HESI-ENDOCRINE QUESTIONS WITH
COMPLETE SOLUTIONS
While assessing Pt's on oncology unit, nurse discovers that Pt's has been
intermittently vomiting all night. Nurse anticipates that Pt's may have which
acid-base imbalance? --Answer-- Metabolic alkalosis occurs with severe
vomiting result loss hydrochloric acid/acids from extracellular fluids.
•Vomiting major side effect chemotherapeutic drugs. Antiemetics given
routinely every 4-6 hrs. Or prophylaxis before chemotherapy initiated.
Metabolic Acidosis: •Caused by loss bicarb or build up acids - Lactic acidosis,
diarrhea, renal failure, ketones, ammonium intoxication. Not caused by
respiration.•HCO3 ↓, ph ↓•Compensation - hyperventilation eliminate CO2
Metabolic Alkalosis• Acid (H+) lost from emesis, diuretics, retention HCO3
from medications, hyperaldosteronism• ↑ HCO3, ↑ ph• Compensation -
Respiratory centers not stimulated, leads to hypoventilation & CO2 retention
Respiratory Alkalosis:•Caused by excessive ventilation• ↓ PCO2, ↑ ph•
Compensation - Kidneys excrete HCO3
Respiratory Acidosis:•Respiratory system cause, for ex. Hypoventilation• ↑
PCO2, ↓ ph• Compensation - Kidneys reabsorb Bicarb (HCO3). ↓↑
While suctioning a client's endotracheal tube, nurse observes sinus
bradycardia on electrocardiograph monitor. What should nurse do next? --
Answer-- client's heart rhythm changed to sinus bradycardia because of
Valsalva response from prolonged suctioning. Nurse should stop suctioning,
administer oxygen as needed, & wait to continue suctioning until client's
heart rate has stabilized.
Atropine is for symptomatic bradycardia only.
Elevating head of bed will not increase client's heart rate.
An acute, severe, prolonged asthmatic attack that is not responsive to usual
treatment is referred to as which of the following? --Answer-- Status
asthmaticus is an acute, prolonged, & severe asthmatic attack that is
unresponsive to usual treatment. Hospitalization is usually required.
,Asthma is a chronic, obstructive airway disease characterized by wheezing. It
is caused by a spasm of bronchial tubes/swelling of bronchial mucosa after
exposure to various stimuli.
Mild intermittent asthma is characterized by brief exacerbations occurring
less than 3 times per week.
Mild persistent asthma is characterized by exacerbations 3 or more times per
week or 3 to 4 nighttime symptoms per month.
Moderate persistent asthma is characterized by daily exacerbations & 1 or
more nighttime exacerbation per week.
Severe persistent asthma is characterized by continual symptoms, frequent
exacerbations, & frequent nighttime symptoms.
Nurse is assessing her patient for pain. Nurse recognizes pain as chronic
because of presence of: --Answer-- •Acute pain often accompanied by
tachycardia, increased or decreased blood pressure, diaphoresis, tachypnea,
& focusing on pain. •Chronic pain often accompanied by depression, social
withdrawal, change in appetite, restricted activity, decreased concentration,
& poor sleep.
Nurse is caring for a patient with a closed ulna fracture after application of a
cast. After patient complains of severe pain, nurse administers an analgesic
& applies an ice pack. When patient states that medication provided no
relief, nurse should be alert to possibility of: --Answer-- Fracture pain is
usually relieved by analgesics, elevation, cold packs, & rest. Pain that is not
improved from these interventions is most likely due to impaired perfusion &
ischemia. Nurse should assess for vascular compromise & then notify
physician immediately• Anxiety often increases pain, but failure to relieve
pain from normal interventions is suspicious of vascular/Arterial compromise
• Infection & its accompanying pain do not develop immediately.
Nurse cares for client who underwent thoracic surgery. Which of following
actions should nurse perform to assess for manifestations of tension
pneumothorax? --Answer-- Tension pneumothorax develops when air is
trapped in pleural space during inspiration & cannot escape during
expiration. Intrapleural pressure becomes greater than lung tissue pressure,
resulting in compression of lung & surrounding structures.
Clinical manifestations of tension pneumothorax include point of maximal
impulse shift; tracheal deviation toward unaffected side; progressive
cyanosis, restlessness, anxiety, & dyspnea; sudden sharp pain on affected
,side with chest movement, breathing, or coughing; asymmetrical chest
expansion; & diminished or absent breath sounds on affected side.
Evidence of labored breathing and hemodynamic compromise (such as
tachycardia or hypotension) suggests a possible tension pneumothorax.
Crackles is one of manifestations for acute pulmonary edema. This is
monitored in clients who may have circulatory overload resulting from
reduced size of pulmonary vascular bed due to surgical removal of
pulmonary tissue & delayed reexpansion of affected lung.
Client admitted to hospital for an overdose of oxycodone. Nurse should
expect physician to order administration of which of following? --Answer--
Naloxone is an opioid receptor competitive antagonist used for opioid
overdose.
Naltrexone is an opioid receptor antagonist (noncompetitive) used for opioid
dependence.
Flumazenil is a γ-aminobutyric acid antagonist used for benzodiazepine
overdose.
Methadone is an opioid analgesic often used for opioid dependency.
Nurse caring for client who sustained a traumatic chest injury that caused
flail chest. Nurse assesses client for which distinctive characteristic of this
condition? --Answer-- Paradoxical motion of chest during respiration
Flail chest life-threatening condition that involves two or more fractures of
adjacent ribs. This causes flail segment to move in opposite direction of
other ribs, causing trauma & contusions.
Dyspnea & bloody sputum are common with flail chest but are not distinctive
characteristics.
Nurse caring for client with fluid overload. The nurse knows that typical
findings in client with fluid excess include which of following? --Answer-- Fluid
overload, or hypervolemia, abnormal increase volume blood plasma with an
increase in total body water
• Typical findings fluid overload include plasma osmolity less than 275
mosm/kg from hemodilution, hematocrit less than 45%, specific gravity of
less than 1.010, BUN level of less than 8 mg/dl & not more than 20 mg/dl, &
plasma sodium level of less than 135 meq/L, depending on type of fluid
excess
Newly admitted patient has sustained deep partial-thickness burns to his
face & trunk. Which of following abnormal values can nurse expect during
, emergent phase? --Answer-- • Due to fluid shift after a burn injury, blood
becomes concentrated & hematocrit will be elevated• Heart rate will
increase (not decrease) due to hypovolemia associated with fluid shift (third
spacing)
• Potassium levels will increase along with cellular destruction
• Hemoglobin levels will be decreased due to hemolysis of red blood cells
• Lactic acid level will increase due to impaired tissue perfusion, not
decrease.
--Answer-- Rheumatic fever is caused by the bacteria Streptococcus
pyogenes. To prevent recurrence and potential complications, such as
endocarditis, the client needs to be on long-term antibiotic treatment.
Antiarrhythmics and antiemetics are not needed for the treatment of
rheumatic fever.
Nonsteroidal anti-inflammatory drugs, or nsaids, can be used to treat fever
and mild pain, but they cannot prevent recurrence of the disease.
Nurse is educating a patient scheduled to undergo a percutaneous
transluminal coronary angioplasty (PTCA). Nurse explains that a balloon-
tipped catheter will: --Answer-- Compress plaque against walls of coronary
arteries.
• During a PTCA, a balloon-tipped catheter is inserted via femoral or radial
artery & along into coronary arteries. Balloon carefully inflated to compress
atheromatous plaque against walls of vessel, widening lumen of vessel that
had been narrowed by plaque & restoring perfusion to myocardium in that
area
• Incorrect: Placing a mesh device to keep artery patent describes placement
of a stent
• Incorrect: Measuring coronary artery pressure describes a process done
during cardiac catheterization
• Incorrect: Cauterizing plaque describes coronary atherectomy
Acute Lithium Toxicity Symptoms CAN HAM SUCS --Answer-- • Confusion
• An increase of urine & thirst
• Nausea
• Hand tremors
• Ataxia (Incoordination of arms and legs)
• Muscle twitches
• Seizures
• Uncontrollable eye movement
COMPLETE SOLUTIONS
While assessing Pt's on oncology unit, nurse discovers that Pt's has been
intermittently vomiting all night. Nurse anticipates that Pt's may have which
acid-base imbalance? --Answer-- Metabolic alkalosis occurs with severe
vomiting result loss hydrochloric acid/acids from extracellular fluids.
•Vomiting major side effect chemotherapeutic drugs. Antiemetics given
routinely every 4-6 hrs. Or prophylaxis before chemotherapy initiated.
Metabolic Acidosis: •Caused by loss bicarb or build up acids - Lactic acidosis,
diarrhea, renal failure, ketones, ammonium intoxication. Not caused by
respiration.•HCO3 ↓, ph ↓•Compensation - hyperventilation eliminate CO2
Metabolic Alkalosis• Acid (H+) lost from emesis, diuretics, retention HCO3
from medications, hyperaldosteronism• ↑ HCO3, ↑ ph• Compensation -
Respiratory centers not stimulated, leads to hypoventilation & CO2 retention
Respiratory Alkalosis:•Caused by excessive ventilation• ↓ PCO2, ↑ ph•
Compensation - Kidneys excrete HCO3
Respiratory Acidosis:•Respiratory system cause, for ex. Hypoventilation• ↑
PCO2, ↓ ph• Compensation - Kidneys reabsorb Bicarb (HCO3). ↓↑
While suctioning a client's endotracheal tube, nurse observes sinus
bradycardia on electrocardiograph monitor. What should nurse do next? --
Answer-- client's heart rhythm changed to sinus bradycardia because of
Valsalva response from prolonged suctioning. Nurse should stop suctioning,
administer oxygen as needed, & wait to continue suctioning until client's
heart rate has stabilized.
Atropine is for symptomatic bradycardia only.
Elevating head of bed will not increase client's heart rate.
An acute, severe, prolonged asthmatic attack that is not responsive to usual
treatment is referred to as which of the following? --Answer-- Status
asthmaticus is an acute, prolonged, & severe asthmatic attack that is
unresponsive to usual treatment. Hospitalization is usually required.
,Asthma is a chronic, obstructive airway disease characterized by wheezing. It
is caused by a spasm of bronchial tubes/swelling of bronchial mucosa after
exposure to various stimuli.
Mild intermittent asthma is characterized by brief exacerbations occurring
less than 3 times per week.
Mild persistent asthma is characterized by exacerbations 3 or more times per
week or 3 to 4 nighttime symptoms per month.
Moderate persistent asthma is characterized by daily exacerbations & 1 or
more nighttime exacerbation per week.
Severe persistent asthma is characterized by continual symptoms, frequent
exacerbations, & frequent nighttime symptoms.
Nurse is assessing her patient for pain. Nurse recognizes pain as chronic
because of presence of: --Answer-- •Acute pain often accompanied by
tachycardia, increased or decreased blood pressure, diaphoresis, tachypnea,
& focusing on pain. •Chronic pain often accompanied by depression, social
withdrawal, change in appetite, restricted activity, decreased concentration,
& poor sleep.
Nurse is caring for a patient with a closed ulna fracture after application of a
cast. After patient complains of severe pain, nurse administers an analgesic
& applies an ice pack. When patient states that medication provided no
relief, nurse should be alert to possibility of: --Answer-- Fracture pain is
usually relieved by analgesics, elevation, cold packs, & rest. Pain that is not
improved from these interventions is most likely due to impaired perfusion &
ischemia. Nurse should assess for vascular compromise & then notify
physician immediately• Anxiety often increases pain, but failure to relieve
pain from normal interventions is suspicious of vascular/Arterial compromise
• Infection & its accompanying pain do not develop immediately.
Nurse cares for client who underwent thoracic surgery. Which of following
actions should nurse perform to assess for manifestations of tension
pneumothorax? --Answer-- Tension pneumothorax develops when air is
trapped in pleural space during inspiration & cannot escape during
expiration. Intrapleural pressure becomes greater than lung tissue pressure,
resulting in compression of lung & surrounding structures.
Clinical manifestations of tension pneumothorax include point of maximal
impulse shift; tracheal deviation toward unaffected side; progressive
cyanosis, restlessness, anxiety, & dyspnea; sudden sharp pain on affected
,side with chest movement, breathing, or coughing; asymmetrical chest
expansion; & diminished or absent breath sounds on affected side.
Evidence of labored breathing and hemodynamic compromise (such as
tachycardia or hypotension) suggests a possible tension pneumothorax.
Crackles is one of manifestations for acute pulmonary edema. This is
monitored in clients who may have circulatory overload resulting from
reduced size of pulmonary vascular bed due to surgical removal of
pulmonary tissue & delayed reexpansion of affected lung.
Client admitted to hospital for an overdose of oxycodone. Nurse should
expect physician to order administration of which of following? --Answer--
Naloxone is an opioid receptor competitive antagonist used for opioid
overdose.
Naltrexone is an opioid receptor antagonist (noncompetitive) used for opioid
dependence.
Flumazenil is a γ-aminobutyric acid antagonist used for benzodiazepine
overdose.
Methadone is an opioid analgesic often used for opioid dependency.
Nurse caring for client who sustained a traumatic chest injury that caused
flail chest. Nurse assesses client for which distinctive characteristic of this
condition? --Answer-- Paradoxical motion of chest during respiration
Flail chest life-threatening condition that involves two or more fractures of
adjacent ribs. This causes flail segment to move in opposite direction of
other ribs, causing trauma & contusions.
Dyspnea & bloody sputum are common with flail chest but are not distinctive
characteristics.
Nurse caring for client with fluid overload. The nurse knows that typical
findings in client with fluid excess include which of following? --Answer-- Fluid
overload, or hypervolemia, abnormal increase volume blood plasma with an
increase in total body water
• Typical findings fluid overload include plasma osmolity less than 275
mosm/kg from hemodilution, hematocrit less than 45%, specific gravity of
less than 1.010, BUN level of less than 8 mg/dl & not more than 20 mg/dl, &
plasma sodium level of less than 135 meq/L, depending on type of fluid
excess
Newly admitted patient has sustained deep partial-thickness burns to his
face & trunk. Which of following abnormal values can nurse expect during
, emergent phase? --Answer-- • Due to fluid shift after a burn injury, blood
becomes concentrated & hematocrit will be elevated• Heart rate will
increase (not decrease) due to hypovolemia associated with fluid shift (third
spacing)
• Potassium levels will increase along with cellular destruction
• Hemoglobin levels will be decreased due to hemolysis of red blood cells
• Lactic acid level will increase due to impaired tissue perfusion, not
decrease.
--Answer-- Rheumatic fever is caused by the bacteria Streptococcus
pyogenes. To prevent recurrence and potential complications, such as
endocarditis, the client needs to be on long-term antibiotic treatment.
Antiarrhythmics and antiemetics are not needed for the treatment of
rheumatic fever.
Nonsteroidal anti-inflammatory drugs, or nsaids, can be used to treat fever
and mild pain, but they cannot prevent recurrence of the disease.
Nurse is educating a patient scheduled to undergo a percutaneous
transluminal coronary angioplasty (PTCA). Nurse explains that a balloon-
tipped catheter will: --Answer-- Compress plaque against walls of coronary
arteries.
• During a PTCA, a balloon-tipped catheter is inserted via femoral or radial
artery & along into coronary arteries. Balloon carefully inflated to compress
atheromatous plaque against walls of vessel, widening lumen of vessel that
had been narrowed by plaque & restoring perfusion to myocardium in that
area
• Incorrect: Placing a mesh device to keep artery patent describes placement
of a stent
• Incorrect: Measuring coronary artery pressure describes a process done
during cardiac catheterization
• Incorrect: Cauterizing plaque describes coronary atherectomy
Acute Lithium Toxicity Symptoms CAN HAM SUCS --Answer-- • Confusion
• An increase of urine & thirst
• Nausea
• Hand tremors
• Ataxia (Incoordination of arms and legs)
• Muscle twitches
• Seizures
• Uncontrollable eye movement
