Endocrine System

1. For the past three days, a LPN has been taking care of a 33-year-old woman who underwent a total thyroidectomy. Every morning, the LPN performs a blood test as prescribe, as well as calcemia monitoring. While speaking to the LPN, the patient reports having difficulty swallowing and feeling a tingling sensation in her upper limbs since her surgery. The nurse is informed of this and suspects hypocalcemia. Given the patient’s condition, which of the following interventions would not be appropriate? *
2. Mr. Samuel Gervais, 22, a known Type 1 diabetic, arrives at the emergency department after two days of vomiting, abdominal pain, and severe thirst. He looks dehydrated and his breathing is deep and rapid with a fruity odor. His vital signs are: BP 94/58 mm Hg, HR 128 bpm, RR 32/min, SpO₂ 97%, T 37.2°C. His capillary glucose is 29.8 mmol/L, and the urinalysis shows large ketones. The physician orders: IV normal saline bolus, blood electrolytes, cardiac monitoring, and IV insulin once hydration starts. Which intervention should be initiated first? *
3. Mrs. Antonella Ruzzo, 71, with poorly controlled Type 2 diabetes, is brought to hospital by her family after 3 days of excessive thirst, confusion, and inability to walk. She is severely dehydrated, lethargic, and disoriented. Vitals: BP 102/64 mm Hg, HR 112 bpm, RR 22/min, T 36.9°C, SpO₂ 96%. Her capillary glucose reads 38.5 mmol/L. The physician orders: IV fluids, bloodwork, neurological checks q1h, and low-dose insulin infusion. Which finding must the LPN monitor most closely? *
4. Mr. Laurent Dupéré, 56, a Type 2 diabetic on insulin therapy, becomes pale and diaphoretic during his breakfast tray delivery. He says he “feels shaky,” then becomes confused. Vitals: BP 138/78, HR 112, RR 20, SpO₂ 98%, T 36.4°C. Capillary glucose: 2.8 mmol/L. Orders: 15 g fast-acting glucose, recheck in 15 min, continue monitoring. What should the LPN do first? *
5. Mrs. Claire Beaulieu, 48, with known Addison’s disease, arrives with vomiting, abdominal pain, and profound weakness after a recent infection. She is pale, shaky, and states she “feels like fainting.” Vitals: BP 74/48, HR 128, RR 28, SpO₂ 95%, T 37.1°C. Orders: IV hydrocortisone STAT, large-volume normal saline, cardiac monitoring, electrolytes. What is the LPN’s priority action? *
6. Mr. Julien Vachon, 63, undergoing investigation for Cushing’s syndrome, presents with fragile skin, abdominal striae, and muscle weakness. He reports new bruising on his arms after minimal contact. Vitals are stable. Orders: fall prevention, skin precautions, BP monitoring, glucose monitoring. Which intervention is most appropriate? *
7. Mrs. Gisèle Charest, 79, is hospitalized with pneumonia and develops SIADH. She is confused and has difficulty concentrating. Vitals: BP 138/82, HR 88, RR 18, SpO₂ 95%. Labs show Na+ 124 mmol/L. Orders: fluid restriction 900 mL/day, daily weights, neuro checks. Which action supports the physician’s plan? *
8. Mr. Farid Nasser, 45, presents with excessive urination and intense thirst. Urine is clear and dilute. Vitals: BP 100/60, HR 110, RR 20, SpO₂ 98%. Orders: strict I&O, daily weight, DDAVP administration, serum sodium. What is the most important parameter to monitor? *
9. Ms. Stéphanie Renaud, 31, diagnosed with Graves disease, arrives with palpitations, tremors, anxiety, and heat intolerance. Vitals: BP 150/82, HR 138, RR 24, T 38.9°C. Orders: cooling measures, beta blockers, cardiac monitoring. Which finding requires immediate reporting? *
10. Mrs. Elise Fortin, 68, presents with fatigue, cold intolerance, slow speech, and puffiness around the eyes. Vitals: BP 102/70, HR 52, RR 12, T 35.8°C. Orders: levothyroxine, cardiac monitoring, warm blankets. Which symptom suggests a severe complication? *
11. Mr. Daniel Houle, 67, diabetic for 20 years, arrives with a small ulcer on his right big toe. The area is red, warm, and mildly swollen. Vitals are stable. Orders: wound care, glucose control, pedal pulse checks. Which assessment is priority? *
12. Mrs. Sarah Gupta, 59, taking metformin, reports new severe fatigue and muscle pain after a gastrointestinal illness. Vitals: BP 110/70, HR 96, RR 20, T 36.8°C. Orders: hold metformin, send labs. Why should metformin be held? *
13. Mr. Jean-Marc Ménard, 52, has been taking prednisone daily for 6 months for chronic asthma. The physician recently ordered a slow taper. Vitals are stable. He reports fatigue and dizziness. Why is tapering necessary? *
14. Mrs. Brigitte Archambault, 72, presents with constipation, bone pain, and frequent urination. Labs reveal hypercalcemia. Orders: IV fluids, ambulation, cardiac monitoring. Which intervention supports calcium reduction? *
15. Mr. Kévin Langlais, 34, recently had thyroid surgery. He reports tingling around the mouth and muscle cramps. Vitals stable. Orders: serum calcium, calcium gluconate PRN.
Which finding signals worsening condition? *
16. Ms. Josée Lachance, 27, was admitted to the medical unit early this morning with diabetic ketoacidosis (DKA). She arrived dehydrated, tachypneic, and nauseated after missing several insulin doses during a stressful week. She is now receiving IV regular insulin, 0.9% NS, and electrolyte replacement as ordered by the physician. Four hours into treatment, Josée is more alert and oriented. Her respirations have eased, and vital signs are stable. However, her latest lab report shows that her serum potassium, originally elevated at admission (5.6 mmol/L), is now trending downward to 3.6 mmol/L. The LPN is reviewing the lab results and preparing to continue monitoring her electrolytes while the insulin infusion continues. Why is continuous potassium monitoring essential during IV insulin therapy for DKA? *
17. Mrs. Nadine Paré, 53, has a recent diagnosis of Cushing’s syndrome secondary to chronic corticosteroid use for rheumatoid arthritis. She presents with moon face, central obesity, abdominal purple striae, and fragile skin that bruises easily. She also reports fatigue and elevated blood glucose levels over several weeks. Today, she tells the LPN that she feels “off” and more tired than usual. Her skin is thin, and she has several bruises on her arms. She is afebrile at the start of the shift, and orders include:

Monitor for infection
Perform blood glucose checks
Maintain strict hand hygiene and skin protection

During reassessment, the LPN obtains a new set of vitals and finds a low-grade fever of 38.1°C. Which finding should the LPN report immediately? *
18. Ms. Mireille Boucher, 29, is 28 weeks pregnant and was diagnosed this week with gestational diabetes after failing her oral glucose tolerance test. She expresses worry that her baby might be harmed and reports feeling overwhelmed by dietary information.

Her vital signs are within normal limits, fetal movements are present, and she has no complications at this time. Physician orders include:

Blood glucose monitoring before meals and at bedtime
Nutritional counseling focused on carbohydrate distribution
Fetal monitoring during prenatal visits

The LPN meets with her to reinforce dietary teaching. Which teaching point is essential to help control gestational diabetes? *
19. Mr. Alexis Desroches, 45, began levothyroxine therapy last week after being diagnosed with primary hypothyroidism. He reports that he has been taking his medication “every evening with dinner because it helps me remember.” He still feels tired but expects improvement soon.

Orders include:
Continue current levothyroxine dose
Reevaluate TSH in 6 weeks
Provide medication teaching

The LPN reviews how he has been taking the medication and identifies a teaching need. What should the LPN teach Alexis regarding levothyroxine? *
20. Mrs. Isabelle Gauthier, 64, has had type 2 diabetes for 20 years. She now experiences peripheral neuropathy, especially in the feet, with numbness and intermittent burning pain at night. She reports rarely checking her feet because “they don’t hurt anyway.”

Orders include:
Daily foot care teaching
Referral to podiatry
Medication for neuropathic pain
Reinforce safety and injury prevention

During assessment, the LPN notes dry skin and reduced sensation to light touch. Which teaching is the priority for Isabelle? *
21. Ms. Fernande Paquette, 40, underwent a total thyroidectomy yesterday for treatment of Graves' disease. This morning, she reports mild throat discomfort and difficulty swallowing. Her vital signs are stable, and her incision is dry with slight swelling.

Orders include:
Monitor for airway compromise
Assess for tetany (possible hypocalcemia)
Keep head of bed elevated
Assess voice quality

During reassessment, Fernande mentions new tingling in her fingers and around her mouth. Which finding is most concerning? *