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396 Cards in this Set
- Front
- Back
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unneeded glucose is stored in the _____ as ______
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liver; glycogen
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The process in which glycogen is converted to glucose:
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glycogenolysis
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glucose is stored in fat cells as __________
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triglycerides
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Definition: glycogenesis
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conversion of glucose to glycogen
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Definition: glycogenolysis
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production of glucose from glycogen
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Definition: gluconeogensis
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formation of glucose from noncarbohydrate sources stimulated by glucocorticoids
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With insufficient insulin glycogenesis is _______ (increased or decreased)
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decreased
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With insufficient insulin glycogenolysis is _______ (increased or decreased)
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increased
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With insufficient insulin gluconeogenesis is _______ (increased or decreased)
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increased
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Definition: glycolysis
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breakdown of glucose to CO2 and H2O
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With insufficient insulin glycolysis is _______ (increased or decreased)
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decreased
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With insufficient insulin lypolysis is _______ (increased or decreased)
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increased
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Definition: lypolysis
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breakdown of fats to ketones
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What are the 5 counterregulatory hormones r/t blood glucose?
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Glucagon
epinephrine cortisol norepinhephrine growth hormone |
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The counterregulatory hormones __________ blood glucose. (increase or decrease)
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increase
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DKA is most common in what type of diabetes?
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Type I/insulin dependent
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What is: an acute complication of DM associated with absolute or relative insulin deficiency resulting in hyperglycemia, dehydration, electrolyte depletion, and ketosis?
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DKA, Diabetic Ketoacidosis
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what is the most common cause of DKA?
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infection
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What will you find when assessing the skin of a pt with DKA?
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hot, dry, skin
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What will you find when assessing the nuero status of a pt with DKA?
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Lethargy, fatigue and altered LOC
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What will you find when assessing the GI symptoms of a pt with DKA?
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Anorexia
nausea vomitting abd. pain |
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What will you find when assessing the respiratory system of a pt with DKA?
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Kussmal respirations
Fruity smelling breath |
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What will you find when assessing the CV system of a pt with DKA?
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tachycardia
hypotension weak/thready pulses |
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What will you find when assessing the weight of a pt with DKA?
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weight loss
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The blood glucose for a patient with DKA will be...
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>300 mg/dL (average is 675 mg/dL)
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A + finding of serum and urine ketones suggest what diabetic emergency?
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DKA
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What will the pH of a patient with DKA be?
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< 7.35 (acidic)
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What will the HCO3 of a patient with DKA be?
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<15 meq/L (metabolic acidosis)
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What is the progression of potassium levels in DKA?
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Normal initially, then high, then low
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What will the BUN of a patient with DKA be?
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>20 mg/dL
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What will the Cr of a patient with DKA be?
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>1.5 meq/L
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What 3 things does treatment of DKA aim to correct?
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Hyperglycemia
volume depletion electrolyte imbalances |
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What are the "three P's" symptoms of DKA?
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polyuria
polydipsia polyphagia |
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what is HHNS?
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Hyperosmolar hyperglycemic state resulting from inadequate insulin secreation WITHOUT SIGNIFICANT KETOSIS
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HHNS is most ocmmon in what type of diabetes?
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type 2 diabetes
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Which is usually more severe: DKA or HHNS?
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HHNS
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What is the most common cause of HHNS?
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severe dehydration
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What is the BG of a patient with HHNS?
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>800 mg/dL (often > 1000mg/dL)
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What is the serum osmolalaity of a patient with with HHNS?
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>350mOms/L (very high/concentrated)
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What is the pH of a patient with with HHNS?
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>7.40
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What is the HCO3 of a patient with with HHNS?
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>20 meq/L (slightly acidodic)
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Will you find serum and urine ketones in a patient with HHNS?
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no
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The BUN and Cr will be _____ in a patient with HHNS. (elevated or low)
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elevated
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What is the time goal for complete rehydration and normalization of BG in a patient with HHNS?
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36-72 hours
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When treating DKA or HHNS how quickly should you try to lower blood glucose?
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by 50-75 mg/dl/hr
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When treating DKA or HHNS what type of insulin will be used?
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loading dose of regular insulin followed by regular insulin infusion
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How often should BG be monitored with a patient in DKA or HHNS?
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qhour
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What fluids are given to a HHNS patient in the first 1-2 hours? what about after the first 1-2 hours?
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2 Liters NS over first 1-2 hours then 1/2 NS slower after
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When treating HHNS what fluids should be given when a patients BG reaches 250?
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D5&1/2NS
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With a patient with HHNS in severe fluid volume deficite you need to watch for ____kalemia,
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hypokalemia
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What are the primary differences between DKA and HHNS?
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DKA- serum and urine ketones and metabolic acidosis
HHNS- SEVERE dehydration |
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What is the most common diabetic emergency?
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hypoglycemia
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Hypolglycemia is clinically characterized by a BG < ___mg/dL, though symptoms may present earlier
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<70 mg/dL
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What are the 3 adrenergic s/s of hypoglycemia?
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shaky/tremulous
heart pounding nervous/anxious |
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what are the 3 cholinergic s/s of hypoglycemia?
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sweaty
hungry tingling |
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If BG is 51-70 what should be given?
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10-15 gm glucose orally if awake
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If BG is 50 or less what should be given?
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20-30 gm glucose orally if awake
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5 gm glucose will elevate BG by how much?
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approx. 20 mg/dL
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If a patient is hypoglycemic and unresponsive what should be given?
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50cc D50W
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Glucagon injections are only affective in patients whose...
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glycogen stores have not been depleted
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How much glucagon can you give a patient whose hypoglycemic and unconcious? how can it be given?
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0.5-1 mg glucagon IM, IV, or SC
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Does insulin stimulate or inhibit: glucose uptake by the cells
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stimulate
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Does insulin stimulate or inhibit: glycogenolysis
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inhibit
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Does insulin stimulate or inhibit: glyconeogenesis
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inhibit
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Does insulin stimulate or inhibit: glycogenesis
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stimulate
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Does insulin stimulate or inhibit: lipolysis
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inhibit
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Does insulin stimulate or inhibit:protein catabolism
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inhibit
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With DKA, the arterial pCO2 will most likely be _______ as a compensatory mechanism
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decreased (respiratory alkalosis)
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What is the Primary difference between DKA and HHNS?
a. level of hyperglycemia b. amount of ketones produced c. level of hyperosmolarity d. amount of fluid depletion |
b. level of ketones produced
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What nursing diagnosis would be appropriate for a pt. with DKA?
a.risk for injury r/t hyperglycemia b. risk for injury r/t hypoglycemia c. body image disturbance d. chronic pain |
a. risk for injury r/t hyperglycemia
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Which of the following should a nurse be prepared to administer to a pt with DKA?
a. orange juice b. D50W c. glucagon injection d. short acting insulin |
d. short acting (regular) insulin
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Two hours after therapy initiation, a patient with DKA has gone from a BG of 900 mg/dL to 400 mg/dl. This patient is now most at risk for:
a. hypoglycemia b. cerebral edema c. renal shutdown d. chronic pain |
a. hypoglycemia. this patients BG is being lowered too quickly
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The adenohypophosis is the (anterior or posterior) lobe of the pituitary gland.
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anterior lobe
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The neurohypophosis is the (anterior or posterior) lobe of the pituitary gland.
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posterior
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ACTH stimulates the adrenal gland to release what?
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cortisol, epinephrine, norepinephrine, aldosterone, etc
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LH stimulates secreation of ________ and _________ and stiumlates __________
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aldosterone and testosterone and ovulation
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FSH stimulates the release of ___________ and stimulates _____________
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estrogen; spermatogenesis
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MSH is responsible for....
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pigmentation in the skin
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where is Vasopressin stored?
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posterior pituitary
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Hypopituitarism is characterized by...
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deficiency of one or more of the hormones produced by the pituitary gland
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a decrease in the release of TSH from the anterior pituiatary will result in....
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hypothyroidism
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A decreases in ACTH from the anterior pituitary can result in...
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secondary adrenocortical insufficiency
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A deficiency of GH from the anterior pituitary will result in...
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dwarfism
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Is this secreted by the anterior or posterior lobe of the pituitary: TSH
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anterior
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Is this secreted by the anterior or posterior lobe of the pituitary: ACTH
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anterior
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Is this secreted by the anterior or posterior lobe of the pituitary:vasopressin (ADH)
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posterior
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Is this secreted by the anterior or posterior lobe of the pituitary: LH
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anterior
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Is this secreted by the anterior or posterior lobe of the pituitary: FSH
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anterior
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Is this secreted by the anterior or posterior lobe of the pituitary: PRL
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anterior
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Is this secreted by the anterior or posterior lobe of the pituitary: Oxytocin
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posterior
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Is this secreted by the anterior or posterior lobe of the pituitary: GH
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anterior
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Is this secreted by the anterior or posterior lobe of the pituitary: MSH
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anterior
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Where is the "problem" with primary hpothyroidism?
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thyroid gland
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Where is the "problem" with secondary hpothyroidism?
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pituitary gland
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Where is the "problem" with tertiary hpothyroidism?
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hypothalmus
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What is characteristic of hyperpitutarism?
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oversecretion of one or more of the hormones secreted by the pituitary gland
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What is gigantism
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too much GH resuilting in overgrowth of Long bone: occurs in children
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what is acromegaly
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too much GH resulting in increased bone thickness and hypertrophy of soft tissue; occurs in adults
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what is the most common cause of hyperpituitarism?
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benihn pituitary adenoma
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What is the most common type of benign pituitary adenoma?
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prolactinomas
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In a patient with hyperpituitarism an angiography is used to...
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observe the blood flow to the pituitary gland
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what is the most common and definitive therapy for hyperpituitarism?
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surgery
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What is the main concern with use of Bromocriptine mesylate (parlodel), Cabergoline (Dostinex), and Pergolide (permax)?
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orthostatic hypotension
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How do Bromocriptine mesylate (parlodel), Cabergoline (Dostinex), and Pergolide (permax) help with hyperpituitarism?
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they stimulate dopamine receptors and inhibit the release of pituitary hormones thus decreasing tumor size and production of hormones
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How are octreiotide (sandostatin) and pegvisomant (somavert) given?
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subcutaneous injection on a daily or weekly basis
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How does Octreotide (sandostatin) help in hyperpituitarism?
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it inhibits GH release
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How does Pegvisomant (Somavert) help in hyperpituitarism?
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it is a GH receptor blocker
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What is a major side effect of both sandostatin and somavert? (these meds are given for hyperpituitarism)
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Gall bladder disease
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What is the most common treatment for hyperpituitarism?
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transsphenoidal hypophysectomy
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Where is the incision made in a transsphenoidal hypophysectomy?
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underneath the upper lip
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How long after a transsphenoidal hypophysectomy will a patient have to breath through their mouth?
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2-3 days postop
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How long will numbness and a decreased sense of smell persist after a transsphenoidal hypophysectomy?
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3-4 months
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How should you position a patient post transsphenoidal hypophysectomy?
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with HOB 30-45 degrees. NO MORE than 45 degrees because it will increase ICP
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What should you encourage a patient to do post transsphenoidal hypophysectomy to prevent PNA?
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Turn and deep breath...use incetive spirometer but NO COUGHING (increases ICP)
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How often should you monitor neuro status post transsphenoidal hypophysectomy?
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q hour
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What is a late sign of increased ICP?
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vital sign changes....it may be too late if you don't catch it before this
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How should a patient wait before brushing teeth post transsphenoidal hypophysectomy?
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at least 2 weeks
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What can be used for mouthcare after transsphenoidal hypophysectomy? how often?
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saline rinse or H2O2/H2O mix (50%) q2h 7-10 daysfor
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What are possible s/s of a CSF leak post transsphenoidal hypophysectomy?
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frequent swallowing, postnasal drip, halo effect on mustache dressing
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What are s/s of meningitis post transsphenoidal hypophysectomy?
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fever, nuchal rigidity, HA
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Where is ADH produced?
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hypothalamus
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Where is ADH stored?
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posterior pituitary gland (neurohypophysis)
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What determines the release of ADH?
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vascular osmolality
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Diabetes insipidus is a deficiencly in...
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synthesis or release of ADH
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Diabetes Insipidus results in excess loss of...
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water
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What causes neurogenic DI?
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ADH deficiency
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What causes nephrogenic DI?
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kidneys are insensitive to ADH
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What is a possible secondary cause of DI?
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overhydration via IV or PO
ex. psychogenic water drinkers |
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Trauma to what 2 areas can results in neurogenic DI?
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pituitary or hypothalamus
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WHat is the most common cause of nephrogenic DI?
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chronic renal disease
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The urine output in DI will be....(high or low)
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very high
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The specific gravity in DI will be....(high or low)
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very low: urine is basically free water, it is very dilute
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What is the primary complication (cause of death) for patients with DI?
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hypovolemic shock
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How much urine is lost with DI per day?
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polyuria....5-40 L/24 hrs
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What is the serum osmolality in DI?
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>295 mOsm/kg H2O....Very concentrated
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What is the serum Na in DI?
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>145 mEq/L (high)
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ADH is _________ in neurogenic DI and ________ in nephrogenic DI
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decreased in neurogenic DI and increased in nephrogenic DI
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Specific gravity in DI will be...
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< 1.005
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Urine osmolality in DI will be....
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< 100 mOsm/kg H2O
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what is the normal value of urine osmolality?
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50-1200 mOsm/kg H2O
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What 2 tests are used to diagnose DI?
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water deprivation test
vasopressin test |
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What should be given for fluid replacement in a patient with DI?
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D5W, if patient is shocky give NS
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What does Chlorpropamide (Diabinese) do in DI?
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increases the action/production of ADH
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What are side affects of Vasopressin?
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HA, nausea, mild abd. cramps
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What do you need to watch for when treating a patient with Vasopressin for DI?
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fluid overload
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What 2 treatments are given for a patient with nephrogenic DI?
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thiazide diuretics to decrease Na and soidum restriction
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CVP and wedge pressure will be ________ if a patient is in fluid volume deficit (high or low?)
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low
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What is the most common cause of Neurogenic DI?
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trauma to the pituitary or hypothalamus
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What is SIADH?
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excess ADH unrelated to plasma osmolality r/t failure in negative feedback mechanism
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What is the most common cause of SIADH?
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small cell carcinoma (lung cancer)
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What 2 tests are used to diagnose DI?
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water deprivation test
vasopressin test |
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What should be given for fluid replacement in a patient with DI?
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D5W, if patient is shocky give NS
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What does Chlorpropamide (Diabinese) do in DI?
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increases the action/production of ADH
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What are side affects of Vasopressin?
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HA, nausea, mild abd. cramps
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What do you need to watch for when treating a patient with Vasopressin for DI?
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fluid overload
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What 2 treatments are given for a patient with nephrogenic DI?
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thiazide diuretics to decrease Na and soidum restriction
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CVP and wedge pressure will be ________ if a patient is in fluid volume deficit (high or low?)
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low
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What is the most common cause of Neurogenic DI?
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trauma to the pituitary or hypothalamus
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What is SIADH?
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excess ADH unrelated to plasma osmolality r/t failure in negative feedback mechanism
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What is the most common cause of SIADH?
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small cell carcinoma (lung cancer)
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What 3 pulmonary disorders could lead to SIADH?
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TB
COPD Pnuemonia |
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In SIADH CVP and wedge pressure will be ____ (high or low)
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high
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What will the renal assessment of a pt with SIADH reveal?
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dark urine, decreased UOP, increased specific gravity and increased osmolality
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Urine specific gravity and osmolality with be ______ in SIADH (increased or decreased)
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increased
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What neuro s/s will be seen in both DI and SIADH?
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confusion, restlessnless, lethargy, HA, seizures, coma
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What GI s/s will be seen in a pt with SIADH?
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N/V
anorexia decreased bowel sounds muscle cramps |
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What respiratory s/s will be seen in SIADH?
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tachypnea
dyspnea adventitious sounds frothy pink sputum |
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What will the serum Na be in a patient with SIADH?
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< 135 mEq/L
Delusional hyponatremia |
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What will the serum osmolality be in a patient with SIADH?
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<275 mOsm/kg H2O
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The serum ADH of a patient with SIADH will be....
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elevated
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Urine sodium in a patient with SIADH will be...
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>20 mEq/L
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What is the primary treatment for SIADH?
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fluid restriction (800-1000 mL/day)
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What will be high in the diet of a patient with SIADH?
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sodium. add salt to everything
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What type of fluids should be given if needed to a pt with SIADH?
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hypertonic saline and diuretics (lasix)
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Why give hypertonic fluids to a patient with SIADH?
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it pulls water out of the cells and into the vascular space
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What can be given in severe cases of SIADH to decrease renal response to ADH?
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demeclocycline
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What does Vaprisol do for a patient with SIADH?
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it blocks vasopressin and premits clearance of free water
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Because Vaprisol is very toxic to the veins, what should be done when administering?
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dilute and give in large vein and rotate administration site q24h
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In a patient with SIADH urine output will be ________ (increased or decreased)
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decreased
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In a patient with SIADH urine osmolality will be ________ (increased or decreased)
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increased (very concentrated)
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In a patient with SIADH urine specific gravity will be ________ (increased or decreased)
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increased
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What 3 hormones are secreted from the adrenal cortex?
|
cortisol, aldosterone, and androgen
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Aldosterone helps the body retain...
|
Na
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Addisons disease results in decreased secretion of what 3 things?
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glucocorticoids, aldosterone, and androgens
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What is the most common cause of addisons disease?
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autoimmune dysfunction
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With addisons disease what 3 things are poorly metabolized?
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CHO, Fats, protein
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In addisons disease ACTH is ________ (increased or decreased)
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increased
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The increase in ACTH with addisons disease causes a stimulation of MSH which leeds to ...
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pigmentation inconsistencies
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In addisons disease there is an ______ loss of Na and H2O (increased or decreased)
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increased
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Why is there excessive loss of sodium and water in addisons disease?
|
insufficient aldosterone production
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Potassium is _________ in addisons disease. (retained or excreted)
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retained; due to the inverse relationship with Na
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What does a person with Addison's disease crave?
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salt
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What GI s/s will be seen in addisons disease?
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anorexia
nausea vomitting |
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What neuro s/s are seen in addisons disease?
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lethargy
fatigue weakness |
|
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Hyperpigmentation and vitiligo can be seen in what endocrine disorder?
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Addison's disease: increasted ACTH leads to increased stimulation of MSH
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Serum calcium will be ______ with addison's disease.(increased or decreased)
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increased
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Serum Na will be ______ with addison's disease.(increased or decreased)
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decreased
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BP will be ______ with addison's disease.(increased or decreased)
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decreased
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Serum potassium will be ______ with addison's disease.(increased or decreased)
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increased
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What GI s/s will be seen in Addison's disease?
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anorexia
nausea vommitting wt. loss abd pain constipation diarrhea |
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Serum cortisol will be ______ with addison's disease.(increased or decreased)
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decreased
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BUN will be ______ with addison's disease.(increased or decreased)
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increased r/t dehydration
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In Addison's disease will cortisol levels rise during a stimulation test?
|
no
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What is the most difinitive diagnostic test for addisons disease?
|
ACTH stimulation test
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Risk for hypoglycemia will be ______ with addison's disease.(increased or decreased)
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increased
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What needs to be monitored when giving fludrocortisone for Addison's disease?
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BP
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If a patient is taking divided doses of cortisol, when should most of the medication be taken?
|
in the AM because that is when your body naturally produces the most cortisol
|
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What is the primary nursing diagnosis for Addison's disease?
|
FVD
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What is Addisonian Crisis?
|
acute adrenal insufficiency that is life-threatening.
|
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What causes Addisonian Crisis?
|
usually a stressful event that increases the need for cortisol and aldosterone beyond the supply
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What must be given ASAP for a person in addisonian crisis?
|
D5NS and Solu-Cortef
|
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What secondary issues need to be managed in Addisonian crisis?
|
Hyperkalemia
Hypoglycemia |
|
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What is Cushings disease?
|
hypersection of the adrenal cortex of one or all hormones (corisol and androgens)
|
|
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What is the most common population for Cushings syndrome?
|
women age 20-40
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What are the primary causes of Cushings syndrome?
|
cortisol secreting tumor
Pituitary tumor excessive administration of glucocorticoids |
|
|
In Cushings disease catabolism of protein and fat will be _______.(increased or decreased)
|
increased
|
|
|
In cushings disease Blood sugar is often ________ (increased or decreased)
|
increased
|
|
|
The increase in chatecholamine sensitivity in Cushings disease leads to vaso_______
|
dilation
|
|
|
What causes impaired immune function in cushings disease?
|
excessive corticosteriods kill leukocytes and suppress manifestations of infection
|
|
|
Where is the weight gain in Cushings disease?
|
trunk
face buffalo hump |
|
|
What injuries is a patient with Cushing's syndrome at risk for?
|
pathologic fractures
skin tears |
|
|
In Cushings Disease serum Coritaol will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease serum Na will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease blood sugar will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease serum Ca will be _________ (increased or decreased)
|
decreased
|
|
|
In Cushings Disease serum k will be _________ (increased or decreased)
|
decreased
|
|
|
In Cushings Disease lymphocytes will be _________ (increased or decreased)
|
decreased
|
|
|
In Cushings Disease urinary cortisol will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease urinary Ca will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease urinary k will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease urinary sugars will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease urinary 17-ketosteroids will be _________ (increased or decreased)
|
increased
|
|
|
In Cushings Disease urinary 17-hydroxycorticosteriods will be _________ (increased or decreased)
|
increased
|
|
|
What is the definitive test for chusings disease?
|
dexamethasone suppression test
|
|
|
The patient with cushings disease is at risk for or in Fluid volume ________ (overload or deficit)
|
overload
|
|
|
What does Mitotane (Lysodren) do for the patient with Cushings disease?
|
inhibits corticosteroid synthesis by destroying cortical cells
|
|
|
What does Aminogluthethamide (cytadren) do for the patient with Cushings disease?
|
it is an adrenal enzyme inhibitor and decreases cortisol production
|
|
|
What should be given 24 hours before, during, and possibly after adrenalectomy?
|
corticosteroid infusion
|
|
|
What is given IV 24-48 hours post op adrenalectomy?
|
IV saline and hydrocortisone
|
|
|
how long is hormone replacement needed for a unilateral adrenalectomy?
|
1-2 years
|
|
|
What is a pheochromocytoma?
|
catecholamine secreting tumor of the chromaffin cells usually found in the adrenal medulla
|
|
|
where is a pheochromocytoma usually located?
|
adrenal medulla
|
|
|
Pheochromocytoma results in an excess secretion of what 2 things?
|
epinephrine and norepinephrine
|
|
|
What affect does excess epi have on HR?
|
increases
|
|
|
What affect does excess epi have on BP?
|
increases
|
|
|
What affect does excess epi have on CO?
|
increases
|
|
|
What affect does excess epi have on RR?
|
increases
|
|
|
What affect does excess epi have on vessels?
|
constriction
|
|
|
What affect does excess epi have on pupils and bronchi?
|
dilates
|
|
|
What affect does excess epi have on body metabolism?
|
increases
|
|
|
What affect does excess norepi have on HR?
|
increases
|
|
|
What affect does excess norepi have on BP?
|
increases
|
|
|
What affect does excess norepi have on metabolism?
|
increases
|
|
|
What affect does excess norepi have on CO?
|
decreases
|
|
|
What affect does excess norepi have on vessels?
|
increases
|
|
|
What affect does excess norepi have on pupils?
|
dilates
|
|
|
What is the primary (and most dangerous) symptom of pheochromocytoma?
|
HTN....often malignant hypertension
|
|
|
What affect does excess norepi and epi have on BG?
|
increases
|
|
|
WIth pheochromocytoma urinary catecholamines will be ________ (increased or decreased)
|
increased
|
|
|
What is the diagnostic test for Pheochromocytoma?
|
24 hour urine
|
|
|
What 5 things must be avoided for 2 full days before a 24 hour urine test for pheochromocytoma?
|
vanilla
chocolate fruit meds tea |
|
|
With pheochromocytoma Serume catecholamines will be ________ (increased or decreased)
|
increased
|
|
|
what is the treatement of choice for pheochromocytoma?
|
adrenalectomy
|
|
|
what is used to stabalize BP preoperatively for 2-3 weeks before adrenalectomy for pheochromocytoma?
|
alpha adrenergic blockers
|
|
|
When performing a physical examination of the thyroid gland, precautions are taken in performing the correct technique because palpation can result in which of the following?
a. damage to the esophagus, causing gastric refulx b. an obstruction of the carotid arteries causing a stroke c. pressure on the trachea and laryngeal nerve causing hoarseness d. an exacerbation of symptoms by releasing additional thyroid hormone |
D and exacerbation of symptoms by releasing additional thyroid hormone
|
|
|
Hyperthyroidism will _______ metabolic rate (increase or decrease)
|
increase
|
|
|
Hypothyroidism will _________ metabolic rate (increase or decrease)
|
decrease
|
|
|
Which of the following is the hallmark assessment finding signifying hyperthyroidism?
a. weight loss b. increased libido c. heat intolerance d. diarrhea |
c. heat intolerance
|
|
|
What is one of the first signals of hyperthyroidism that is often noticed by pt?
a. eyelid or globe lab b. vision changes or tiring of the eyes c. protruding eyes d. photophobia |
b vision changes or tiring of the eyes
|
|
|
Which of the following lab results is consistent with hyperthyroidism?
a. decreased t3 and t4 levels b. elevated TRH level c. decreased radioatctive iodine uptake d. increased T3 and T4 levels |
d. increased serum T3 and T4 levels
|
|
|
The clinical manifestation resulting from an increase in thyroid hormon production is known as which of the following?
a. thyrotoxicosis b. euthyroid function c. graves disease d. hypermetabolism |
a thyrotoxicosis
|
|
|
What is the most common cause of hyperthyroidism?
a. radiation to thyroid b. graves disease c. thyroid cancer d. thyroiditis |
b. graves disease
|
|
|
Exophthalmos
|
abnormal protrusion of the eyes
|
|
|
pretibial myxedema
|
dry waxy swelling of fron surface of lower extremity
|
|
|
eyelid retraction
|
lid lag- upper lid fails to descend when client gazes slowly downward
|
|
|
Globe (eyeball) lag
|
upper lid pulls back faster than the eye when client gazes up
|
|
|
Lab findings of elevated T3 and T4, decreased TSH, and high thyrotropin receptor antibody titer indicate which?
a multinodular goiter b. hyperthyroidism r/t overmedication c. a pituitary tumor suppressing TSH d. Graves disease |
d. Grave's disease
|
|
|
A client with exopthalmost form hyperthyroidism complains of dry eyes, especially in the morning. whats the best nursing advise?
a. wear sunglasses at all times when outside in the sun b. use cool compresses to the eye four times a day c. tape the eyes closed with non-allergenic tape d. there is nothing that can be done |
c. tape the eyes closed with non-allergenic tape
|
|
|
What is thyroid storm?
|
extreme state of hyperthyroidism that is life threatening, comes on quicly, and occurs in clients who are uncontrolled
|
|
|
What can trigger thyroid storm?
|
stressors such as trauma, infection, DKA, pregnancy, vigorous palpation of goiter
|
|
|
Temperature in thyroid storm will be _______ (high or low)
|
high; fever
|
|
|
HR in thyroid storm will be _______ (high or low)
|
high; tachycardia
|
|
|
BP in thyroid storm will be _______ (high or low)
|
High; systolic HTN
|
|
|
What are neuro s/s of thyroid storm?
|
tremors
anxiety restlessness confusion psychosis seizures coma |
|
|
what are GI s/s of thyroid storm?
|
N/V
diarrhea abd. pain |
|
|
What is the mortality of thyroid storm?
|
25%
|
|
|
What antithyroid drugs can be used for thyroid storm?
|
PTU
Tapezole Iodine products Inderal Steroids |
|
|
Management of the client with hyperthyroidism focuses on which of the following (check all that apply)
a. blocking the effects of excessive thyroid secretion b. treating the signs and symptoms the client experiences c. establishing euthyroid function d. preventing the spread of disease |
A, B, and C
|
|
|
Which medicine given for hyperthyrdoidism must be discontinued if sore throat, fever, HA, or skin eruptions occur?
|
Tapazole (antithyroid)
|
|
|
What drugs can be used as preoperative treatment to obtain euthyroid? (3)
|
Tapazole
PTU Iodine preparations |
|
|
Which 2 drugs decrease the production of thyroid hormone?
|
Tapazole and PTU
|
|
|
What drug works to control hyperthyroid symptoms r/t sympathetic nervous system of tachycardia, palpations, anxiety, and diaphoresis?
|
Inderal (beta-blocker)
|
|
|
A total thyroidectomy will require thyroid replacement therapy for how long?
|
lifelong
|
|
|
What drug is used limitedly with hyperthyroidism because of its side effects?
|
Lithium carbonate
|
|
|
What drug used to treat hyperthyroidism must be taken with food?
|
Inderal (beta blocker)
|
|
|
What drug may cause hypothyroidism over time?
|
Radioactive iodine
|
|
|
What drug used to treat hyperthyroidism is contraindicated in pregnancy because it crosses the placenta?
|
Radioactive iodine
|
|
|
What drug must be administered around the clock?
|
PTU
|
|
|
What 2 treatements may require antithyroid medication for up to 8 weeks past treatment?
|
Radioactive iodine
subtotal thyroidectomy |
|
|
What hyperthyroid medication acts to decrease blood flow to reduce hormone produciton with results in 2-6 weeks?
|
iodine preparations
|
|
|
What drug works to correct hyperthyroidism by damaging the thyroid gland?
|
Radioactive iodine
|
|
|
What treatement for hyperthyroidism removes all of the thyroid?
|
total thyroidectomy
|
|
|
What medication given for hyperthyroidism includes teaching to avoid crowds and sick people due to reduced immune response?
|
dexamethasone
|
|
|
What is the treatment for thyroid cancer?
|
total thyroidectom
|
|
|
T or F: teach thyroid surgery pts of postoperative restrictions such as no coughing and deep breathing exercies to prevent strain on suture lines.
|
F, a patient may cough and deep breath post op and needs to support the neck while doing so
|
|
|
T or F: teach moving and turning technique of manually suppporting the head and avoiding neck extension to minimize strain on the suture line to all thyroid surgery patients
|
T
|
|
|
T or F: inform the client that hoarsness for a few days post thyroid surgery is usually the result of a breathing tube useding during surgery but will be monitored with respiration and weakness of voice.
|
T
|
|
|
T or F: Humidification of air may be helpful to promote expectoration of secretions post thyroid surgery. Suctioning may also be used
|
T
|
|
|
T or F: clarify any questions regarding placement of incision, complications, and post op care for every surgery.
|
T
|
|
|
T or F: supine position and lying flat will be maintained postopertaively for thyroid surgery to avoid strain on the suture line
|
F; semi fowlers positions
|
|
|
T or F: teach the client to report immediately any repiratory difficulty, tingling around lips or fingers, or muscular twitching post thyroid surgery
|
T
|
|
|
T or F: a drain may be present in the incision post thyroid surgery. ALl drainange and dressings will be monitored closely for 24 hours
|
T
|
|
|
When would calcium gluconate or calcium chloride be given IV for a postop thyroid surgery pt?
|
for hypocalcemia and tetany= if there is tingling aroudn the mouth or toes and fingers, positive trousseau and chevosteks
|
|
|
Following a thyroidectomy, a client complains of tingling around the mouth and muscle twitching. These assessment findings indicate to the nurse which of the following complications?
a. hemorrhage b. respiratory disease c. thyroid storm d. hypocalcermia and parathyroid gland injury |
d. hypocalcemia and parathyroid gland injury
|
|
|
What should a client with hoarseness post thyroidectomy be told?
|
it is usually temporary but will be assessed q2h until resolved.
|
|
|
Which of the following is the hallmark assessment finding signifying hypothyroidism?
a. irritability b. cold intolerance c. constipation d. fatigue |
d. fatigue
|
|
|
The lab results for a 53 year old client indicate a low T3 level and elevated TSH. WHat do these results indicate?
a. hyperthyroidism b. hypothyroidism c. malfunctioning pituitary gland d. these are normal findings |
b. hypothyroidism
|
|
|
What insufficiency could cause hypothyroidism?
|
iodine deficiency
|
|
|
Which of the following conditions is a life=threatening emergency and serious complication of untreated or poorly treated hypothyroidism?
a. an endemic goiter b. myxedema coma c. toxic multinodular goiter d. thyroiditis |
b. myxedema coma
|
|
|
A client has the following assessment findings: elevated TSH, low T3 and T4, difficulty with memory, lethargy, and muscle stiffness. These are clinical manifestations of which of the following
a. hypothyroidism b. hyperthyroidism c. hyperparathyroidism d. hypoparathyroidism |
a. hypothyroidism
|
|
|
With correction of hypothyroidism with thyroid hormome, the client can expect improvement in mental awarenes within how long?
a. a few days b. 2 weeks c. 1 month d. 3 months |
2 weeks
|
|
|
Hyperthyroidism or Hypothyroidism: weight loss with increased appetite
|
hyperthyroidism
|
|
|
Hyperthyroidism or Hypothyroidism: constipation
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: increased HR and palpitations
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: photophobia
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: manic behavior
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: decreased libido
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: dyspnea with or without exertion
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: insomnia
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: cold intolerance
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: increased stools
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: corneal ulcers
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: fatigue, increased sleeping
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: irritability
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: impaired memory
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: fine, soft, silky body hair
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: facial puffiness
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: increased libido
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: heat intolerance, warm skin
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: weight gain
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: dry, coarse , brittle hair
|
hypo
|
|
|
Hyperthyroidism or Hypothyroidism: diaphoresis
|
hyper
|
|
|
Hyperthyroidism or Hypothyroidism: tremors
|
hyper
|
|
|
T or F: exopthalmos only occurs in hyperthyroidism resulting from Grave's disease
|
T
|
|
|
T or F: Grave's disease is hereditary
|
F, autoimmune
|
|
|
T or F: a decrease metabolic rate results in TSH binding to thyroid cells, causing and enlarged thyroid
|
T
|
|
|
T or F: hypothyroidism can occur anytime throughout the lifespan
|
T
|
|
|
T or F: hypothyroidism and hyperthyroidism occur more frequentsly in women than men
|
T
|
|
|
T or F: simple goiter associated with hypothyroidism is usually due to insufficient iodine intake.
|
T
|
|
|
T or F: Hashimoto's disease is a type of hypothyroidism
|
T
|
|
|
T or F: the effect of antithyroid medication can be delayed due to storage and release of large amounts of thyroid hormone
|
T
|
|
|
T or F: Hypothyroidism causes elevated systolic pressure, wide pulse pressure, tachycardia, and dysrhythmias.
|
F, HYPERthyroidism
|
|
|
T or F: thyroid storm following surgical intervention for hyperthyroidism is rare because of pretreatement with medications
|
T
|
|
|
T or F: euthyroid is defined as near-normal thyroid function
|
T
|
|
|
T or F: Radiation precautions are required with treatment of I-131 for hyperthyroidism.
|
F, not required
|
|
|
T or F: Non-surgical treatment is the preferred treatment for hyperthyroidism
|
T
|
|
|
Parathyroid hormone production _______ serum calcium levels. (raises or lowers)
|
raises
|
|
|
Calcitonin production ________ serum calcium levels. (raises or lowers)
|
lowers
|
|
|
Bone changes in the older adult are often seen with endocrine dysfunction and increased secretion of which of the following?
a. parathyroid hormone b. calcitonin c. insulin d. testosterone |
a. parathyroid hormone
|
|
|
IN addition to regulation of calcium levels, parathyroid hormone and caclitonin regulate the circulation blood levels of which of the following?
a. potassium b. sodium c. phosphate d. chloride |
c. phosphate
|
|
|
A client has a positive Trousseau's or Chvosteks sign from hypoparathyroidism. This assessment finding indicates which of the following?
a. hypercalcemia b. hypocalcemia c. hyperphosphatemia d. hypophosphatemia |
b. hypocalcemia
|
|
|
Which food should the client with hypoparathyroidism avoid?
a. canned vegetables b. fresh fruit c. red meat d. milk |
d. milk
|
|
|
A client in the ED who had continuous spasm of the muscles was diagnosed with hypoparathyroidism. THe muscle psasms are a clinical manifestation of which of the following?
a. nerve damage b. seizures c. tetany d. decreased potassium |
c. tetany
|
|
|
Hypoparathyroidism or Hyperparathyroidism: chronic renal disease
|
hyper
|
|
|
Hypoparathyroidism or Hyperparathyroidism: Vitamin D deficiency
|
Hyper
|
|
|
Hypoparathyroidism or Hyperparathyroidism: removal of the thyroid gland
|
hypo
|
|
|
Hypoparathyroidism or Hyperparathyroidism: neck trauma
|
hyper
|
|
|
Hypoparathyroidism or Hyperparathyroidism: parathyroidectomy
|
hypo
|
|
|
Hypoparathyroidism or Hyperparathyroidism: carcinoma of lung, kidney, or GI tract producing PTH-like substnaces
|
hyper
|
|
|
With Hyperparathyroidism, serum calcium is ________ (increased or decreased)
|
increased
|
|
|
With Hyperparathyroidism, serum phosphate is ________ (increased or decreased)
|
decreased
|
|
|
With Hyperparathyroidism, serum PTH is ________ (increased or decreased)
|
increased
|
|
|
With Hypoparathyroidism, serum calcium is ________ (increased or decreased)
|
decreased
|
|
|
With Hypoparathyroidism, serum phosphate is ________ (increased or decreased)
|
increased
|
|
|
With Hypoparathyroidism, serum PTH is ________ (increased or decreased)
|
decreased
|
|
|
Which of the following is the most common initial treatement a client with hyperparathyroidism and high levels of serum calcium will recieve?
a. fore fluids (IV or PO) and Lasix b. calcitonin c. oral phsophates d. mithramycin |
a. Force fluids and lasix- promotes excretion of Ca
|
|
|
Postoperative nursing care for parathyroidectomy is similar to thatof thyroid surgery with emphasis on monitoring and providing emergency interveintion for which of the following?
a. hypercalcemia b. hypocalcermia c. intake and output d. vitamin D deficiency |
b. hypocalcemia
|
|
|
What are the s/s of hypocalcemia?
|
tingling and twitching of face and extremities, positive Trousseau and chevostek
|
|
|
Hypoparathyroidism or Hyperparathyroidism: carcinoma of lung, kidney, or GI tract producing PTH-like substnaces
|
hyper
|
|
|
With Hyperparathyroidism, serum calcium is ________ (increased or decreased)
|
increased
|
|
|
With Hyperparathyroidism, serum phosphate is ________ (increased or decreased)
|
decreased
|
|
|
With Hyperparathyroidism, serum PTH is ________ (increased or decreased)
|
increased
|
|
|
With Hypoparathyroidism, serum calcium is ________ (increased or decreased)
|
decreased
|
|
|
With Hypoparathyroidism, serum phosphate is ________ (increased or decreased)
|
increased
|
|
|
With Hypoparathyroidism, serum PTH is ________ (increased or decreased)
|
decreased
|
|
|
Which of the following is the most common initial treatement a client with hyperparathyroidism and high levels of serum calcium will recieve?
a. force fluids (IV or PO) and Lasix b. calcitonin c. oral phsophates d. mithramycin |
a. Force fluids and lasix- promotes excretion of Ca
|
|
|
Postoperative nursing care for parathyroidectomy is similar to thatof thyroid surgery with emphasis on monitoring and providing emergency interveintion for which of the following?
a. hypercalcemia b. hypocalcermia c. intake and output d. vitamin D deficiency |
b. hypocalcemia
|
|
|
What are the s/s of hypocalcemia?
|
tingling and twitching of face and extremities, positive Trousseau and chevostek
|
|
|
What 4 medications are frequently used to treat hypoparathyroidism?
|
Ca Chloride
Ca gluconate Cacitrial (Rocaltrol) Mg Sulfate IV or IM |
|
|
How long are medications for hypoparathyroism taken?
|
lifelong
|
|
|
A client with hypoparathyroidism should eat a diet high in ______ but low in ________
|
calcium, phosphorous
|
|
|
In older adults, assessment finding of fatigue, altered thought process, dry skin, and constipation are often mistaken of signs of aging rather than assessment findings for which endocrine disorder?
a. hyperthyroidism b. hypothyroidism c. hyperparathyroidism d. hypoparathyroidism |
b. hypothyroidism
|
|
|
Increased T3 and T4 are indicative of....
|
hyperthyroidism
|
|
|
Decreased T3, T4 and increased TSH are indicative of....
|
hypothyroidism
|
|
|
Increased PTH, CA, and decreased PO4 are indicative of....
|
hyperparathyroidism
|
|
|
Decreased PTH, CA, and increased PO4 are indicative of....
|
hypoparathyroidism
|
