How to Study Endocrine in Med-Surg

I love seeing that “lightbulb” moment when students realize that they’ve been making the endocrine system a lot harder than it needs to be. Which is why I was so surprised when I realized that I’ve never, ever explained the best way to study Endocrine diseases on this blog. After all, Endocrine is only about the scariest, most intimidating, and seemingly complicated Med-Surg topic that you’ll ever encounter in nursing school.

Lucky for you, that’s not how I approach Endocrine topics when I tutor students. In fact, I actually GET EXCITED when tutoring Endocrine! Yes, I realize that this makes me a big nerd. And yes, I am totally okay with that :)

The truth is that you don’t have to memorize every little cause, symptom, complication, and treatment in order to become an endocrine master in nursing school. In fact, it’s really a waste of time to try and memorize everything! Even if you can keep all those memorized facts straight long enough to pass your class exam, there’s no way that info will still be clear and strong in your memory when it’s time to take NCLEX.

I’m not saying that you don’t need to memorize anything, though. There’s certain things about Endocrine that you really DO need to memorize. But there’s also a bunch of things that you shouldn’t memorize…and it’s that non-memorization category of concepts that needs to be understood. Once you know the difference between the two types of Endocrine information, then you’ll begin to see how much easier it is to learn (and remember!) the endocrine system.

Endocrine: So What Needs to be Memorized?

The Anatomy & Physiology, of course! But what makes up the A&P of the Endocrine system? It comes down to a list of basic things that can be easily organized into chart form and memorized. You’ll need to memorize 3 types of Endocrine facts:

  1. The Endocrine glands (i.e. anterior pituitary gland, posterior pituitary gland, thyroid, parathyroid, etc)
  2. Which hormones are produced by each gland (i.e. posterior pituitary gland produces Oxytocin and Anti-Diuretic Hormone (ADH), etc)
  3. What each hormone does (i.e. Anti-Diuretic Hormone (ADH) tells the kidneys to keep water instead of peeing it out, etc)

In my opinion, the best way to memorize these Endocrine facts is to organize the information and practice writing it over and over again in chart form. And over. And over yet again. In fact, when I first learned this myself, I felt like I was wasting so much paper using the “write it out” method of memorization that I finally replaced pencil and paper with a whiteboard and dry erase marker – much better for the environment! Not to mention cheaper in the long-run…

That’s Fine For A&P. But How Do I Learn Endocrine Disorders Without Memorizing Them?

Most students approach Endocrine disorders backwards. They start with the disorder, then try to learn all the facts.

Instead, you should start with the hormone and think about what happens when there’s too much or too little being produced. When you approach diseases this way, studying becomes all about looking for patterns and understanding the bigger concepts. Plus, Endocrine is actually very easy once you get to this step, because all the diseases occur in pairs!  Let’s go through Anti-Diuretic Hormone (ADH) to show you exactly what I mean.

To do this part, you’ll need to have already memorized that Anti-Diuretic Hormone comes from the Posterior Pituitary gland, and that Anti-Diuretic Hormone does exactly what its name says: it tells the kidneys to hold onto water, and only water, which decreases the amount of urine that the kidneys produce. So what happens if you have too much ADH being released by the Posterior Pituitary gland?

  • Too much ADH, means too many messages to the kidneys to hold onto too much water in the body (see a pattern developing here?)

And what symptoms would you expect to see if the body is holding onto too much water? Don’t jump to your textbook yet, let’s use your common sense and nursing knowledge, because you already know a lot more than you think!

  • Too much water in the body can lead to high blood pressure (because there’s too much water in the blood vessels), weight gain (because water equals weight and there’s too much water in the body), oliguria or anuria (because the kidneys are keeping too much water, instead of turning it into pee), high specific gravity of urine (because the kidneys are keeping too much water, making the urine very concentrated), and even hyponatremia and all the symptoms that go along with that imbalance (because the body is keeping too much water, but the same amount of sodium).

Ta-Da! Now you know about Syndrome of Anti-Diuretic Hormone (SIADH). That wasn’t as hard as you thought it would be, was it?

Once you understand what the hormone does, it becomes a lot easier to see the patterns and understand (and remember!) what happens when something goes wrong with that hormone.

Want another example? Let’s take ADH in the opposite direction: what happens when there’s TOO LITTLE ADH?

  • Too little ADH, means too few messages to the kidneys, which means the kidneys will keep too little water in the body

Which leads to what kind of symptoms…?

  • Too little water in the body can lead to low blood pressure (because there’s too little water in the blood vessels), polydipsia (because there’s too little water in the body which causes thirst), polyuria (because the kidneys are keeping too little water, and the rest of it is being used to make pee), low specific gravity of urine (because the kidneys are keeping too little water and getting rid of the rest which makes urine very dilute), and even dehydration and hypernatremia (because the body is left with too little water in the blood vessels, but the same amount of sodium).

Voila! You know about Diabetes Insipidus now. Notice how it’s basically the opposite of Syndrome of Anti-Diuretic Hormone (SIADH)?

Ok, But What About The Nursing Care? I Have To Have That Memorized, Right?

Um, no. There’s no “special” nursing care that you only use for SIADH patients. As nurses, we treat the symptoms! Of course, you also have to use your common sense and your new-found knowledge of why these symptoms occur in an SIADH patient so that you can use your clinical judgement to decide which particular nursing interventions would be best.

Nursing Care for SIADH:

  • High blood pressure: Monitor vital signs, administer blood pressure meds and/or diuretic as ordered
  • Weight gain: Monitor weight to measure fluid retention, fluid restrictions to help control symptoms
  • Oliguria/anuria and High specific gravity of urine: Monitor urine output and concentration (color and amount, lab tests)
  • Hyponatremia: monitor level of consciousness, encourage extra sodium intake in diet (Sometimes with hyponatremia we would also give a hypertonic or isotonic IV solution…but this is a perfect example of how you also have to use your common sense! SIADH patients are on fluid overload already, so additional IV solutions should be given with extreme caution.)

Fine, I Get The Nursing Care. But I’m Sure That There’s Some Medical Interventions I’ll Need To Memorize…

No, not so much. See, any medical intervention is going to either A) manage the symptoms, or B) fix the underlying problem. We’ve already covered “manage the symptoms” in nursing care. But how do you “understand” how to fix the underlying problem?

By going back to your memorized A&P, of course! If SIADH causes too much ADH to be released, then the medical intervention is going to involve something that tries to fix that underlying A&P problem. In the case of ADH, you want to stop the posterior pituitary gland from producing excess ADH. How would you do that? In this case, surgery is going to be your answer! After all, if there’s no posterior pituitary gland…there will be no more excess ADH.

In fact, there might be no more ADH at all if they remove all of the posterior pituitary gland! So continue using your nursing knowledge (combined with common sense) to proceed from there. If the posterior pituitary gland is suddenly gone via surgery, what kind of complications and/or nursing care are we going to be thinking about after surgery? Perhaps a missing posterior pituitary gland would lead to…too little ADH?!?!? (And what does too little ADH lead to…?) Oh my!

As you go through this study process on your own, compare your educated guesses with the textbook. Often, you’ll find that you’re exactly right! The only difference might be that your explanation will make a LOT more sense than the complicated jargon that the textbook uses. And if you do find that you’ve missed an important detail, simply add it to your own explanation (making sure that you take the time to understand how that new detail fits into the overall A&P, of course!)

Believe it or not, this bottom-up approach to studying is what it means to think like a nurse. And Endocrine really isn’t so bad after all, is it?

The Best Time to Study Was 3 Months Ago…

“The best time to plant a tree is 20-years ago.  The second best time is today.”  Chinese Proverb

“The best time to study properly is at the beginning of the semester.  The second best time is today.”  Your Nursing Tutor Proverb


We all have regrets.  Often, those regrets have to do with something we wish we would have done sooner so that we could be reaping the benefits now…like studying!  In nursing school, it’s too easy to focus on what is urgent, instead of what’s important (I talk in more detail about this issue of urgent versus important in the PASS Program).  It’s kind of like collecting acorns instead of planting them, where acorns are nursing facts and planting them is good study habits.

Yeah, I like corny analogies.  It’s part of my charm as a tutor.  Or so I tell myself whenever I create corny analogies.

In any case, it may seem urgent to grab as many acorns as possible when there are millions of them scattered all over the ground (and in your textbook).  After all, you never know how many you will need!  What if you plant some and they never grow?  What if the squirrels get them first?  What if???  And why won’t anybody even tell you how many acorns you need, anyway? Is this some sort of strange, nursing school conspiracy to make you…nuts?!?! [Read more…]

Does Heartburn Cause Cancer?

I have 3 kids under the age of 5.  So when I had the chance to go grocery shopping the other day all by myself, I jumped on it.  What a wonderful feeling, gliding lightly through the parking lot, feeling the breeze in my hair, noticing the trees preparing for spring.  Not having to mutter crazy things like “Please give that half-eaten sandwich back to the seagulls,” or “Of course we’ll say hi to the lobsters when we get inside.”  Sometimes, it’s the little things that bring the most joy…

In any case, I was very much enjoying my mini vacation.  And since my attention was free to wander, I happened to see a bumper sticker I wouldn’t have otherwise noticed.  The car parked next to me stated “Heartburn can cause Cancer.”  Being a nurse, I immediately wondered…is that true? [Read more…]

I Hate Mnemonics

I hate mnemonics.  Maybe that’s a little bit extreme, or even inflammatory.  After all, you can find entire study books dedicated to nursing mnemonics.  Maybe I should say “I Hate Most Mnemonics,” or even “Mnemonics are Not Your Friend.”

Whatever.  The truth remains that I generally don’t like mnemonics.  I’ve seem them misused waaaaay too often by students.  And teachers.  And especially by NCLEX review books.  With so many mnemonics getting passed around by reputable sources, nursing students can easily be fooled into believing that all they need is the right combination of helpful mnemonics in order to successfully think like a nurse.  Unfortunately, nothing could be further from the truth.

With mnemonics, as with most things, moderation is key.  Whenever you study, you have to use your brain…but mnemonics discourage you from using your brain when not used correctly.  If you try to use mnemonics to memorize everything, then you won’t understand anything.  And understanding is how you learn to think like a nurse.  Instead of offering you a shortcut, mnemonics can actually make your nursing school experience more difficult when not used correctly.

Let’s compare two mnemonics so I can show you the difference:

Mnemonic Example #1:  ROME (for ABG interpretation)

Respiratory Opposite, Metabolic Equal

VERSUS [Read more…]

Why you NEED to know about Bloom’s Taxonomy

You might have heard about Bloom’s Taxonomy, even if you’re not sure what it is. Bloom’s Taxonomy is the framework used to create and measure the difficulty of the questions you answer on NCLEX. If you answer enough of the more difficult, higher-level question types, then you pass. If you can only answer the easier, lower-level question types, then you fail.


The lower level questions are based on Recall/Recognition and basic Understanding of the nursing information. The higher level questions are based on Application and Analysis levels of nursing information. Here’s how it breaks down:

Recall/Recognition: Includes “What is…” type questions. You either know the answer or you don’t. Students who spend most of their study time memorizing will be good at these question types, but will have difficulty with the higher level question types.

Understanding: Includes “Why” type questions. Students who study in order to gain or maintain a solid foundation in A&P will do better with these question types, and will have an excellent foundation on which to start practicing the higher level question types. [Read more…]

Is Your 2014 Off to a Good Start?

Is your 2014 off to a good start?  Or do you already feel like you’re hanging on for dear life?  Many times nursing students approach the holidays with great intentions to review old material and get a head start on the upcoming semester.  Just as many times, the spring semester rolls around and you’re still at square one!  Hopefully more well-rested and relaxed from the much needed break, though.

I’m not immune to the hectic December holiday schedule either.  That’s why I started doing something a few years ago that has changed the way I approach the new year.

Each Fall, around October or early November (notice:  before the holiday season gets into full swing), I plan my goals for the following year.  I write personal goals, parenting goals, marriage goals, and (of course!) nursing goals.  Setting goals is the most important step towards making progress in your life.  If you don’t know where you want to go, then you will never be able to figure out how to get there.   [Read more…]

Did You Fail a Class?

Were you one of the many nursing students who failed a class last semester?  It sucks.  It’s way more than just a bad grade.  It also hits you emotionally and financially in addition to academically.  And if you intend to continue in nursing school and try again, then it’s going to be essential for you to address all three of these areas.

Unfortunately, most nursing students are at a loss as to what to do first.  And so they end up doing the worst thing possible:  they “hope” that they’ll do better the next time they take the class.  What kind of plan is that?  No wonder students retaking a class have exponentially higher anxiety levels…that plan is terrible!  If you want to get different results next time, you need to do something differently next time.  So here’s how you can create a plan that will actually work.

Emotionally:  Put things in perspective and get your anxiety under control

You’re human, and you failed a class.  That’s it.  It doesn’t mean the world is coming to an end, it doesn’t mean your friends hate you, it doesn’t mean that your family will disown you, and it doesn’t mean that you’ll never be a nurse.  When we’re disappointed and uncertain about the future, we have the tendency to assume the worst.  And that often leaves us pessimistic and anxious; not a good combination.

Give yourself a bit of grace.  Failing a class should not [Read more…]

HESI A2 – Reading Comprehension

When I was a kid, I used to get in trouble for reading after bedtime.  I kept a flashlight in my bedside drawer so I could start reading under the covers after my parents tucked me in at night.  Of course, they occasionally came back up to check on me and discovered my nerdy disobedience!  But I suppose those long hours of reading have paid of, because to this day I love reading and can get through a book fairly quickly.  That’s just one of the reasons why I wasn’t to worried about the Reading Comprehension section of the HESI A2.

I’ve also taken many Reading Comprehension exams over my life:  3 PSATs and 2-3 SATs in high school, plus the GREs in college.  Oh, and I also taught SAT prep classes for a nationally known test prep company while I was in college.  So unlike some of the other sections on the HESI A2, I really wasn’t too worried about it.  Before I jump into the details of my HESI A2 Reading Comprehension experience, I need to give a little disclaimer.  I never had to take HESI A2 when I applied to my nursing school, but I’ve gotten so many questions about it over the years that I signed up to take it earlier this year and I’m in the process of sharing my experience in a series of blog posts.

That being said…for those of you that are new to Your Nursing Tutor, I’m going to let you know up front that I think maintaining honesty and integrity are two of the most important things you need to do as a nurse.  And that includes not cheating on tests for any reason when you are a student nurse.   I will never share specific test questions, and I am not interested in buying or selling test banks for exams or textbooks.  If you email me to ask me for something like that, I’ll politely tell you no and refer you to this previous blog post.

Now that we’ve gotten that little disclaimer out of the way… [Read more…]

The Flu Vaccine Myth

Flu season is well upon us, and the final end-of-semester “push” is over for most of us.  Have you ever noticed how you always seem to get sick immediately after Finals are over?

Yeah, there’s actually a good reason for why that happens.  It has to do with your stress hormones, but that’s a whole other blog post.  Today I want to talk about something entirely different.

Has anybody ever told you that the last time they got a flu shot, it gave them the flu? Or that they didn’t want to get the flu vaccine because they were afraid that they’d come down with the flu?

Is that true? CAN you catch the flu from the flu vaccine?

Usually, the answer is no, but there are a few caveats.  First, it depends on the type of flu vaccine you get.  There are two:  the traditional injection, and the relatively newer nasal spray.

You absolutely do not get the flu from the traditional injection.  These vaccines inoculate using either deactivated flu virus, or “pieces” of flu virus (recombinant type).  The goal is to “show” your immune system just enough of what that flu strain “looks like” so that your body can create antibodies to be ready in case the real flu virus enters your body later in the flu season.  Whichever version you receive, the flu virus will be non-functioning, so it cannot multiply and spread throughout your body.

The nasal spray, on the other hand, contains [Read more…]

HESI A2 – Chemistry

Chemistry was never my strong suit.  I took Honors Chemistry 101 my very first semester the first time I went to college to study Psychology (nursing was my second degree a few years later).  For my second semester I ditched the Honors class and took standard Chem 102.  I remember frantically studying for my final exam, as my smug classmate down the hall kept wandering in to tell me how he would have to get a -33% on the Final in order to fail the class (yes, if you’re paying attention, that it is impossible to get a negative score on an exam).  Needless to say, I needed a grade much higher than that, and I was more than a little nervous about it!

I passed both of my Chemistry classes with less than flying colors, so I was curious how much I would actually have to recall for the HESI A2.  Before I jump into the details of my HESI A2 Chemistry experience, I need to give a little disclaimer.  I never had to take HESI A2 when I applied to my nursing school, but I’ve gotten so many questions about it over the years that I signed up to take it earlier this year and I’m in the process of sharing my experience in a series of blog posts.

That being said…for those of you that are new to Your Nursing Tutor, I’m going to let you know up front that I think maintaining honesty and integrity are two of the most important things you need to do as a nurse.  And that includes not cheating on tests for any reason when you are a student nurse.   I will never share specific test questions, and I am not interested in buying or selling test banks for exams or textbooks.  If you email me to ask me for something like that, I’ll politely tell you no and refer you to this previous blog post.

Now that we’ve gotten that little disclaimer out of the way… [Read more…]