypertension).

**CRITICAL NCLEX CONTRAINDICATION**: **Do NOT palpate the abdomen**. Palpation can precipitate a catastrophic release of catecholamines, leading to sudden, lethal hypertensive crisis.

Question 15

Hyperparathyroidism vs. Hypoparathyroidism Lab Findings

Accepted Answer

**Hyperparathyroidism**: - $\uparrow ext{ PTH} ightarrow \uparrow ext{ Serum Calcium } (> 10.5 ext{ mg/dL}) ext{ and } \downarrow ext{ Serum Phosphate } (< 3.0 ext{ mg/dL})$ - Complications: Pathologic fractures, renal calculi ("groans, stones, bones, and psychiatric overtones"). **Hypoparathyroidism**: - $\downarrow ext{ PTH} ightarrow \downarrow ext{ Serum Calcium } (< 8.5 ext{ mg/dL}) ext{ and } \uparrow ext{ Serum Phosphate } (> 4.5 ext{ mg/dL})$ - Complications: Tetany, laryngospasm, positive Chvostek's/Trousseau's signs.

Question 16

Emergency Medical Management of Severe Hyperkalemia ($K^+ > 6.5	ext{ mEq/L}$)

Accepted Answer

1. **IV Calcium Gluconate**: Immediately stabilizes cardiac myocyte membranes (prevents fatal arrhythmias; does not reduce serum $K^+$).
2. **IV Regular Insulin + $D_{50}W$**: Shifts potassium from extracellular fluid into cells.
3. **Inhaled Albuterol / IV Sodium Bicarbonate**: Promotes intracellular shift of $K^+$.
4. **Sodium Polystyrene Sulfonate (Kayexalate) or Patiromer**: Excretes potassium through bowel elimination.
5. **Hemodialysis**: Ultimate definitive clearance for refractory high potassium.

Question 17

Somogyi Effect vs. Dawn Phenomenon Differentiation

Accepted Answer

Both cause hyperglycemia upon awakening, but require opposing midnight interventions. Differentiated by checking blood glucose at $3:00	ext{ AM}$:

- **Somogyi Effect**: Hypoglycemia at $3:00	ext{ AM}$ triggers counter-regulatory hormones causing rebound morning hyperglycemia. *Treatment*: Reduce bedtime insulin or consume a bedtime carbohydrate snack.
- **Dawn Phenomenon**: Normal or high blood glucose at $3:00	ext{ AM}$ due to nocturnal growth hormone surge. *Treatment*: Increase bedtime insulin dose.

Question 18

Transsphenoidal Hypophysectomy Nursing Considerations

Accepted Answer

Surgical removal of the pituitary gland via the sphenoid sinus.

**Priority Post-Op Nursing Actions**:
- Monitor for **Cerebrospinal Fluid (CSF) Leak**: Test clear nasal drainage for glucose ("halo sign").
- Prevent Increased ICP: Instruct patient to **avoid coughing, sneezing, blowing nose, or bending at the waist**.
- Position: Elevate Head of Bed to $30^\circ$.
- Oral Care: Perform frequent oral rinses; avoid toothbrush usage for $10	ext{--}14	ext{ days}$ to preserve incision site integrity.

Question 19

Key Nursing Safety Precautions: Severe Hyponatremia vs. Hypernatremia

Accepted Answer

**Hyponatremia ($Na^+ < 120	ext{ mEq/L}$)**:
- Fluid shifts into brain cells causing cerebral edema, confusion, seizures, and coma.
- Priority: Implement **Seizure Precautions** and padded side rails.

**Hypernatremia ($Na^+ > 145	ext{ mEq/L}$)**:
- Causes cellular dehydration and extreme agitation.
- Priority: Rehydrate slowly with hypotonic/isotonic IV fluids to avoid rapid fluid shifts causing cerebral edema.

Question 20

Normal Electrolyte & Lab Reference Ranges for NCLEX

Accepted Answer

- **Serum Sodium ($Na^+$)**: $135	ext{--}145	ext{ mEq/L}$
- **Serum Potassium ($K^+$)**: $3.5	ext{--}5.0	ext{ mEq/L}$
- **Total Calcium ($Ca^{2+}$)**: $8.5	ext{--}10.5	ext{ mg/dL}$
- **Serum Magnesium ($Mg^{2+}$)**: $1.5	ext{--}2.5	ext{ mEq/L}$
- **Serum Phosphate ($PO_4^{3-}$)**: $3.0	ext{--}4.5	ext{ mg/dL}$
- **Urine Specific Gravity**: $1.005	ext{--}1.030$

NCLEX-RN - Medical-Surgical Nursing: Endocrine & Metabolic Disorders

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