Mallory Christ
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Quiz on NURS 6895 Endocrine (Exam 2), created by Mallory Christ on 24/10/2021.

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NURS 6895 Endocrine (Exam 2)

Question 1 of 23

1

Which of the following systemic changes does diabetes cause?

Select one or more of the following:

  • Delayed gastric emptying

  • Altered airway anatomy

  • Autonomic changes (such as decreased HR variability)

  • Increased risk of wound infection

  • Increased risk of nerve injury

  • Development of hypothyroidism

Explanation

Question 2 of 23

1

Insulin therapy is 1 of the 6 predicators for a major adverse cardiac event (MACE) on the RCRI scale

Select one of the following:

  • True
  • False

Explanation

Question 3 of 23

1

Diabetic patients should take their prescribed sulfonyurea on the morning of surgery

Select one of the following:

  • True
  • False

Explanation

Question 4 of 23

1

When should an diabetic patient hold their prescribed metformin preoperatively?

Select one of the following:

  • If they are completing a bowel prep before surgery

  • If they have renal impairment

  • If the fasting period is brief

  • Both A & B

Explanation

Question 5 of 23

1

Preoperatively, diabetic patients should take their long acting insulin and hold their short acting insulin

Select one of the following:

  • True
  • False

Explanation

Question 6 of 23

1

Which of the following is important consideration for patients with hyperthyroidism who report dysphagia and dyspnea when lying flat?

Select one of the following:

  • Ensure patient takes morning dose of thyroxine on the morning of surgery

  • Be prepared to administer glucocorticoids intraoperatively

  • Have a dose of magnesium drawn up in case the patient goes into Torsades

  • Do NOT administer a paralytic to these patients

  • All of the above

Explanation

Question 7 of 23

1

Your patient has Hashimoto thyroiditis. During your preop assessment, you notice they are bradycardic. What should you do?

Select one of the following:

  • Obtain labs (TSH & T4 levels) and proceed with surgery if they are normal

  • Order a transesophogeal echocardiogram (TEE)

  • Reschedule the surgery and refer them to their endocrinologist

  • Proceed with surgery as this is a normal finding of Hashimotos

Explanation

Question 8 of 23

1

If your preoperative patient took glucocorticoids within the last _________, you should complete a thorough assessment (what steroid they took, for how long, if they tapered, etc) due to concern for development of adrenal insufficiency

Select one of the following:

  • 2 weeks

  • 1 month

  • 3 months

  • 1 year

Explanation

Question 9 of 23

1

20 mg prednisone per day is considered high dose glucocorticoids

Select one of the following:

  • True
  • False

Explanation

Question 10 of 23

1

Your patient has adrenal insufficiency and develops severe hypotension immediately after induction. What should you do?

Select one of the following:

  • Administer stress dose steroids

  • Administer fluid boluses

  • Start vasopressors immediately

  • There is not a need to do anything as the hypotension will likely self resolve within minutes

Explanation

Question 11 of 23

1

What are symptoms of adrenal insufficiency?

Select one or more of the following:

  • Fatigue

  • Myalgias & arthralgias

  • Nausea/vomiting & loss of appetite

  • CNS stimulation & anxiety

  • Weight gain

  • Development of goiter

  • Hypotension refractory to vasopressor therapy & fluid

Explanation

Question 12 of 23

1

In a patient with acromegaly, what assessment finding would indicate compression of the left recurrent laryngeal nerve?

Select one of the following:

  • Severe hypertension

  • Presence of a "buffalo hump"

  • Voice hoarseness and stridor

  • Narrowing of the subglottic opening

Explanation

Question 13 of 23

1

If a patient has a carcinoid tumor and develops carcinoid syndrome, what are their symptoms and where does the tumor drain?

Select one of the following:

  • Symptoms are flushing, diarrhea, tachycardia, and bronchospasm. The tumor drains into portal circulation

  • Symptoms are flushing, diarrhea, tachycardia, and bronchospasm. The tumor does NOT drain into portal circulation

  • Symptoms are cold intolerance, constipation, and bradycardia. The tumor drains into portal circulation

  • Symptoms are cold intolerance, constipation, and bradycardia. The tumor does NOT drain into portal circulation

Explanation

Question 14 of 23

1

What are the three symptoms of a pheochromocytoma?

Select one or more of the following:

  • Headache

  • Hypoglycemia

  • Presence of a goiter

  • Diaphoresis

  • Bradycardia

  • Tachycardia

Explanation

Question 15 of 23

1

Which of the following is an appropriate consideration for a patient with a pheochromocytoma?

Select one of the following:

  • Prepare to discharge patient home several hours after surgery

  • Ensure patient is appropriately alpha blocked (with phenoxybenzamine) prior to operating

  • Instruct patient to hold morning meds the day of surgery

  • Continue octreotide drip throughout entire surgery

Explanation

Question 16 of 23

1

Your patient is confused, lethargic, and is having seizures. They are euvolemic and do not appear fluid overloaded, but their urine is concentrated. What do you suspect?

Select one of the following:

  • Hyponatremia due to SIADH

  • Hyponatremia due to diabetes insipidus

  • Pheochromocytoma

  • Adrenal insufficiency

Explanation

Question 17 of 23

1

At what rate should you correct hyponatremia?

Select one of the following:

  • 0.5 mEq/L/hr

  • 1 mEq/L/hr

  • 5 mEq/L/hr

  • As quickly as possible to avoid neurologic injury

Explanation

Question 18 of 23

1

Hypoparathyroidism is the most common cause of hypercalcemia

Select one of the following:

  • True
  • False

Explanation

Question 19 of 23

1

Intraoperatively, your patient's labs come back showing a calcium of 3.5 mg/dL. Which is the most important consideration?

Select one of the following:

  • You will monitor the ECG closely for ST segment changes, T wave abnormalities, or a shortened QT interval

  • You will aggressively treat the hypertension that is likely to ensue

  • You will correct the calcium slowly to prevent neurological damage

  • You will not plan on extubating this patient due to risk of laryngospasm

Explanation

Question 20 of 23

1

Your patient has a BMI of 37. What is their BMI classification?

Select one of the following:

  • Normal

  • Overweight

  • Obese

  • Severely obese

  • Morbidly obese

Explanation

Question 21 of 23

1

What is the single biggest indicator of a difficult airway?

Select one of the following:

  • BMI over 40

  • Male gender

  • Presence of metabolic syndrome

  • Large neck circumference

Explanation

Question 22 of 23

1

For which condition would you want your patient on an octreotide drip going into surgery?

Select one of the following:

  • Acromegaly

  • Carcinoid tumor

  • Pheochromocytoma

  • Adrenal insufficiency

Explanation

Question 23 of 23

1

Your patient has a(n) __________ diagnosis. Prior to surgery, you must ensure they have a recent echocardiogram (within one year) to evaluate their ejection fraction due to risk of left ventricular hypertrophy.

Select one of the following:

  • Pheochromocytoma

  • Adrenal insufficiency

  • Acromegaly

  • Cushing Syndrome

Explanation

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