Common Edocrine Disorders: Ch 44 In Critical Care Nursing: A Holistic Approach

Front 1

Which one of the following pharmacological agents is indicated for the treatment of hyperthyroidism?

A. Aspirin
B. Synthroid
C. Demeclocycline
D. Prophylthiouracil

Back 1

D. Prophylthiouracil

Propylthiouracil is the only med that is appropriate for a pt with hyperthyroidism. Aspirin is contraindicated because it can exacerbate circulating triiodothronine (T3) and thyroxine (T4) levels. Synthroid is exogenous T4 and should not be given. Demeclocycline is given to block antiduretic hormone (ADH) effects on kidney in pts with syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Front 2

Which lab value is most consistent with diabetes insipidus?
A. blood glucose greater than 200 mg/dL
B. hematocrit greater than 30%
C. serum osmolality greater than 295 mOsm/L
D. Urine osmolality greater than 150 mOsm/L

Back 2

C. Serum osmolality greater than 295 mOsm/L.

Pts with diabetes insipidus become quite dehydrated and will display unusually high serum osmolality. Hematocrit and blood sugar levels may become slightly elevated as a result of hemoconcentration, but, they will not be this abnormal. Urine osmolality will be quite low, reflective of the copious, dilute urine that accompanies diabetes insipidus.

Front 3

Myexedema coma is characterized by all but which one of the following?

A. Hypotension, bradycardia, hypothermia
B. Tachycardia, hypotension, hypothermia
C. Hypothermia, tachycardia, hypertension
D. Hypoventilation, bradycardia, hypothermia

Back 3

A. Hypotension, bradycardia, hypothermia

Pts with extreme hypothyroidism disorder will be bradycardic, hypotension, and hypothermic, and will hypoventilate. All the symptoms result from inadequate thyroid hormone.

Front 4

The most serious underlying probelm for the pt with adrenal insufficiency is:
A. hyperkalemia
B. dehydration
C. hyperglycemia
D. hypothyroidism

Back 4

B. Dehydration

The pt with adrenal insufficiency will quickly dehydrate in the absence of cortisol and aldosterone.

Front 5

Diabetic ketoacidosis (DKA) is often precipitated by which one of the following conditions?

A. Overinsulinization
B. Growth spurt
C. Compliance with oral meds.
D. Taking insulin when acutely ill

Back 5

B. Growth spurt

Diabetes Ketoacidosis (DKA) is often precipitated by couter-regulatory hormone activation: growth hormone, cortisol, and epinephrine. Using insulin when ill will protect the pt from DKA.

Front 6

Traditional therapy for diabetic ketoacidosis (DKA) consists of all but which one of the following?

A. Fluid replacement with isotonic saline, insulin, possible potassium replacement
B. Fluid replacement with normal saline, insulin, bolus of sodium bicarbonate
C. Fluid replacement with dextrose in 5% lactated Ringer's solution (D5LR) initially, insulin, clhoride bolus
D. Hemodialysis to correct underlying fluid and electrolyte disturbances, insulin, and oxygen

Back 6

A. Fluid replacement with isotonic saline, insulin, possible potassium replacement.

Intial treatment for diabetic ketoacidosis includes rapid fluid replacement with isotonic or hypotonic saline, insulin, and supportive care. Typically the pt will not require sodium bicarbonate, chloride, or other electrolytes since fluid will usually correct the problem.

Front 7

During hyperglycemic hyperosmolar state (HHS),

A. the anion gap is usually 15 mEq/L or greater.
B. ketonemia is present.
C. serum glucose levels may be 600-2400 mg/dL.
D. serum bicarbonate level is less than 10 mEq/L.

Back 7

C. serum glucose levels may be 600-2400 mg/dL.

In hyperglycemic hyperosmolar state (HHS), the pt will produce sufficient insulin to avoid ketosis and will not display ketoacidosis or abnormally low bicarbonate. The pt will develop extremely high glucose levels and may also display lactic acidosis.

Front 8

One initial goal of hyperglycemic hyperosmolar state (HHS) is to:

A. bring the blood glucose level to a normal range quickly.
B. alleviate ketosis.
C. diurese the pt aggressively.
D. rehydrate the pt slowly.

Back 8

D. rehydrate the pt slowly.

In HHS, the pt is usually frail and elderly with a multitude of other medical complications. Fluid resuscitation must proceed slowly in order to avoid cerebral edema and pulmonary edema.

Front 9

Severe hypoglycemia is usually caused by which one of the following?

A. missed meals or too much exercise
B. counter-regulatory hormones such as cortisol or epinephrine
C. skipping oral hypoglycemic medications
D. severe, critical illness in a pt with diabetes

Back 9

A. missed meals or too much exercise.

Missed meals and excessive exercise will lower glucose levels. Counter-regulatory hormones (such as cortisol and epinephrine), skipping oral hypoglycemic meds, and severe illness in a person with diabetes elevate the glucose level.

Front 10

Hypoglycemia can be treated by all the following excpet:

A. glucagon injection
B. glipizide orally
C. dextrose intravenous push
D. orange juice orally

Back 10

B. Glipizide orally

Glipizide is a potent oral sulfonylurea drud that will aggravate hypoglycemia. Glucagon injection, dextrose IV push, and orange juice will all correct hypoglycemia.

Front 11

A 14-year-old boy is admitted with DKA. He is exhibiting Kussmaul's breathing. This is most likely:

A. a sign of respiratory acidosis
B. an attempt to compensate for metabolic acidosis
C. caused by central nervous system failure.
D. a sign of underlying pneumonia.

Back 11

B. an attempt to compensate for metabolic acidosis.

If bicarbonate anion is lost because of its displacement by ketoacid anions, excess carbon dioxide gas must be driven off at the level of the lung by hyperventilation.

Front 12

A 40-year-old insulin-dependent diabetic is becoming increasingly stuporous. He is pale, diaphoretic, and tachycardic. The initial treatment of choice in this case is:

A. a low-dose insulin infusion.
B. a bolus of high-dose insulin
C. a bolus of 50% dextrose.
D. fluid replacement.

Back 12

C. a bolus of 50% dextrose

Treatment of insulin reactions is always glucose. If the patient is too groggy, stuporous, or uncooperative to drink, a bolus of 25 g of 50% dextrose is given intravenously over several minutes.

Front 13

A critically ill patient is admitted for "thyrotoxicosis." An appropriate nursing assessment would be:

A. checking the patient's temperature
B. monitoring intake and output.
C. performing daily weights.
D. assessing for signs of infection.

Back 13

A. checking the patient's temperature

Extremes of manifestations, specifically temperature greater than 104 degrees F (40 degrees C) in the absence of infection, tachycardia, and CNS dysfunction, may be present.

Front 14

A patient being admitted through the emergency room with a diagnosis of hyperosmolar hyperglycemia, nonketotic coma (HHS) will most likely have which of the following signs and symptoms upon arrival?

A. Dehydration
B. Hyperventilation
C. Cyanosis
D. Fluid overload

Back 14

A. Dehydration

Marked dehydration develops if the patient is unable to maintain an adequate fluid intake.

Front 15

Complications of hypothyroidism include:

A. paralytic ileus.
B. malignant hypertension.
C. pulmonary edema.
D. All of the above are correct

Back 15

A. paralytic ileus.

Signs and symptoms of hypothyroidism include fatigue, weakness, decreased bowel sounds, decreased appetite, weight gain, and ECG changes.

Front 16

Hypoglycemia or an insulin reaction is best treated with:

A. fluids.
B. glucose.
C. vitamins.
D. all of the above.

Back 16

B. glucose.

Treatment of insulin reactions is always glucose.

Front 17

If left untreated, a critically ill patient with diabetes insipidus can quickly develop:
A. fluid overload.
B. seizures.
C. hypovolemia.
D. pulmonary embolus.

Back 17

C. hypovolemia

Diabetes insipidus can lead to water diuresis and dehydration.

Front 18

In diabetic ketoacidosis (DKA), glomerular filtration is decreased leading to a/an:
A. increased blood glucose.
B. decreased serum potassium
C. decreased serum creatinine.
D. both b and c.

Back 18

A. increased blood glucose

As vascular volume falls, glomerular filtration also falls. This decreasing renal function leads to increasing blood levels of glucose, potassium, urea nitrogen, and creatinine.

Front 19

In managing a patient with Addison's disease, the immediate goal of therapy is to:
A. control the dysrhythmias.
B. promote renal perfusion.
C. stabilize the body temperature.
D. restore hormones.

Back 19

D. restore hormones.

The immediate goal of therapy is to administer the needed hormones and restore fluid and electrolyte balance.

Front 20

In managing the patient with DKA, the immediate treatment modality would be to:

A. restore potassium levels
B. replace fluids.
C. administer dextrose.
D. control arrhythmias.

Back 20

B. replace fluids.

Treatment goals for the patient with DKA include improving circulatory volume and tissue perfusion; correcting electrolyte imbalances; decreasing serum glucose; correcting ketoacidosis; and determining the precipitating cause.

Front 21

In thyroid toxicosis, severe cardiac decompensation can most likely result from:
A. an altered, ineffective airway.
B. a reduced cardiac output.
C. poor renal perfusion.
D. ineffective breathing patterns.

Back 21

B. a reduced cardiac output.

Cardiovascular decompensation, secondary to decreased stroke volume and reduced cardiac output, may be life-threatening.

Front 22

Mineralocorticoid deficiency can result in:
A. hypoglycemia.
B. hypercalcemia.
C. hyperkalemia.
D. hypernatremia.

Back 22

C. hyperkalemia

Laboratory values in acute conditions of glucocorticoid and mineralocorticoid deficiency show hyponatremia, hyperkalemia, decreased serum bicarbonate levels, and elevated blood urea nitrogen.

Front 23

Mr. Klein has oat cell carcinoma of the lung. He is currently admitted with acute mental status changes and a sodium level of 118 mEq/L. His diagnosis most likely is:

A. hypothyroidism.
B. Graves' disease.
C. SIADH.
D. diabetes insipidus.

Back 23

C. SIADH.

Hyponatremia is the clinical focus and probable cause of hospital admission in patients with SIADH.

Front 24

Myxedema is brought on by:

A. severe hyponatremia.
B. profound increased metabolism.
C. extreme hypothyroidism
D. adrenal crisis.

Back 24

C. extreme hypothyroidism.

Myxedema coma is a rare, life-threatening emergency brought on by extreme hypothyroidism.

Front 25

Propylthiouracil is administered to:

A. increase levels of triiodothyronine
B. block conversion of thyroxine to triiodothyronine.
C. manage symptoms of hypothyroidism.
D. take the place of thyroxine.

Back 25

B. block conversion of thyroxine to triiodothyronine.

Propylthiouracil blocks the conversion of T4 to T3 in peripheral tissues.

Front 26

The most common cause of primary adrenal insufficiency in the industrialized West is:

A. asbestos exposure.
B. malnutrition.
C. Mycobacterium tuberculosis infection.
D. autoimmune adrenalitis.

Back 26

D. autoimmune adrenalitis.

The most common cause of primary adrenal insufficiency in the industrialized West is autoimmune adrenalitis.

Front 27

The patient with diabetic ketoacidosis will most likely have:

A. hypo-osmolarity.
B. uncontrolled ketogenesis.
C. hypoventilation.
D. hypoglycemia.

Back 27

B. uncontrolled ketogenesis.

The second major consequence of severe insulin deficiency is uncontrolled ketogenesis.

Front 28

Undiagnosed Graves' disease can lead to:

A. thyroid crisis.
B. myxedema coma.
C. adrenal crisis.
D. syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Back 28

A. thyroid crisis.

Specific diseases that cause hyperthyroidism include Graves' disease, exogenous hyperthyroidism, thyroiditis, toxic nodular goiter, and thyroid cancer.

Front 29

Volume depletion in the patient with DKA is a direct result of:

A. glycosuria.
B. acidosis.
C. decreased glomerular filtration.
D. the brain's response to glucose deprivation.

Back 29

A. glycosuria.

Glycosuria is largely responsible for volume depletion.

Front 30

When assessing for lab abnormalities in the critically ill patient with the syndrome of inappropriate antidiuretic hormone (SIADH), the nurse will find:

A. plasma hyponatremia.
B. serum hyperkalemia.
C. serum hypercalcemia.
D. low urine specific gravity.

Back 30

A. plasma hyponatremia.

Hypotonic hyponatremia is the hallmark of SIADH.