Endocrine Combined

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Which blood glucose test listed below can by classified by the following: The production of insulin begins with proinsulin with an A chain of amino acids and a B chain of amino acids with a connecting peptide. Allows the A and B proinsulin to fold and cleave together, creating the structure of insulin. After the connection has been made, the fusion occurs, creating insulin and a C-peptide by-product. The C-peptide level may be measured in a patient with type 2 DM. ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

C-peptide test

To excrete the increased glucose, the kidneys require extra water for dilution

Causes Polyuria

What tests can be anticipated in diagnosing acromegaly?

Growth hormone suppression test.

Are the following s/s of *hypoglycemia or hyperglycemia*? ~ Dry mouth ~ Polyuria ~ Polydipsia ~ Nocturia ~ Drowsiness

Hyperglycemia

Are the following s/s of Hyperthyroidism or Hypothyroidism? ~ Bradycardia ~ *Ataxia (losing control of body movements)* ~ Hypotension ~ Bradypnea ~ Facial features become enlarged ~ Edematous ~ Voice low and hoarse ~ Exercise intolerance ~ Weakness/clumsiness

Hypothyroidism

What condition results from *deficiency in growth hormone* due to the following where most cases are idiopathic? ~ Small number can be attributed to autosomal-recessive trait ~ In some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and gonadotropins (Hint: *Hypopituitarism*)

Dwarfism

What diagnostic test for thyroid cancer has a possibility of "seeding" adjacent tissue with cancer cells causing metastasis?

Needle biopsy

What is the *antagonist to calcitonin released by the thyroid gland* that will increase the reabsorption of calcium and magnesium from kidney tubules and increases elimination of phosphorous by kidneys?

Parathormone (aka Parathyroid hormone)

What type of insulin can be classified by the following? ~ Type: *Lispro,* Aspart, Glulisine ~ Onset: 15 - 30min ~ Peak 60 - 90min ~ Duration: 3 - 4 hours

Rapid Acting Insulin

Meglitinides

Repaglinide (Prandin), Nateglinide (Starlix) -Lower blood glucose by stimulating beta cells of the pancreas to release insulin and increasing receptor sensitivity to insulin -Requires functioning pancreatic beta cells -Have much shorter duration of action and must be given with each meal *-CANNOT be combined with sulfonylureas*

4. When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? a. Random blood glucose level above 170 mg/dL b. Blood glucose level of less than 50 mg/dL after meals c. Fasting blood glucose level between 70 and 100 mg/dL d. Evening blood glucose level below 80 mg/dL

ANS: C A fasting blood glucose level between 70 and 100 mg/dL indicates a therapeutic response to drugs that decrease glucose levels. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 511 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

1. The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

ANS: C Adrenergic drugs mimic the effects of the sympathetic nervous system. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 300 TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. A patient has undergone tests that indicate a deficiency of the parathyroid hormone secretion. She should be informed of which potential complication? a. Osteoporosis b. Lethargy c. Laryngeal spasms d. Kidney stones

ANS: C Decreased parathyroid hormone levels in the blood stream cause a decreased calcium level. Severe hypocalcemia may result in laryngeal spasm, stridor, cyanosis, and increased possibility of asphyxia. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1745 OBJ: 5 TOP: Hypoparathyroidism KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

7. When reviewing the drugs taken by a patient who will be starting thyroid replacement preparations, the nurse notes that an interaction may occur with which of these drugs? a. Vitamin supplements b. Antibiotics c. Oral antidiabetic drugs d. Beta blockers

ANS: C Drug interactions with thyroid replacement preparations include oral antidiabetic drugs, anticoagulants, cholestyramine, and digitalis. See Table 31-3. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 503 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including a. hypothermia and seizures. b. nausea and diarrhea. c. confusion and sweating. d. fruity, acetone odor to the breath.

ANS: C Early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 525 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Health Promotion and Maintenance

2. Which diagnostic test for diabetes mellitus provides a measure of glucose levels for the previous 8 to 12 weeks? a. Fasting blood sugar (FBS) b. Oral glucose tolerance test (OGT) c. Glycosylated hemoglobin (HbA1c) d. Postprandial glucose test (PPBG)

ANS: C Glycosylated hemoglobin (HbA1c)—This blood test measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte. Because glycosylation occurs constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1764, Box 50-2 OBJ: 8 TOP: Glucose monitoring KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

21. The physician orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100 subcutaneously daily for a patient with diabetes mellitus. Why would a mid-afternoon snack of milk and crackers be given? a. To improve nutrition b. To improve carbohydrate metabolism c. To prevent an insulin reaction d. To prevent diabetic coma

ANS: C Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of hypoglycemia (a less-than-normal amount of glucose in the blood, usually caused by administration of too much insulin, excessive secretion of insulin by the islet cells of the pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is taking. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1768, Table 50-5 OBJ: 13 TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

32. What information should be obtained from the patient before an iodine-131 test? a. Presence of metal in the body b. Allergy to sulfa drugs c. Status of possible pregnancy d. Use of prescription drugs for hypertension

ANS: C Iodine-131 is not a radiation hazard to the nonpregnant patient but is absolutely contraindicated during pregnancy. Pregnant nurses should not care for this patient for several days. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1736 OBJ: 5 TOP: Iodine-131 KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. When reviewing the medication profile of a patient with a new order for desmopressin (DDAVP), the nurse notes that a drug interaction will occur if which drug is taken with desmopressin? a. aspirin b. digoxin c. lithium d. penicillin

ANS: C Lithium may cause a decreased therapeutic effect of desmopressin. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 496 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. What is an appropriate nursing diagnosis for a patient who has recently been diagnosed with acromegaly? a. Ineffective coping b. Activity intolerance c. Risk for trauma d. Chronic low self-esteem

ANS: C Nursing interventions are mainly supportive. The presence of muscle weakness, joint pain, or stiffness warrants assessment of the ability to perform activities of daily living (ADLs). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1728 OBJ: 5 TOP: Acromegaly KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

26. The physician prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when diet and exercise have not been able to control type 2 diabetes. What should the nurse include in the teaching plan about this medication? a. It is a substitute for insulin and acts by directly stimulating glucose uptake into the cell. b. It does not cause the hypoglycemic reactions that may occur with insulin use. c. It is thought to stimulate insulin production and increase sensitivity to insulin at receptor sites. d. It lowers blood sugar by inhibiting glucagon release from the liver, preventing gluconeogenesis.

ANS: C Oral hypoglycemics are compounds that stimulate the beta cells in the pancreas to increase insulin release. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1769, Table 50-7 OBJ: 8 TOP: Medications KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

12. A patient has a diagnosis of primary hypothyroidism. Which statement accurately describes this problem? a. The hypothalamus is not secreting thyrotropin-releasing hormone (TRH), therefore thyroid-stimulating hormone (TSH) is not released from the pituitary gland. b. The pituitary gland is dysfunctional and is not secreting TSH. c. The abnormality is in the thyroid gland itself. d. The abnormality is caused by an insufficient intake of iodine.

ANS: C Primary hypothyroidism stems from an abnormality in the thyroid gland itself and occurs when the thyroid gland is not able to perform one of its many functions. Secondary hypothyroidism begins at the level of the pituitary gland and results from reduced secretion of TSH. TSH is needed to trigger the release of the T3 and T4 stored in the thyroid gland. Tertiary hypothyroidism is caused by a reduced level of the TRH from the hypothalamus. This reduced level, in turn, reduces TSH and thyroid hormone levels. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 502 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The purpose of the use of radioactive iodine in the treatment of hyperthyroidism is to: a. stimulate the thyroid gland. b. depress the pituitary. c. destroy some of the thyroid tissue. d. alter the stimulus from the pituitary.

ANS: C Radioactive iodine 131 destroys some of the hyperactive thyroid gland to produce a more normally functioning gland. PTS: 1 DIF: Cognitive Level: Application REF: Page 1736, Box 50-1 OBJ: 5 TOP: Radioactive iodine 131 KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

2. A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next? a. He will need to stop participating in school physical education classes. b. The somatropin must be discontinued immediately. c. The somatropin dosage may be adjusted. d. His growth will be documented and monitored for changes.

ANS: C Somatropin is to be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient's growth will be measured and documented throughout therapy with somatropin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 496 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. Which precaution(s) should the nurse take when caring for a patient who is being treated with radioactive iodine 131 (RAIU)? a. Initiate radioactive safety precautions b. Avoid assigning any young woman to the patient c. Wait three days after dose before assigning a pregnant nurse to care for this patient d. Advise visitors to sit at least 10 feet away from the patient

ANS: C The dose is patient specific and at a very low level. No radioactive safety precautions are necessary and pregnant nurses can be assigned 3 days after the dose. RAIU is not harmful to nonpregnant women. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1736, Box 50-1 OBJ: 5 TOP: Thyroid disorders KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

20. The nurse caring for a 75-year-old man who has developed diabetes insipidus following a head injury will include in the plan of care provisions for: a. limiting fluids to 1500 mL a day. b. encouraging physical exercise. c. protecting patient from injury. d. discouraging daytime naps.

ANS: C The patients need protection from injury because they are often exhausted from sleep deprivation and having to get up frequently at night. Fluids should not be limited and their energy should be preserved. PTS: 1 DIF: Cognitive Level: Application REF: Page 1733 OBJ: 5 TOP: Diabetes insipidus KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

6. A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs? a. Administer half the original dose. b. Withhold all medications as ordered. c. Contact the prescriber for further orders. d. Give the medication with a sip of water.

ANS: C When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 529 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Identify two characteristics of patients with dwarfism?

-Child is great deal shorter than peers -Well proportioned, but smaller -Sexual development is usually normal but delayed -May produce normal offspring

10. After undergoing a thyroidectomy as treatment for a thyroid tumor that turned out to be benign, Rebecca is given a prescription for levothyroxine (Levothroid). "I thought I would be cured after this surgery!" she exclaimed. "Why do I have to take a pill every day?" What will the nurse explain to Rebecca?

10. Surgery to remove all or part of the thyroid gland is an effective way to treat hyperthyroidism, but as a result, lifelong hormone replacement is normally required. (Lilley, 122012)

17. Patients should be educated that complications from diabetes can be greatly decreased by proper maintenance of the blood glucose levels of ______ and by appropriate HbA1c levels of less than ______. (1753)

17. 60-99 mg/dL; 5-6%

1. A patient is about to receive a dose of octreotide (Sandostatin). The nurse will assess for which contraindications or cautions? (Select all that apply.) a. Carcinoid crisis b. Diarrhea c. Type 1 diabetes mellitus d. Gallbladder disease e. Chronic renal failure f. Esophageal varices

ANS: C, D, E Octreotide is used with caution in patients with diabetes (type 1 or 2), gallbladder impairment, or renal impairment. Carcinoid crisis, which may be associated with severe diarrhea and flushing, is an indication for octreotide; esophageal varices are also an indication. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 496-197 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Where is the parathyroid gland located?

The posterior surface of the thyroid gland

What often occurs rarely within 12hrs postop and can usually be attributed to manipulation of the thyroid during surgery, which causes the release of large amounts of thyroid hormones into the bloodstream? (Note: Medical Emergency)

Thyroid Storm

The following are forms of surgical treatment for what type of Diabetes Mellitus? ~ Pancreas/kidney transplant ~ Islet cell transplantation

Type I DM

When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? 1insulin glargine (Lantus) 2glipizide (Glucotrol) 3insulin glulisine (Apidra) 4NPH insulin

2 Oral antidiabetic drugs are generally not recommended for pregnant patients.

1. A patient, newly diagnosed with hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug? a. Infection b. Diabetes mellitus c. Liver disease d. Recent myocardial infarction

ANS: D Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 503 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? a. Improved appetite b. Increased serum albumin levels c. Increased serum potassium levels d. Decreased urinary output

ANS: D Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 497 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites? a. Avoid the abdomen because absorption there is irregular. b. Choose a different site at random for each injection. c. Give the injection in the same area each time. d. Rotate sites within the same location for about 1 week before rotating to a new location.

ANS: D Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least to 1 inch away from the previous site. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 528 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

28. What instructions should be included in the discharge instructions for a 47-year-old patient with hypothyroidism? a. Taking medication whenever symptoms cause discomfort b. Decreasing fluid and fiber intake c. Consuming foods rich in iron d. Seeing the physician regularly for follow-up care

ANS: D Regular checkups are essential, because drug dosage may have to be adjusted from time to time. PTS: 1 DIF: Cognitive Level: Application REF: Page 1740 OBJ: 5 TOP: Hypothyroidism KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

11. A patient has been taking levothyroxine (Synthroid) for more than 1 decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse's best advice? a. "This would be a great way to save money." b. "There's no difference in brands of this medication." c. "This should never be done; once you start with a certain brand, you must stay with it." d. "It's better not to switch brands unless we check with your doctor."

ANS: D Switching brands of levothyroxine during treatment can destabilize the course of treatment. Thyroid function test results need to be monitored more carefully when switching products. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 504 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

20. When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? a. "Take metformin if your blood glucose level is above 150 mg/dL." b. "Take this 60 minutes after breakfast." c. "Take the medication on an empty stomach 1 hour before meals." d. "Take the medication with food to reduce gastrointestinal (GI) effects."

ANS: D The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 520 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Which of the following forms of medical management for Hyperthyroidism is the gold standard? ~ Medications such as Propylthioruacil & Methimazole ~ Ablation Therapy ~ Subtotal Thyroidectomy

Ablation Therapy

3. What is the master gland of the body? 1. Thyroid gland 2. Adrenal gland 3. Pineal gland 4. Pituitary gland

4(Check back of book if this doesn't match up)

8. The nurse is assessing a postoperative thyroidectomy patient for damage to the laryngeal nerve. Which is most likely to suggest that damage may have occurred? 1. The patient complains of a slight sore throat. 2. The patient's voice tone has changed slightly. 3. The patient is unable to swallow fluids. 4. The patient is becoming increasingly hoarse.

4(Check back of book if this doesn't match up)

Are the forms of diagnostic evaluation found/used in Cushing's or Addison's Disease? ~ Hyponatremia ~ Hypoglycemia ~ Hyperkalemia ~ 24-hr urine ~ Cortisol & aldosterone are low

Addison's Disease (Adrenal Hypofunction)

Adrenocortical insufficiency occurs when the *adrenal cortex does not secrete adequate amounts of glucocorticoids, mineralocorticoids, and androgens* leading to what disease? (Note: Aldosterone and cortisol are the two main hormones that are not secreted)

Addison's Disease (Adrenal Hypofunction)

The following are s/s for what form of adrenal dysfunction? ~ Electrolyte and fluid imbalance results in water loss, dehydration & hypovolemia ~ Nausea, anorexia and salt craving ~ Postural hypotension ~ Vertigo, weakness, and syncope ~ Severe headache, disorientation, abdominal pain ~ Anxious and apprehensive ~ Skin hyperpigmentation ~ Weight loss ~ Abnormal temperature

Addison's Disease (Adrenal Hypofunction)

What does the thyroid require in order to produce Thyroxine(T4) and Triiodothyronine(T3) which regulates growth, development, metabolism, and the activity of the nervous system? (Hint: Mineral needed and foods high in it)

Adequate iodine intake such as: ~ Fish ~ Table Salt ~ Eggs ~ Beans (Note: Controlled by TSH)

2. antidiuretic (posterior pituitary) (1726)

a. Causes the kidneys to conserve water by decreasing the amount of urine produced

Question: Deficiencies in aldosterone and cortisol will produce what type of metabolic disturbances?

Answer: Deficiencies in aldosterone and cortisol produce disturbances of the metabolism of carbohydrates, fats, proteins, as well as sodium, potassium, and water

Question: What are the cardinal manifestations of diabetes?

Answer: Glycosuria, polyuria, polydipsia, and polyphagia

Question: When there is an electrolyte imbalance what is the serum osmolality?

Answer: Greater > 300 mOsm / kg.

Question: What are 2 goals for diabetic clients?

Answer: Helping achieve normal blood glucose level < 126 mg/dl. Prevention and treatment of acute complications

Question: What dietary instructions are important for the patient with hypothyroidism?

Answer: High-protein, high-fiber, low-calorie diet avoiding sweets.

Question: What is the main difference in hyperthyroidism and hypothyroidism?

Answer: Hyperthyroidism is an increase in the amount of thyroid hormones produced and hypothyroidism is a decrease in the amount of thyroid hormones produced.

Question: Where is the Thyroid Gland located?

Answer: Just below the larynx on either side of the trachea

Question: What does the Thyroid gland regulate?

Answer: Metabolism, growth and development, and activity of the nervous system.

Question: What nursing interventions are suggested for a patient with a goiter?

Answer: Prevention of post-operative complications (thyroid storm, bleeding, and tetany). Teach/assess understanding of dietary and medication regimen. Patients will require regular medical follow-up.

Question: What is the most common symptom of pheochromocytoma?

Answer: Severe hypertension.

Question: What are the signs/symptoms of Addisonian Crisis?

Answer: Symptoms may include anorexia, nausea and vomiting, diarrhea, abdominal pain, headache, hypotension, restlessness, and fever.

Question: What dietary information is important for the patient to know when he/she has a goiter?

Answer: The importance of taking in adequate dietary intake of iodine.

Name three symptoms of water intoxication:

Answer: changes in LOC, nausea, decreased UOP, weight gain

SIADH is potentially dangerous, but treatable. What happens if treatment is withheld?

Answer: coma and death can occur.

Which of the following posterior pituitary (neurohypophysis) hormones is stimulated by the hypothalamus due to *stress/hypernatremia* causing the kidneys to conserve water and the constriction of arterioles? ~ Anti-diuretic Hormone (ADH) ~ Oxytocin

Anti-diuretic Hormone (ADH) aka vasopressin

The following are what classification of medication used for patients with cancer? ~ Asparaginase (Elspar) ~ Paclitaxel (Taxol) ~ Docetaxel (Taxotere) ~ Topotecan (Hycamtin) ~ Irinotecan (CPT-11, Camptosar)

Antineoplastic Agents

48. A nurse hears in shift report that a diabetic patient has been NPO since midnight for a surgical procedure that should happen this morning. On assessment, the patient is irritable, and his skin is cool and clammy. His blood glucose is 45mg/dL. What should the nurse do first? (1766) 1. Give the patient some juice and a peanut butter sandwich. 2. Administer 50% glucose per emergency protocol. 3. Call the operating room and cancel the procedure. 4. Call the health care provider and inform about findings

48. Answer 2: This patient is NPO for a procedure, so the nurse decides not to feed this conscious patient, but to use the emergency protocol to administer 50% dextrose. Once the patient has received the bolus, the nurse should recheck the blood glucose and call the health care provider. The nurse cannot make the decision to cancel the procedure.

6 Which drugs have an action similar to that of the naturally occurring hormone ADH? (Select all that apply.) a cosyntropin (Cortrosyn) b desmopressin (DDAVP) c somatropin (Humatrope) d vasopressin (Pitressin) e octreotide (Sandostatin)

B,D

Insulin must be present to enable muscle cells and other cells of the body to use glucose, what are the only organs that can use free serum glucose without insulin?

Brain and Kidney

1 When monitoring the laboratory values of a patient who is taking antithyroid drugs, the nurse knows to watch for a increased platelet counts. b decreased white blood cell counts. c decreased blood urea nitrogen level. d increased blood glucose levels.

1. When administering insulin, the nurse must keep in mind that which is the most immediate and serious adverse effect of insulin therapy? a. Hyperglycemia b. Hypoglycemia c. Bradycardia d. Orthostatic hypotension

5 The nurse is teaching a patient who has a new prescription for the antithyroid drug propylthiouracil (PTU). Which statement by the nurse is correct? a "There are no food restrictions while on this drug." b "You need to avoid foods high in iodine, such as iodized salt, seafood, and soy products." c "This drug is given to raise the thyroid hormone levels in your blood." d "Take this drug in the morning on an empty stomach."

6. The nurse has been providing patient education regarding thyroid hormone replacement therapy. Which statement by the patient reflects a need for further teaching? a. "I will take this pill in the mornings." b. "Sometimes this medicine can make my heart skip beats, but that's a normal side effect." c. "I need to take this pill on an empty stomach, and wait about 30 to 60 minutes before eating." d. "I will be sure to go to the clinic to have my thyroid levels tested regularly." (Lilley, 122012)

Body attempts to rid itself of the excess glucose by excreting it in to the urine

Causes glycosuria

Because the kidneys require extra water, the client develops excessive thirst

Causes polydipsia

2 A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition? a octreotide (Sandostatin) b vasopressin (Pitressin) c somatropin (Humatrope) d cosyntropin (Cortrosyn)

3 The nurse is reviewing the medication list for a patient who will be starting therapy with somatropin. Which type of drug would raise a concern that needs to be addressed before the patient starts the somatropin? a Nonsteroidal antiinflammatory drug for arthritis b Antidepressant drug c Penicillin d Glucocorticoid

5 When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful? a Increased insulin levels b Decreased diarrhea c Improved nasal patency d Decreased thirst

1 oxytocin (posterior pituitary) (1726)

b. Promotes the release of milk and stimulates uterine contractions during labor

Radioactive iodine isotopes will do which of the following? ~ Stimulate the synthesis of T3 and T4 hormones ~ Increase the storage of thyroxine before thyroid surgery ~ Destroy hyperactive thyroid tissue ~ Replace deficient thyroid hormone

Destroy hyperactive thyroid tissue

Hypothyroidism

Development of atherosclerosis /CAD (Coronary artery disease)

What results from *under secretion of antidiuretic hormone (ADH), or vasopressin (Pitressin)* and produces a state of uncontrolled diuresis that can result in the following manifestations? ~ First sign is enuresis ~ Polyuria ~ Polydipsia ~ Hypernatremia ~ Severe dehydration ~ Specific urine gravity (1.001-1.005) ~ May exceed 5 to 20 L/ 24-hour period ~ Output typically exceeds 200mL/hr >2 consecutive hours ~ Craves cold or iced water ~ May drink 4 to 20 L daily

Diabetes Insipidus

A systemic metabolic disorder that involves improper metabolism of carbohydrates, fats, and proteins causing a decrease or absolute lack of insulin production by the beta cells in the pancreas is known as what?

Diabetes Mellitus

What is a general systemic metabolic disorder that involves improper metabolism of carbohydrates, fats and proteins due to a lack of insulin and causes the following? ~ Carbohydrates can not be used properly ~ Body's fat and protein sources are broken down for energy ~ Ketone bodies flood the circulation ~ Ketones are acidic, accumulation causes ketoacidosis ~ Metabolic acidosis

Diabetes Mellitus (DM)

What disease often occurs in Type I IDDM patients when blood glucose levels are elevated, but no insulin is present to promote glucose entry into cells causing the body to compensate by: ~ Using fats & proteins for energy ~ Ketones are produced ~ Ketones accumulates in the blood ~ pH decreases ~ *Client begins to hyperventilate in an effort to blow off CO2 to counteract the fall in pH* ~ Hypovolemia & electrolyte imbalances occur due to the elevated blood glucose

Diabetic Ketoacidosis aka Diabetic Coma

What condition is marked by the following manifestations? ~ Shorter than their peers ~ Well proportioned ~ Well nourished ~ Appear younger than chronological age ~ Underdeveloped jaws ~ Sexual development normal but delayed ~ Normal intelligence ~ Reproduce normal offspring, ~ Only a small number of children experience short stature or delayed growth ~ Diagnostic work-up crucial

Dwarfism

Be alert for signs of hypoglycemia

Faintness Sudden weakness Diaphoresis Irritability Hunger Palpitations Trembling Drowsiness

True or False: Levothyroxine (Synthroid) may be safely interchanged with other brands without any concern to the patient

False

True or false: It is more important to focus on the type of carbohydrate such as increasing potatoes/rice and limiting sugar than the amount for Type II DM?

False (Reasoning: Some complex carbohydrates such as rice, potatoes and bread produce a glycemic response similar to sucrose aka table sugar)

Which blood glucose test listed below can by classified by the following: After an 8-hour fast, blood is drawn. Normal is 60 to 110 mg/dL of venous blood; 126 mg/dL or greater is considered abnormal. ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

Fasting blood glucose (FBG)

Sulfonylureas

Glipizide (Glucotrol); Glyburide (Diabeta) -Lower blood glucose by stimulating beta cells of the pancreas to release insulin and increasing receptor sensitivity to insulin -Decrease secretion of glucagon -Requires functioning pancreatic beta cells -*Cannot be combined with Meglitinides*

Is insulin or glucagon a hormone normally secreted by the *alpha cells* of the pancreas that stimulates the liver to change stored glycogen into glucose, which is then released into the bloodstream?

Glucagon

What hormone, secreted by the *adrenal cortex*, is involved in glucose metabolism, energy in times of stress, and has anti-inflammatory properties? (Hint: Cortisol)

Glucocorticoids

Needle biopsy of Thyroid

High probability of "seeding" adjacent tissues with cancerous cells causing metastasis

What is the definition of Hormones?

Hormones are chemical messengers which travel to target organs to achieve balance.

Explain stimulation of the pituitary gland, that is, negative feedback loop?

Hormones are released in response to low circulating hormones or decreased organ function.

Overdose of thyroid agents such as the following should be withheld for 2-6 days and acute overdose is treated by induction of emesis, gastric lavage, and activated charcoal; what is the cardinal sign of this overdose? ~ Levothyroxine (tablets can be crushed if needed) ~ Liothyronine (use IV only q4-12hrs) ~ Liotrix ~ Thyroid

Hyperthyroidism

The following are ways to diagnose what endocrine disorder? ~ Increased serum T3 and T4 levels and decreased TSH ~ Radioactive iodine uptake test (RAIU) ~ Thyroid scan

Hyperthyroidism

What results from an overproduction of the thyroid hormones (T3 & T4) that results in exaggerated metabolic processes and the following s/s? ~ Anterior neck enlargement ~ Exophthalmos (bulging eyes) ~ Decreased ability to concentrate ~ Tachycardia, Hypertension, Elevated Temp ~ Dysphagia or hoarse voice ~ Weight loss with increased appetite ~ Nervousness, jittery, excitable, ~ Insomnia

Hyperthyroidism aka Graves' disease

Are the following s/s of *hypoglycemia or hyperglycemia*? ~ Faintness ~ Sudden weakness ~ Diaphoresis ~ Irritability ~ Hunger ~ Palpitations ~ Trembling ~ Drowsiness ~ Pallor ~ Headache ~ Nausea/vomiting ~ Personality changes ~ LOC changes

Hypoglycemia

What condition occurs when there is decreased PTH, resulting in decreased levels of serum calcium, and has the following s/s? ~ Hypocalcemia ~ Hyperphosphatemia ~ Neuromuscular hyperexcitability ~ Muscle spasms ~ *Laryngeal spasm*, stridor, cyanosis with increased risk of asphyxia ~ Calcification of the basal ganglia in the brain ~ Complaint of dysphagia ~ Complaint of numbness and tingling ~ Anxiety, irritability, depression ~ Headaches, nausea ~ Kidney stone formation due to increased renal excretion ~ Decreased cardiac output (Hint: Thyroidectomy is the most common cause)

Hypoparathyroidism

16. A patient who has been taking metformin (Glucophage) for type 2 diabetes mellitus needs to have a radiology exam with contrast dye. What is the nurse's best action regarding the metformin?

If the patient receiving metformin is to undergo diagnostic studies with contrast dye, the prescriber will need to discontinue the drug on the day of the test and restart it 48 hours after the tests. It may be necessary to reevaluate the patient's renal status. (Lilley, 122012)

In DM, Client should not go _________________ at any time

barefoot

Exophthalmos

bulging of the eyes seen with graves disease

1. A patient who is beginning therapy with levothyrox- ine (Synthroid) asks the nurse when the medication will start working. What is the nurse's best answer? a. Immediately b.Within a few days c.Within a few weeks d.Within a few months

3. A nurse is administering octreotide (Sandostatin) to a patient who has a metastatic carcinoid tumor. The patient asks about the purpose of this drug. What is the nurse's best response? a. "This drug helps to reduce the size of your tumor." b. "This drug works to prevent the spread of your tumor." c. "This drug helps to control the flushing and di- arrhea that you are experiencing." d. "This drug reduces the nausea and vomiting you are having from the chemotherapy." (Lilley, 122012)

5. A patient is scheduled for a radioactive isotope study. The scheduling nurse notes that he takes levothyroxine (Levothroid) daily. Which medication or- der needs to be made before the radioactive isotope study is scheduled? a. Continue to take the levothyroxine as ordered. b. Do not take the levothyroxine on the morning of the test. c. Stop the levothyroxine about 4 weeks before the test. d. Reduce the levothyroxine dosage by one-half 1 week before the test.

Which of the following hormones secreted by the anterior pituitary (adenohypophysis) accelerates anabolism of proteins and catabolism of fats while slowing catabolism of carbohydrates (glucose). In addition, it aids in bone, cartilage, muscle and organs development aka *somatotropin*. ~ Growth Hormone (GH) ~ Thyroid Stimulating Hormone (TSH) ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Growth Hormone (GH)

13. What is the postoperative position for a person who has had a thyroidectomy? a. Prone b. Semi-Fowler c. Side-lying d. Supine

ANS: B Postoperative management of this patient includes keeping the bed in a semi-Fowler position, with pillows supporting the head and shoulders. There should be a suction apparatus and tracheotomy tray available for emergency use. PTS: 1 DIF: Cognitive Level: Application REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

What type of insulin can be classified by the following? ~ Type: *NPH*, Humulin N, Novolin N, Lente ~ *Onset: 2 - 4 hours* ~ Peak: 6 - 8 hours ~ Duration: 12 - 16 hours (Note: *Admin in morning*)

Intermediate acting insulin

Are the physical manifestations of acromegaly reversible?

The overproduction of what hormone/condition is marked by an increase in renal excretion of phosphorus resulting in bones becomes weak due to a loss of calcium leading to the following manifestations? ~ Stones ~ Pyelonephritis ~ Uremia ~ *Hypophosphatemia* ~ *Hypercalcemia* ~ Hematuria ~ Personality changes ~ Disorientation ~ Paranoia ~ Skeletal deformity ~ Renal Disease ~ N/V ~ Abnormal bone movement ~ Hypertension ~ Cardiac dysrhythmias ~ Bradycardia

Parathormone via Hyperparathyroidism

Which blood glucose test listed below can by classified by the following: A blood sample is obtained by the *fingerstick method* or *urine dipstick*, by either the patient or the nurse, and tested using a blood glucose-monitoring device. ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

Patient self-monitoring of blood glucose (SMBG)

What is a mostly benign cell tumor (Chromaffin cell tumor), usually found in the adrenal medulla, that causes *excessive secretion of epinephrine and norepinephrine* which results in the following? ~ Presence of severe headache, palpitations, anxiety ~ *Severe hypertension* ~ Tremors, nervousness, dizzy and dyspnea ~ Nausea and intolerance to heat ~ Paresthesias ~ Hyperglycemia ~ Glycosuria

Pheochromocytoma

What mineral matches the following? ~ Inverse proportion to calcium ~ Important for energy storage and transfer ~ Component of bones and teeth ~ Decreased levels results in poor growth

Phosphorus

What gland can be classified by the following? ~ "Master Gland" Controls and communicates the functions over the other endocrine glands through the negative feedback system ~ Hormones are chemical in nature and are considered messengers ~ Secretes hormones that activate other endocrine glands in response to low ~ Circulating levels of that hormone or decreased function of the endocrine gland ~ Works closely with the hypothalamus

Pituitary Gland

Which of the following anterior pituitary hormone is not a tropic hormone? ~ Growth Hormone (GH) ~ Adrenocorticotropic Hormone (ACTH) ~ Thyroid Stimulating Hormone (TSH) ~ Follicle Stimulating Hormone- female (FSH) ~ Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Prolactin (PRL)

Which of the following hormones secreted by the anterior pituitary (adenohypophysis) stimulates breast development during pregnancy and milk secretion in the mammary glands after delivery of the baby? ~ Growth Hormone (GH) ~ Thyroid Stimulating Hormone (TSH) ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Prolactin (PRL)

What procedure for acromegaly uses very low doses of radiation to destroy GH-secreting tumors and therefore is much less destructive to adjacent tissues, such as the hypothalamus and temporal lobes, than conventional radiation therapy?

Proton beam therapy

How long after administration of insulin can a patient begin eating?

Rapid: 5 - 15min All others: 30min

What type of *insulin can be administered via IV*?

Regular

Only insulin that be given IV

Regular, Humulin R, Novolin R

What is the most common cause of hypoparathyroidism? (Hint: Trama)

Removal or destruction of one or more of the tiny parathyroid glands during thyroidectomy

A 48-year-old is diagnosed with metabolic syndrome and is started on the *biguanide metformin (Glucophage)*. The purpose of the metformin, in this situation, is to: ~ Increase the pancreatic secretion of insulin ~ Decrease insulin resistance ~ Increase blood glucose levels ~ Decrease the pancreatic secretion of insulin

Resulting in decreased insulin resistance (Reasoning: Metformin is a oral hypoglycemic that decreases glucose production by the liver; decreases intestinal absorption of glucose; improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance)

How should insulin be stored once its been opened?

Room temperature for up to one month (Note: Vials not in use should be refrigerated until expiration)

Which of the following hormones secreted by the anterior pituitary (adenohypophysis) stimulates the pineal gland to release melatonin? ~ Growth Hormone (GH) ~ Thyroid Stimulating Hormone (TSH) ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Melanocyte Stimulating Hormone (MSH) (what in the actual heck is this, melanocytes produce melanin, not melatonin) (melatonin, suppresses gondatropins)

What hormone, secreted by the *adrenal cortex*, helps regulate water/electrolyte balance and indirectly manages blood pressure by causing retention of sodium/water? (Hint: Aldosterone)

Mineralocorticoids

14. Mrs. F. is 5 feet tall and weighs 180 pounds. During a routine physical, laboratory studies indicate an el- evated fasting blood glucose level and a hemoglobin A1C level of 6.6%. The nurse's assessment of Mrs. F. reveals that she is a smoker with mild hyperten- sion. The physician suspects type 2 diabetes. What initial treatment is indicated for Mrs. F.? Explain your answer.

Mrs.F.needstomakesomesignificantlifestyle changes. She must stop smoking, lose weight, and exercise regularly, which will help with both the high blood glucose level and the hypertension. The American Diabetes Association also recommends that, in addition to lifestyle changes, the oral bigu- anide drug metformin (Glucophage) be started as initial therapy for lowering blood glucose levels. (Lilley, 122012)

4. calcitonin(thyroid)(1728)

c. Decreases blood calcium levels by causing calcium to be stored in the bones

Which of the following medications is prescribed for calcium electrolyte replacement and therefore patients on it via IV should be monitored for cardiac status/BP due bradycardia, hypercalcemia, and dysrhythmias? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

calcium salts (gluconate, lactate, chloride gluceptate)

2. When administering vasopressin, which is the priority vital sign for the nurse to monitor? a. Temperature b. Pulse c. Respirations d.Blood pressure (Lilley, 122012)

3 When assessing the elderly patient, the nurse keeps in mind that certain nonspecific symptoms may represent hypothyroidism in these patients, such as: a leukopenia, anemia b loss of appetite, polyuria c weight loss, dry cough d cold intolerance, depression

7. The nurse is reviewing the history of a patient who will be taking the amylin mimetic drug pramlintide (Symlin). Which condition is a contraindication to the use of this drug? a. Hypertension b.Coronary artery disease c. Hypothyroidism d. Gastroparesis

*What condition can be classified by the following pathophysiology*? ~ Pituitary releases too much ADH ~ Kidneys reabsorb more water ~ Urine output decreases ~ Circulating volume expands ~ Hyponatremia, hemodilution and fluid overload without peripheral edema result

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

What diagnostic test is used to evaluate Gigantism, revealing elevated baseline GH levels and the inability to suppress serum GH ~ Oral Glucose Challenge ~ The GH suppression test (aka glucose-loading test)

The GH suppression test (aka glucose-loading test)

What are the signs of *hypoparathyroidism* and *hypocalcemia* that nurses need to be aware of when taking care of a child who is post-thyroidectomy?

~ *Chvostek's Sign* (Cheek) ~ *Trousseau's Sign* (Carpal spasm w/BP) ~ *Tetany* (Spasms)

6. mineralocorticoids (adrenal cortex) (1728)

h. Water and electrolyte balance; indirectly manages blood pressure

Desiccated animal thyroid (Armhour)

dried and powdered pig thyroid

7. glucocorticoids (adrenal cortex) (1728)

e. Involved in glucose metabolism; provides extra reserve energy in times of stress; exhibits anti-inflammatory properties

Acromegaly

early heart failure

Patient Teaching-Hyperthyroidism

follow-up, lifelong thyroid hormone replacement. high-calorie, high-protein, high-carbohydrate diet until weight has stabilized.

What gland is described by the following? ~ Butterfly shaped with one lobe lying on either side of the trachea ~ Lies just below the larynx ~ Lobes connected by isthmus ~ Very vascular

Thyroid Gland

Which of the following hormones secreted by the anterior pituitary (adenohypophysis) stimulates the thyroid gland to secrete the thyroid hormone? ~ Growth Hormone (GH) ~ Thyroid Stimulating Hormone (TSH) ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Thyroid Stimulating Hormone (TSH)

What *gland can be classified* by the following? ~ Located in the neck in front of the trachea ~ Manufactures and secretes Thyroxine (T4) & Triiodothyronine (T3) ~ Iodine is essential to the manufacturing of both hormones ~ Controlled by negative feedback mechanism ~ Regulated by thyroid stimulating hormone produced by the anterior pituitary gland ~ Gland is very vascular and receives approximately 80 to 120 mL of blood per minute

Thyroid gland

What *gland releases calcitonin* and plays a vital role in the following? ~ Growth and development ~ Metabolism ~ Activity of the nervous system

Thyroid gland

What possible complications are associated with total thyroidectomy?

Thyroid storm (excessive t3 &t4), tetany (spasms of the hands and feet, cramps, hypocalcemia) , excess bleeding.

Surgical treatment to remove pituitary tumors associated with acromegaly is accomplished with the transsphenoidal removal of tumor tissue known as what? (Note: The goal is to remove only the tumor that is causing GH secretion)

Transsphenoidal hypophysectomy

Even with adequate medical or surgical treatment, the physical changes are irreversible, and the patient is prone to developing complications in acromegaly T or F

True

Oral hypoglycemic medications lower blood glucose by stimulating beta cells of the pancreas, what type of diabetes is this most commonly used for?

Type 2 DM

What medication classifications is used to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy?

*Antithyroid Agents* (Note: *Iodine Containing agents* also used)

What type of cell produces insulin and where does it take place?

*Beta cells* of the *Islets of Langerhans* in the Pancreas

The following are clinical manifestations of what systemic metabolic disorder? ~ *Polyuria* ~ *Polydipsia* ~ *Polyphagia* ~ Glycosuria ~ Ketonuria ~ Nocturia ~ Nausea ~ Fatigue ~ BG >200 ~ Blurred vision, Headache, Nausea

*Diabetes Mellitus*

The following are late s/s of what disorder? ~ *Kussmaul's breathing* (rapid/deep) ~ High blood glucose levels (*300 -800* mg/dl) ~ <7.35pH ~ Sweetish odor on breath ~ Acetone ~ Hypotension ~ Tachycardia ~ Restlessness ~ Stupor, coma, Death (Hint: Early s/s are similar to hyperglycemia)

*Diabetic Ketoacidosis* aka Diabetic Coma

While the following can all be used to treat type II DM which one is the *primary form of treatment*? ~ Insulin ~ Oral Hypoglycemics such as *Glucotrol XL* a Sulfonylureas ~ Diet

*Diet*

What type of Diabetes Mellitus is due to little or no endogenous insulin being produced *requiring injections of insulin* and can be caused by the following? ~ Autoimmune process ~ Viral ~ Genetic predisposition ~ Chemical agents

*Insulin Dependent Diabetes Mellitus aka Type I*

When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the *early signs of hypoglycemia* such as which of the following: ~ Hypothermia and seizures ~ Nausea and diarrhea ~ Irritability and confusion ~ Fruity, acetone odor to the breath

*Irritability and confusion*

The primary treatment for hypothyroidism is which of the following that is lifelong and must never be combined or immediately cut off: ~ Levothyroxine ~ Radioactive iodine ~ Propylthiouracil ~ Methimazole

*Levothyroxine aka synthroid aka (T4)* (Reasoning: It is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine replaces both hormones)

The nurse is administering *lispro insulin*, and should keep in mind that this insulin is: ~ A rapid-acting insulin ~ An intermediate-acting insulin ~ A long-acting insulin ~ Given based on blood glucose levels measured before meals

*Lispro insulin is a rapid-acting insulin*

*Severe hypothyroidism in adults* that is characterized by edema of the hands, face, feet, and periorbital tissues is known as what?

*Myxedema*

WHAT IS TETANY?

*NUMBNESS, TINGLING IN FINGERS TOES *MUSCULAR HYPERTONIA

What type of Diabetes Mellitus is strongly associated with obesity and is caused by the following? ~ *Decrease tissue responsiveness to insulin* ~ Caused by receptor defects ~ Insulin resistance occurs ~ Decrease secretion of insulin from beta cells ~ Abnormal hepatic regulation

*Non-Insulin Dependent Diabetes Mellitus aka Type II*

Which blood glucose test listed below can by classified by the following: The client *fasts for 8 hours* before providing blood and urine samples for baseline after which the *client ingests an oral glucose solution* and blood/urine is *drawn periodically* (30 min, 1 hour, 2 hour, 3 hour) ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

*Oral glucose tolerance test (OGTT)*

Which blood glucose test listed below can by classified by the following: Give a fasting patient a measured amount of carbohydrate solution orally, or have the patient eat a measured amount of foods containing carbohydrates, fats, and proteins. Draw a blood sample *2 hours after completion of the meal*. Elevated plasma glucose over 160 mg/dL may indicate the presence of DM. ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

*Postprandial (after a meal) blood glucose (PPBG)*

Which of the following increases the production of GH? ~ Sandostatin ~ Bromocriptine mesylate ~ Somatotropin ~ Cabergoline

*Somatotropin releases GH*

What is tetany?

*Spasms* (Note: Numbness/tingling in fingers/toes and muscular hypertonia can also occur)

*What is the sole purpose of the parathyroid gland*?

*To regulate calcium levels*

Does Type I or Type II DM result in *muscle wasting and weight loss*?

*Type I DM*

Does Type I or Type II DM result in slow wound healing and *decreased sensation to pain/temp in extremities*?

*Type II DM*

51. Discuss considerations for older adults related to endocrine disorders. (1764)

-Diabetes mellitus is more prevalent in older adults. A major reason for this is that the process of aging involves insulin resistance and glucose intolerance, which are believed to be precursors to type 2 diabetes. The classic signs and symptoms of diabetes may not be obvious in older adults. Older adult diabetic patients are at increased risk for infection and should be counseled to receive proper immunizations and seek regular medical attention for even minor symptoms. The older adult often has difficulty managing diabetes. Dietary management may be complicated by a variety of functional, social, economic, and financial factors. -Some symptoms of hypothyroidism in the older adult are similar to those in a younger person but are more likely to be overlooked because the symptoms—fatigue, mental impairment, sluggishness, and constipation—are often attributed solely to aging. The older person with hypothyroidism has more disturbances of the central nervous system, such as syncope, convulsions, dementia, and coma. There is often pitting edema and deafness. -The older patient with hyperthyroidism frequently has manifestations related only to the cardiovascular system, such as palpitations, angina, atrial fibrillation, and breathlessness. Signs and symptoms often attributed to "aging" may actually indicate an endocrine problem.

11. Mr. D., who has had a history of problems with a hormonal imbalance, has been admitted for sep- tic shock, and the physician prescribes dopamine. However, the nurse double-checks the patient's his- tory before administering the drug. What condition may be a contraindication to dopamine? (Lilley, 122012)

Useofthedrugiscontraindicatedinpatientswho have a tumor that secretes catecholamines, such as a pheochromocytoma. (Lilley, 122012)

What is a form of diagnostic evaluation for Diabetes Insipidus where if positive, requires *Vasopressin (Pitressin) or DDAVP* to treat? (Note: DDAVP must be *suspended in oil* prior to being drawn up and administered)

Water deprivation test (Note: Fluid is restricted however, there is little or no effect on urine formation)

The nurse is teaching a group of patients about self-administration of insulin. Which of the following teaching points is important to include? ~ Patients should use the injection site that is the most accessible ~ During times of illness, patients should increase their insulin dosage by 25% ~ When mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first ~ When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first

When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first. (Note: Injection sites should also be rotated)

When collecting information from the patient with acromegaly, what subjective data should be gathered?

-Neurological (headaches, visual disturbances) -Muscle weakness -Sexual problems (male impotency, female - masculinization).

WHAT ARE POSSIBLE COMPLICATIONS OF HYPERCALCEMIA?

-PATHOLOGIC FRACTURE -CARDIAC ARRHYTHMIAS -RENAL DISEASE -NAUSEA/VOMITING

Thyroid Storm (Rare)

-increased heart rate, restlessness, persistent sweating, loss of consciousness, nausea and abdominal pain

6. The nurse is caring for a patient who had cranial surgery to remove a pituitary tumor 3 days ago, leaving the patient with partial left hemiparesis and diabetes insipidus. Which nursing diagnosis is of the greatest priority postoperatively? 1. Risk for deficient fluid volume, related to excessive loss via the urinary system 2. Hopelessness, related to development of chronic illness (hemiparesis and diabetes insipidus) 3. Risk for impaired oral mucous membranes, related to dehydration 4. Coping, ineffective family: compromised, risk for, related to chronic illness

1(Check back of book if this doesn't match up)

16. The nurse is conducting a class for diabetic patients in the community. What information should the nurse include in the educational plan? (Select all that apply.) 1. Regular insulin (Humulin R) has an onset of action of 30 minutes to 1 hour. 2. Lispro (Humalog) has an onset of action of 15 minutes. 3. NPH (Humulin N) has an onset of action of 2 hours. 4. Glargine (Lantus) has an onset of action of 6 to 10 hours. 5. Lantus has a peak of 8 to 10 hours.

1,2(Check back of book if this doesn't match up)

When teaching a patient regarding desmopressin (DDAVP), the nurse will inform the patient to monitor for which potential side effects? Select all that apply. 1 Headache 2 Weight gain 3 Nasal irritation 4 Hyperglycemia 5 Hypotension

1,2,3 Desmopressin works to decrease urine output; thus the patient would retain fluid and gain weight. Headache may also occur as a sequela of fluid retention. Because it is administered intranasally, it can be irritating; thus nostrils should be rotated. Desmopressin does not affect serum glucose levels.

20. The nurse is reviewing the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). What would nurse include in the interventions? (Select all that apply.) 1. Daily weight 2. I&O 3. Fluid restriction 4. Foods high in sodium 5. Assessment for abdominal sounds

1,2,3(Check back of book if this doesn't match up)

18. The nurse is aware that SIADH is characterized by which clinical manifestations? (Select all that apply.) 1. Peripheral edema 2. Hyponatremia 3. Water retention 4. Brain cells becoming edematous 5. Intake equal to output

1,2,3,4(Check back of book if this doesn't match up)

The nurse is caring for a patient who has undergone a thyroidectomy. Which signs or symptoms should be reported immediately to the RN/MD for further evaluation? Select all that apply. 1Numbness in the fingers 2Heart rate of 160 3Blood pressure of 134/74 4Noticeable arm twitching while assessing blood pressure 5Complaints of a sore throat

1,2,4 Numbness in the fingers in the patient who has undergone a thyroidectomy could be a sign of low serum calcium, which might be due to an occlusion of parathyroid hormone release into the bloodstream (secondary to edema of the operative site). This requires further investigation and possible treatment. A heart rate of 160 will need to be reported immediately. After surgery this could be a sign of hemorrhage; but in the case of thyroid surgery it could be a sign of thyroid crisis or thyroid storm. In thyroid crisis, all signs and symptoms of hyperthyroidism are exaggerated. The patient may also have nausea, vomiting, severe tachycardia, severe hypertension, and occasionally hyperthermia up to 41° C (106° F). Noticeable arm twitching when taking the patient's blood pressure might indicate low serum calcium, which might be due to an occlusion of parathyroid hormone release into the bloodstream (secondary to edema of the operative site). This requires further investigation and possible treatment. A blood pressure of 134/74 would not be an emergency, although it must be compared to the patient's baseline. If it is slightly elevated from the patient's normal blood pressure, perhaps pain medication is needed. In any event, it is necessary to notify the RN of the patient's vital signs postoperatively, but this BP does not appear to be a medical emergency. A patient who has had a thyroidectomy would expect to have a sore throat. The LPN would immediately report increasing hoarseness, which may indicate a swelling of the throat.REF: Page 1738

Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? Select all that apply. 1Limit your alcohol consumption. 2Report symptoms of anorexia and fatigue. 3Take your medication only as needed. 4Notify your physician if blood glucose levels rise above the level set for you.

1,2,4 Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. All other options are correct.

The nurse is reviewing adverse effects of antithyroid medications with a patient who has been taking PTU. What adverse effects does the nurse include in the teaching? Select all that apply. 1 Liver toxicity 2Polyuria 3Kidney damage 4Bone marrow toxicity 5Joint pain

1,4,5 The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU

*Answer the following questions for post op thyroidectomy*? 1. What type of supplements should be taken 2. What is needed at bedside 3. Where do we check for bleeding 4. What position should the patient be in and why?

1. Calcium supplements & *Vitamin D* 2. Mechanical ventilation, Endotracheal intubation equipment (trach tray/suction) 3. Check behind the neck for bleeding, not just bandage 4. Semi fowlers position for edema control

11. The nurse is examining changes in a medication administration record after new orders were written. One new medication order reads, "levothyroxine (Levothroid), 200 mg, once a day." The nurse sus- pects an error. What is wrong with this order?

11. There are two errors. (1) Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micro- grams. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg must be questioned in case this error occurred. (2) The route is not written. This drug would be admin- istered PO. (Lilley, 122012)

12. Rory, age 32, has been given a prescription for pro- pylthiouracil (PTU) as part of treatment for Graves' disease. What laboratory tests are important to assess before she begins this medication? (Lilley, 122012)

12. The most damaging or serious adverse effects of pro- pylthiouracil (PTU) medications are liver and bone marrow toxicity. Therefore, it is important to assess liver function studies as well as a complete blood count (white blood cells, red blood cells, platelets). (Lilley, 122012)

6 When teaching a patient who has a new prescription for thyroid hormone, the nurse will instruct the patient to notify the physician if which adverse effects are noted? (Select all that apply.) a Palpitations b Weight gain c Angina d Fatigue e Cold intoleranc

a,c

4. Which information needs to be included in the nurse's teaching of patients taking thyroid medications? (Select all that apply.) a. Keeping a log or journal of individual responses and a graph of pulse rate, weight, and mood would be helpful. b. The medication will be discontinued if the adverse effects become too strong. c. The medication needs to be taken at the same time every day. d. Nervousness, irritability, and insomnia may be a result of a dosage that is too high. e. Take thyroid replacement drugs after meals.

a,c,d

12. Alice occasionally experiences hypoglycemia as a result of her diabetes drug therapy. (Lilley, 122012) a.The nurse will teach Alice about what signs and symptoms of hypoglycemia? b.The nurse knows that one of the early signs of hypoglycemia is irritability. Why is this true? c.If Alice experiences hypoglycemia at home, what are the treatment options?

12. a. Confusion, irritability, tremor, and sweating (Lilley, 122012) b. The brain needs a constant amount of glucose to function; thus the central nervous system mani- festations of hypoglycemia (such as irritability and confusion) are often the first to appear. c. In the conscious person, oral forms of glucose are used, such as rapidly dissolving buccal tablets or semisolid gel forms designed for rapid mucosal absorption. She could also try corn syrup, honey, fruit juice, a nondiet soft drink, or a small snack such as crackers or half a sandwich. (Lilley, 122012)

18. A patient with type 2 diabetes mellitus often has a history of ________________________, ________________________, ________________________, hypercholesterolemia, and cardiovascular risk (MI, stroke) before the disease is diagnosed. (1753)

18. hypertension, obesity, dyslipidemia

19. ________________________ causes more cases of blindness in the United States than any other disease. (1764)

19. Diabetes

What is a characteristic of hyperparathyroidism? 1Decreased parathormone levels 2Increased serum calcium 3Decreased alkaline phosphatase levels 4Increased serum phosphorous levels

2 Increased serum calcium is the primary clinical manifestation of hyperparathyroidism. This occurs as calcium leaves the bone and accumulates in the bloodstream. As a result, bones become demineralized, causing skeletal pain, pain on weight bearing, and pathologic fractures. In hyperparathyroidism, there is an overactivity of the parathyroid glands, with increased production of parathormone; therefore, parathormone levels will be increased, not decreased. In hyperparathyroidism, there will be increased alkaline phosphatase levels. Alkaline phosphatase is an enzyme that is present in bone (and other) tissues. In this disease, it is released into the bloodstream because of bone breakdown and demineralization. In hyperparathyroidism, there is a decrease in serum phosphorous levels. This occurs because of the increase in calcium levels: the body maintains an inverse relationship between the two (when calcium goes up, phosphorous goes down, and vice versa).REF: Page 1743

20. Approximately __________ of diabetic patients have to undergo either peritoneal dialysis or hemodialy␣ sis as a result of vascular changes that affect the kidney. (1765)

20. 45%

The nurse is talking to a patient who was recently diagnosed with acromegaly. The woman says, "My career is over. I'll become so hideous, I'm sure i"ll get fired" What is the most therapeutic response? (1730) 1. "You have talents and abilities; surely those qualities will be considered" 2. "Why don't you wait and cross that bridge when you come to it" 3. "You are thinking about how your life and and career might change" 4. "Let's talk about what you could do to enhance your appearance

22. Answer 3: First, the nurse acknowledges the underlying feelings of change and loss. Option 1 is false reassurance. Option 2 is a platitude. Option 4 may be a possibility after assessment, treatment, and discussion.

23. The school nurse is taking the height and weight measurements of all of the children at the beginning of the school year. Measurement for one of the students shows a deviation over two percentile levels from the median. What should the nurse do? (1732) 1. Call the parents and ask about the child's birth weight and growth patterns. 2. Contact the parents and suggest they take the child to the health care provider. 3. Recheck the child's height and weight once a month for the next several months. 4. Track the child's growth over time and compare findings to siblings and classmates"

23. Answer 2: A school nurse would notify the parents, so the child could be evaluated by a health care provider (for diagnostic testing to rule out giantism). A nurse who works with/ for the health care provider would perform the other options. The health care provider might also contact the school nurse and ask for regular height and weight reports.

What is the term for a chemical messenger that travels throughout the bloodstream to its target organ? 1Exocrine gland 2Endocrine gland 3Hormone 4Negative feedback system

3 A chemical messenger that travels throughout the bloodstream to its target organ is known as a hormone. The endocrine system communicates through hormones. When the hormone reaches its target, a metabolic change occurs. An exocrine gland secretes through a series of ducts: sebaceous and sudoriferous glands of the skin. Their secretions are protective and functional. An endocrine gland is ductless; it releases its secretions directly into the bloodstream. Secretions from endocrine glands have a regulatory function. Negative feedback is a decrease in function in response to stimuli. In a negative feedback system, information is constantly being exchanged between the target organ and the pituitary gland via the bloodstream regarding the impact of the hormone on the target organ.REF: Pages 1724-1725

1. Which hormones are responsible for "fight or flight"? 1. Estrogen and testosterone 2. FSH and LH 3. Epinephrine and norepinephrine 4. Calcitonin and parathyroid hormone

3(Check back of book if this doesn't match up)

15. Which is an appropriate instruction for the patient with diabetes related to care of the feet? 1. Use heat to increase blood supply. 2. Avoid softening lotions and creams. 3. Inspect all surfaces of the feet daily. 4. Use iodine to disinfect cuts and abrasions.

3(Check back of book if this doesn't match up)

4. What hormone is responsible for male secondary sex characteristics? 1. Estrogen 2. Progesterone 3. Testosterone 4. Adrenaline

3(Check back of book if this doesn't match up)

Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? Select all that apply. 1Stimulate insulin secretion from beta cells 2Increase hepatic glucose production 3Enhance action of insulin in various tissues 4Inhibit breakdown of insulin by liver

3,4 The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.

17. For each symptom listed below, specify whether it is associated with hyperglycemia or hypoglycemia. a. Irritability b. Fatigue c. Polydipsia d. Tremors e. Sweating (Lilley, 122012)

a. Hypoglycemia b. Hyperglycemia c. Hyperglycemia d. Hypoglycemia e. Hypoglycemia (Lilley, 122012)

13. The newly graduated nurse is preparing a dose of Novolin-R insulin to administer to a patient. a.Before the nurse administers the medication, how will the nurse's co-worker verify the order? b.After examining the syringe, the nurse's co- worker tells the graduate nurse that the syringe must be discarded because the insulin is cloudy. The new graduate states, "Insulin is supposed to look this way." Who is right, the new nurse or the co-worker? c.The nurse examines the vial. A date on the label indicates that it has been on the shelf in this room for 2 months. Is this a problem?

a. The graduate nurse will check the order at least three times and then have another licensed nurse check the prepared injection to be sure it is in accordance with the prescriber's order. These sec- ond checks may vary with facilities. b. The graduate nurse's co-worker. Novolin-R is regular insulin, and regular insulin is clear. c. If left at room temperature, the insulin in the vial must be discarded after 1 month. (Lilley, 122012)

4. Which nursing diagnosis is most appropriate for a patient who is receiving a pituitary drug? a. Constipation b. Disturbed body image c. Impaired physical mobility d. Impaired skin integrity

8. The nurse will monitor for significant interactions if sitagliptin (Januvia) is given with which of these? a. Corticosteroids b. Sulfonylureas c.Thyroid drugs d.Nonsteroidal antiinflammatory drugs (Lilley, 122012)

Thyroid Function Tests (TFT)

blood levels

Which of the following medications inhibits prolactin secretion, lowers serum levels of growth hormone and is a dopamine receptor agonist but patients on it should change positions slowly due to headache, dizziness, and orthostatic hypotension? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

bromocriptine (Parlodel)

4 To help with the insomnia associated with thyroid hormone replacement therapy, the nurse will teach the patient to a take half the dose at lunchtime and the other half 2 hours later. b use a sedative to assist with falling asleep. c take the dose upon awakening in the morning. d reduce the dosage as needed if sleep is impaired.

4. While monitoring a patient who is receiving insu- lin therapy, the nurse observes for which signs of hypoglycemia? a. Decreased pulse and respiratory rates and flushed skin b. Increased pulse rate and a fruity, acetone breath odor c. Irritability, sweating, and confusion d. Increased urine output and edema (Lilley, 122012)

6. During vasopressin therapy, which is the priority nursing action? a. Check blood glucose levels regularly. b. Monitor the electrocardiogram for changes. c. Monitor the IV site for signs of infiltration. d. Watch for hyperthermia.

16. The human insulin whose onset of action occurs within ____ minutes is lispro (Humalog). a. 30 b. 60 c. 15 d. 45

ANS: C Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The new formula can be injected 15 minutes before a meal. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1768, Table 50-5 OBJ: 13 TOP: Insulin KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. The order reads, "Give levothyroxine (Synthroid), 200 mg, PO once every morning." Which action by the nurse is correct? a. Give the medication as ordered. b. Change the dose to 200 mcg, because that is what the prescriber meant. c. Hold the drug until the prescriber returns to see the patient. d. Question the order because the dose is higher than 200 mcg.

ANS: D Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micrograms. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned in case this error has occurred. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 504 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

A life-threatening state of profound adrenal cortical insufficiency that occurs when the adrenal glands suddenly fail, causing the following, is known as what? ~ Sudden, severe drop in B/P (hypotension) ~ Anorexia, nausea and vomiting ~ Extremely high temperature ~ Diarrhea, abdominal pain ~ Profound weakness ~ Headache, restlessness or fever ~ Can lead to *vasomotor collapse*

Addisonian Crisis

Tetany

calcium imbalance marked by tonic spasm of muscles; associated with deficient parathyroid secretion ; hypocalcemia

2 The pharmacy has called a patient to notify her that the current brand of thyroid replacement hormone is on back order. The patient calls the clinic to ask what to do. Which is the best response by the nurse? a "Go ahead and take the other brand that the pharmacy has available for now." b "You can stop the medication until your current brand is available." c "You can split the thyroid pills that you have left so that they will last longer." d "Let me ask your physician what needs to be done; we will need to watch how you do if you switch brands."

2. A dose of long-acting insulin has been ordered for bedtime for a diabetic patient. The nurse expects to give which type of insulin? a. Regular b. Lispro c. NPH d. Glargine

2. A patient wants to switch brands of levothyroxine (Synthroid). What is the nurse's best response? a. "If you do this, you should reduce the dosage of your current brand before starting the new one." b. "Levothyroxine has been standardized, so there is only one brand." c. "It shouldn't matter if you switch brands; they are all very much the same." d. "You should check with your provider before switching brands."

31. The nurse is caring for a patient who had a thyroidectomy 6 hours ago. The patient now exhibits extreme anxiety and irritability with a severe elevation in pulse, blood pressure, and temperature. The nurse would initiate emergency measures for which postoperative complication? (1739) 1. Hypovolemic shock 2. Thyroid crisis 3. Airway obstruction 4. Septic shock

31. Answer 2: The patient is displaying symptoms of thyroid crisis. The risk is greatest in the first 12 hours after surgery.

32. The nurse reads in the patient's chart that a firm, fixed, small, rounded, painless module was felt during palpation of the thyroid gland. The nurse prepares to support the patient when the health care provider informs about the need for diagnostic testing for: (1743) 1. Myxedema. 2. Colloid goiter. 3. Thyroid cancer. 4. Cretinism.

32. Answer 3: Upon finding a palpable nodule, the health care provider would order diagnostic testing to rule out thyroid cancer. Severe hypothyroidism in adults is called myxedema. It is characterized by edema of the hands, the face, the feet, and periorbital tissues. Congenital hypothyroidism is called cretinism. Colloid goiter could manifest as an unsightly enlargement of the thyroid gland or with dysphagia, hoarseness, or dyspnea.

33. The nurse is caring for a patient who has a pathologic fracture secondary to hyperparathyroidism. Which food needs to be taken off the patient's breakfast tray? (1745) 1.Glass of whole milk 2.White toast with jam 3. Sugared cereal flakes 4.Fried egg with bacon

33. Answer 1: Although the nurse may see that the patient would benefit from a MyPlate review, the dietary restriction related to the hyperparathyroidism is dairy products.

34. Why is the diuretic medication furosemide (Lasix) prescribed for a patient with hyperparathyroidism? (1745) 1.Preserve existing kidney function 2. Decrease fluid retention and edema 3.Encourage the elimination of serum calcium 4.Decrease blood pressure

34. Answer 3: Hyperparathyroidism causes an increase in serum calcium and the goal is to rid the body of the excess. Thiazide diuretics are not used because they decrease renal excretion of calcium and thus increase the hypercalcemic state. Diuretics can be used in acute renal failure to preserve kidney function or in disorders that cause fluid retention, such as congestive heart failure. Diuretics are usually included in the regimen for hypertension.

What takes place when hormones reach the target organ?

A metabolic change takes place.

When regular and another insulin are mixed in the same syringe, it must be administered within what timeframe?

5min

What is the BG range for hypoglycemia?

<70 mg/dl

1 A patient is experiencing severe diarrhea, flushing, and life-threatening hypotension associated with carcinoid crisis. The nurse will prepare to administer which drug? a octreotide (Sandostatin) b vasopressin (Pitressin) c somatropin (Humatrope) d cosyntropin (Cortrosyn)

1 Which is the most appropriate timing regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient? a Give it 15 minutes before the patient begins a meal. b Give it ½ hour before a meal. c Give it 1 hour after a meal. d The timing of the insulin injection does not matter with insulin lispro.

5 A patient with type 2 diabetes has a new prescription for repaglinide (Prandin). After 1 week, she calls the office to ask what to do, because she keeps missing meals. "I work right through lunch sometimes, and I'm not sure whether I need to take it. What do I need to do?" What is the nurse's best response? a "You need to try not to skip meals, but if that happens, you will need to skip that dose of Prandin." b "We will probably need to change your prescription to insulin injections because you can't eat meals on a regular basis." c "Go ahead and take the pill when you first remember that you missed it." d "Take both pills with the next meal, and try to eat a little extra to make up for what you missed at lunchtime."

9. Mrs. W., age 43, comes into the clinic complaining of hair loss, lethargy, and constipation. "I just can't eat anything," she says. As the nurse takes her blood pressure, he notices that her skin feels thickened. She also seems to have a lump in her neck. The primary care provider makes a diagnosis of hypothyroidism. Suggest several possible appropriate medications. Which of those is generally preferred? Why?

9. Mrs. W. probably has hypothyroidism, which may result in the formation of a goiter, an enlargement of the thyroid gland resulting from its overstimulation by elevated levels of thyroid-stimulating hormone. She may benefit from one of the thyroid drugs, including thyroid, levothyroxine, liothyronine, or liotrix. Levothyroxine is generally preferred because, as a chemically pure formulation of 100% thyroxine, its hormonal content is standardized; therefore, its effect is predictable. (Lilley, 122012)

10. insulin(pancreas)(1729)

i. Secreted in response to decreased levels of glucose in the blood

12. melatonin(pineal)(1729)

j. Inhibits reproductive activities by inhibiting the gonadotropic hormones

9. norepinephrine (adrenal medulla) (1730)

k. Combines with epinephrine to produce "flight or fight" response

11. glucagons (pancreas) (1729)

l. Secreted in response to increased levels of glucose in the blood

Which of the following medications is a adrenal cytotoxic agent that reduces production of adrenal steroids and patients on it should use contraception? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

mitotane (Lysodren)

Which of the following medications is a secretory inhibitory growth hormone suppressant that suppresses secretion of serotonin and gastroenteropancreatic peptides that will enhances fluid and electrolyte absorption from the GI tract? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

octreotide (Sandostatin)

Which of the following medications blocks the release of thyroid hormone in thyroid storm and hyperthyroidism but can also used as an expectorant? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

potassium iodide (SSKI)

Always draw up_____________________ first

regular insulin

Diabetic Medications must be injected ____________________.

subcutaneously

Radical neck dissection with metastasis

surgery done to remove lymph nodes that contain cancer

Always have the dose drawn up in the ___________________ by another nurse prior to administration

syringe checked

Which of the following medications is a synthetic pituitary hormone with antidiuretic effects on the kidney (*treats diabetes insipidus*) and also a potent vasoconstrictor? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

vasopressin (Pitressin)

What are some forms of treatment for hypoglycemia? (Hint: Rapid acting simple carbohydrates q15min)

~ *4 oz orange juice* or regular soft drink ~ ½ candy bar or one granola bar ~ Dextrose tablets or glucose paste ~ 5 - 6 lifesavers ~ 4 animal crackers ~ Glucagon (IV or IM)

What are some *nursing interventions* for someone with Diabetes Insipidus?

~ *Eliminate caffeine* ~ *Monitor fluid and electrolyte balance* ~ *Strict I & O* ~ *Daily Weights* ~ *BP lying/standing*

Which of the following medications are forms of thyroid hormone replacement and along with *being given in morning to minimize insomnia* should never be swapped for a different brand without consulting your MD? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

~ *Levothyroxine* (Eltroxin, Synthroid, Levothroid) ~ Liothyronine (Cytomel) ~ Liotrix (Thyrolar) ~ Thyroid (Thyrar, Armour Thyroid) (Note: Last one is bonus med)

Medical management of Cushing's Syndrome revolves around treating the causative factor such as what two surgeries in what two locations? (Note: mitotane aka Lysodern can be used to treat along with major lifestyle changes)

~ Adrenal Glands/Cortex via Adrenalectomy ~ Pituitary Tumors via Irradiated or removed surgically

What two hormones, secreted by the *adrenal cortex*, is involved in sexual function for males and females?

~ Androgens in males ~ Estrogens in females

The following are forms of Medical Management for SIADH, what medication would you expect this type of patient to be placed on? ~ Fluid restriction initially 800 to 1000 ml of fluid per day (severe hyponatremia may be restricted to 500 ml per day) ~ Prevention of hypovolemia ~ Hypertonic saline infusion (3% - 5%) to correct sodium imbalance ~ Correction of serum sodium must be gradual to prevent neurologic damage

~ Demeclocycline (Declomycin) ~ *Lithium Carbonate* (Reasoning: Interferes with the antidiuretic action of ADH and causes polyuria)

What is the most common form of diagnosing and treating Dwarfism? (Note: Prognosis is good and they lead fairly normal lives)

~ Diagnose: Decreased plasma levels of growth hormone ~ Treat: GH injection (or removal of tumors)

What two hormones will the Adrenal Medulla release during stress that will cause the following reactions? ~ Increase heart rate & BP ~ Bronchodilation ~ Cause liver to release glucose for immediate energy (Hint: Fight or flight)

~ Epinephrine (adrenaline) ~ Norepinephrine

Name the 7 hormones secreted by the Anterior Pituitary Gland?

~ Growth Hormone (GH) ~ *Thyroid Stimulating Hormone (TSH)* ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

In addition to replacing adrenal hormones with Hydrocortisone or Fludrocortisone what diet should a patient with Addison's Disease be on? (Note: Pt will be on long term steroid therapy)

~ High sodium ~ Low potassium

When diagnosing a patient with Hypoparathyroidism, will the following be increased or decreased? ~ Serum Calcium ~ Serum Phosphate ~ Urine Calcium ~ Urine Phosphate

~ Hypocalcemia ~ Hyperphosphatemia ~ Increased Urinary calcium ~ Decreased Urinary Phosphorous

What diet should a patient with Cushing's Syndrome be on?

~ Low Sodium ~ Low sugar ~ High calcium (book states increased urinary secretion of calcium m, but nothing about a diet) -High Potassium (Book states this)

What are the three main *hormones secreted by the adrenal cortex*?

~ Mineralocorticoids ~ Glucocorticoids ~ Sex Hormones

What are some s/s of water intoxication?

~ Nausea ~ Weight Gain ~ Changes in LOC ~ Decreased urine output

What would you want to monitor for a patient who just had a removal of hypertrophied gland tissue or of an individual tumor due to hyperparathyroidism?

~ Observe for signs and symptoms of hypoparathyroidism ~ Assess for signs of hypocalcemia

Thyroid Cancer is a rare malignancy where the cancer grows slowly but is usually contained and does not spread beyond adjacent lymph nodes; what are the three types of this? (Note: Palpable firm, fixed, painless nodules)

~ Papillary ~ Follicular ~ Anaplastic

While discussing thyroid replacement therapy and establishing treatment goals with a patient since it will be *lifelong*, the nurse explains that knowing to look for certain adverse effects ahead of time will help her to respond to them before they become serious problems. Some of the adverse effects to discuss with her are:

~ Tachycardia ~ Dysrhythmias ~ Weight loss ~ Fever

What must be done before administering Insulin? (Hint: Test done before, how mixed insulin is drawn, & verification)

~ Take BG ~ *Draw Clear before Cloudy* ~ Must have another licensed professional double tap dosage/syringe

8. epinephrine (adrenal medulla) (1729)

f. Causes the heart rate and blood pressure to increase

Which of the following medications is a adrenal corticosteroid with mineralocorticoid activity that promotes sodium and water retention so patients on it should be monitored for hypokalemia and fluid retention due to edema/hypertension being s/s? ~ bromocriptine (Parlodel) ~ calcium salts (gluconate, lactate, chloride gluceptate) ~ fludrocortisone (Florinef) ~ levothyroxine, liothyronine, liotrix ~ mitotane (Lysodren) ~ potassium iodide (SSKI) ~ octreotide (Sandostatin) ~ vasopressin (Pitressin)

fludrocortisone (Florinef)

5. parathormone (parathyroid) (1728)

g. Increases the concentration of calcium in the blood and regulates phosphorus in the blood

Question: What is the primary treatment for hyperthyroidism?

Answer: Ablation therapy with Radioactive Iodine to destroy hypertrophies thyroid tissue. (thyroid absorbs all of the iodine in the body and when its radioactive it destroys the thyroid.)

49. Arrange the steps of drawing up a short-acting and a long-acting insulin in the same syringe. (Separate letters by a comma and space as follows: A, B, C, D) a. Draw up amount of shorter-acting insulin b. Check insulin dose with a second licensed nurse c. Inject the desired amount of air into the long-acting insulin d. Clean rubber stopper of both vials with alcohol e. Draw up desired amount of longer-acting insulin f. Inject the desired amount of air into the short-acting insulin

ANS: D, C, F, A, E, B When drawing up two different types of insulin, the two vials are prepared by cleansing the tops, air is injected in the longer-acting insulin, air is injected into the short-acting insulin, and the required dose is drawn up. Set the vial of short-acting insulin out of reach to prevent accidental reuse. Handing the plunger securely, insert the needle in the long-acting insulin and withdraw the dose very carefully. Check the dose with a licensed nurse before administering. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1759, Box 50-3 OBJ: 14 TOP: Mixing insulin KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

48. Arrange the steps of the negative feedback system in the control of blood glucose in chronologic order. (Separate letters by a comma and space as follows: A, B, C, D): a. Elevation of blood glucose b. Decrease in blood glucose c. Beta cells repressed d. Beta cells of pancreas stimulated to excrete insulin e. Intake of nutrients

ANS: E, A, D, B, C After the intake of food the blood glucose increases, which stimulates the beta cells of the pancreas to excrete insulin. Insulin decreases the blood glucose and the negative feedback system represses the beta cells of the pancreas. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1728 OBJ: 2 TOP: Negative feedback system KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

46. ________________is the term that describes a condition of normal thyroid function.

ANS: Euthyroid Euthyroid is the term that describes a condition of normal thyroid function. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1737 OBJ: 5 TOP: Euthyroid KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

42. The nurse is administering long-acting insulin once a day, which provides insulin coverage for 24 hours. This insulin is _________________.

ANS: Lantus Lantus is a long-acting synthetic (recombinant DNA origin, human-made) human insulin. It is used once a day at bedtime and works around the clock for 24 hours. PTS: 1 DIF: Cognitive Level: Implementation REF: Page 1768, Table 50-5 OBJ: 3 TOP: Insulin KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

47. When the nurse inflates the sphygmomanometer cuff exceeding the systolic blood pressure and observes a carpal spasm, this is a(n) __________ ____________.

ANS: Trousseau sign Trousseau sign is a carpal spasm brought on by pressure of a cuff. This is an indicator for hypocalcemia and hypomagnesemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1738 OBJ: 6 TOP: Trousseau sign KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

43. Another term for hyperglycemic reaction is ____________ ______________.

ANS: diabetic ketoacidosis (DKA) diabetic ketoacidosis DKA Hyperglycemic reaction—the body eliminates the excess glucose by the kidneys releasing it in the urine. Diabetic ketoacidosis (DKA) (acidosis accompanied by an accumulation of ketones in the blood), formerly called diabetic coma, may develop and the patient could die. DKA is a severe metabolic disturbance caused by an acute insulin deficiency, decreased peripheral glucose use, and increased fat mobilization and ketogenesis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1765, Table 50-6 OBJ: 10 TOP: Hyperglycemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

45. A condition with a deficiency in growth hormone is called ________________.

ANS: hypopituitary dwarfism A condition with a deficiency in growth hormone is called hypopituitary dwarfism. Most cases are idiopathic, but a small number can be attributed to an autosomal-recessive trait. In some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and the gonadotropins. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1731 OBJ: 5 TOP: Dwarfism KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

44. Only ________insulin can be administered intravenously.

ANS: regular Insulin is given subcutaneously, although intravenous (IV) administration of regular insulin can be done when immediate onset of action is desired. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1768, Table 50-5 OBJ: 13 TOP: Insulin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic

ANS: A An increased force of contraction is known as a positive inotropic effect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 302 TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? a. "Basal dosing delivers a constant dose of insulin." b. "With basal dosing, you can eat what you want and then give yourself a dose of insulin." c. "Glargine insulin is given as a bolus with meals." d. "Basal-bolus dosing is the traditional method of managing blood glucose levels."

ANS: A Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 519 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient's medication order indicates that he is to receive a dose of cosyntropin (Cortrosyn). The nurse is aware that this drug is used to diagnose which condition? a. Adrenocortical insufficiency b. Diabetes insipidus c. Myasthenia gravis d. Pituitary dwarfism

ANS: A Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 495 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. In diabetes insipidus, a deficiency of which hormone causes clinical manifestations? a. antidiuretic hormone (ADH) b. follicle-stimulating hormone (FSH) c. thyroid-stimulating hormone (TSH) d. adrenocorticotropic hormone (ACTH)

ANS: A Diabetes insipidus is a transient or permanent metabolic disorder of the posterior pituitary in which ADH is deficient. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1732 OBJ: 5 TOP: Diabetes insipidus KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. Which test will furnish immediate feedback for a newly diagnosed diabetic who is not yet under control? a. Fasting blood sugar (FBS) b. Glycosylated hemoglobin (HgbA1c) c. Oral glucose tolerance test (OGTT) d. Clinitest

ANS: A Diabetics should do a fingerstick blood glucose level test before each meal and at bedtime each day until their disease is under control. The HgbA1c serum test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1764, Box 50-2 OBJ: 9 TOP: Diabetes mellitus KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

5. A 75-year-old woman with type 2 diabetes has recently been placed on glyburide (Diabeta), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response? a. "Take this medication in the morning, 30 minutes before breakfast." b. "Take this medication in the evening with a snack." c. "This medication needs to be taken after the midday meal." d. "It does not matter what time of day you take this medication."

ANS: A Glyburide is taken in the morning, 30 minutes before breakfast. When taken at this time, it has a longer duration of action, causing a constant amount of insulin to be released. This may be beneficial in controlling blood glucose levels throughout the day. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 528 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

23. The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool and moist, and the respirations are 32 and shallow. These are signs of: a. hypoglycemic reaction; give 6 oz of orange juice. b. hyperglycemic reaction; give ordered regular insulin. c. hyperglycemic hyperosmolar nonketotic reaction; squeeze glucagon gel in buccal cavity. d. hypoglycemic reaction; give ordered insulin.

ANS: A Hypoglycemic reaction is due to not enough food for the insulin. Quick acting carbohydrates—such as orange juice or longer acting foods such as milk, crackers, and cheese—are beneficial. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1765, Table 50-6 OBJ: 9 TOP: Diabetes mellitus complications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day? a. In the morning b. With the noon meal c. With the evening meal d. At bedtime

ANS: A If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 507 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

29. How should the nurse administer insulin to prevent lipohypertrophy? a. At room temperature b. At body temperature c. Straight from the refrigerator d. After rolling bottle between hands to warm

ANS: A In fact, it is now believed that insulin should be administered at room temperature, not straight from the refrigerator, to help prevent insulin lipohypertrophy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1759 OBJ: 8 TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

5. An 8-year-old child has been diagnosed with true pituitary dwarfism and is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome? a. Increased growth b. Decreased urinary output c. Increased muscle strength d. Increased height when the child reaches puberty

ANS: A In patients for whom somatropin is indicated, increased growth is expected. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 499 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis

ANS: A Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 300 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. What do the Chvostek sign and the Trousseau sign indicate? a. Low levels of serum calcium b. High levels of blood sugar c. Low levels of serum sodium d. High levels of serum aldosterone

ANS: A Low levels of blood calcium may cause the Chvostek sign and Trousseau sign. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1738 OBJ: 6 TOP: Chvostek sign KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient? a. Give it within 15 minutes of mealtime. b. Give it after the meal has been completed. c. Administer it once daily at the time of the midday meal. d. Administer it with a snack before bedtime.

ANS: A Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body's natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient's mealtime. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

1. The nurse explains that the negative feedback system controls hormone release by communication between: a. the pituitary and the target organ. b. the thymus and the blood stream. c. lymphatic system and the target organ. d. central nervous system and the blood stream.

ANS: A The amount of hormone released is controlled by a negative feedback system. When the level of the particular hormone is appropriate, the target organ signals the pituitary to stop the stimulation of the target organ. PTS: 1 DIF: Cognitive Level: Implementation REF: Page 1725 OBJ: 2 TOP: Anatomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. To which diet should a patient with Cushing syndrome adhere? a. Less sodium b. More calories c. Less potassium d. More carbohydrates

ANS: A The diet should be lower in sodium to help decrease edema. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1749, Table 50-3 OBJ: 5 TOP: Cushing syndrome KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

33. The patient being treated for hypothyroidism should be instructed to eat well-balanced meals including intake of iodine. Which of the following foods contains iodine? a. Eggs b. Pork c. White bread d. Skinless chicken

ANS: A The hypothyroid diet should be adequate in intake of iodine, in foods such as saltwater fish, milk, and eggs; fluids should be increased to help prevent constipation. PTS: 1 DIF: Cognitive Level: Application REF: Page 1740 OBJ: 8 TOP: Hypothyroidism KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

1. The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame? a. 15 minutes b. 1 to 2 hours c. 80 minutes d. 3 to 5 hours

ANS: A The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 518 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

24. A patient has come to the clinic because of enlarged hands and feet, amenorrhea, and increased hair growth. These symptoms most likely indicate problems with the: a. pituitary gland. b. adrenal glands. c. thyroid gland. d. pancreas.

ANS: A The pituitary gland may produce an overabundance of growth hormone. This overproduction of hormones may cause changes throughout the patient's body, including enlargement of the pituitary gland and hands and feet. Female patients may develop a deepened voice, increased facial hair growth, and amenorrhea. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1728 OBJ: 5 TOP: Acromegaly KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

15. As the nurse is shaving a patient who is 2 days postoperative from a thyroidectomy, the patient has a spasm of the facial muscles. What should the nurse recognize this as? a. Chvostek sign b. Montgomery sign c. Trousseau sign d. Homans sign

ANS: A The spasm of facial muscles when stimulated is the Chvostek sign, an indication of hypocalcemic tetany. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 5 TOP: Chvostek sign KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

1. A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) a. Hypoglycemia b. Nausea c. Diarrhea d. Weight gain e. Peripheral edema

ANS: A, B, D The most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 521 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is presenting information to a class of students about adrenergic drugs. Which are effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.) a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis

ANS: A, D, E, G Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and *glycogenolysis* as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 300 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Question: What is considered a definitive diagnosis?

Answer: Decreased plasma levels of growth hormone.

Question: What is the purpose of the Water deprivation test?

Answer: To determine how well the Pituitary is producing ADH.

27. A 27-year-old patient with hypothyroidism is referred to the dietitian for dietary consultation. What should nutritional interventions include? a. Frequent small meals high in carbohydrates b. Calorie-restricted meals c. Caffeine-rich beverages d. Fluid restrictions

ANS: B A high-protein, high-fiber, lower calorie diet is given. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1740 OBJ: 5 TOP: Hypothyroidism KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

10. When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect? a. Decreased glucose levels b. Decreased white blood cell count c. Increased red blood cell count d. Increased platelet count

ANS: B Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 505 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? a. The antibiotics may cause an increase in glucose levels. b. The corticosteroids may cause an increase in glucose levels. c. His type 2 diabetes has converted to type 1. d. The hypoxia caused by the chronic obstructive pulmonary disease causes an increased need for insulin.

ANS: B Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 517 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate? a. It blocks the action of thyroid hormone. b. It slows down the formation of thyroid hormone. c. It destroys overactive cells in the thyroid gland. d. It inactivates already existing thyroid hormone in the bloodstream.

ANS: B Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 505 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? a. Insulin is never given intravenously. b. Only regular insulin can be administered intravenously. c. Insulin aspart or lispro can be administered intravenously, but there must be a 50% dose reduction. d. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.

ANS: B Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 527 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

17. The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? a. glitazone b. insulin c. metformin (Glucophage) d. sulfonylurea

ANS: B Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 524 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25. What instructions should a nurse give to a diabetic patient to prevent injury to the feet? a. Soak feet in warm water every day. b. Avoid going barefoot and always wear shoes with soles. c. Use of commercial keratolytic agents to remove corns and calluses are preferred to cutting off corns and calluses. d. Use a heating pad to warm feet when they feel cool to the touch.

ANS: B Sturdy, properly fitting shoes should be worn. Use of corn removers and heating pads is not beneficial to preserve the health of a diabetic's feet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1762 OBJ: 8 TOP: Foot care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

35. The nurse cautions the patient who is being instructed on self-medication with insulin to be aware that there are 25-, 30-, 50-, and 100-unit syringes. How is the 100-unit syringe marked? a. 1-unit increments b. 2-unitt increments c. 4-unit increments d. 5-unit increments

ANS: B The 100-unit syringe is marked in 2-unit increments while the smaller syringes are marked in 1-unit increments. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1759 OBJ: 14 TOP: Insulin administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

10. After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? a. Hemoglobin levels b. Hemoglobin A1C level c. Fingerstick fasting blood glucose level d. Serum insulin levels

ANS: B The hemoglobin A1C level reflects the patient's adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 530 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Health Promotion and Maintenance

17. What should the nurse caution a type I diabetic about excessive exercise? a. It can increase the need for insulin and may result in hyperglycemia. b. It can decrease the need for insulin and may result in hypoglycemia. c. It can increase muscle bulk and may result in malabsorption of insulin. d. It can decrease metabolic demand and may result in metabolic acidosis.

ANS: B The patient with diabetes should exercise regularly. Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1755 OBJ: 11 TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

8. When monitoring a patient who is taking a thyroid replacement hormone, which adverse effect needs to be reported to the prescriber? a. Weakness b. Palpitations c. Constipation d. Drowsiness

ANS: B The signs of excess dosages of thyroid replacement hormone mimic those of hyperthyroidism. Instruct the patient to report immediately any of the following to the prescriber: chest pain, weight loss, palpitations, tremors, sweating, nervousness, shortness of breath, or insomnia. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 508 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

16. When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? a. Give the drug as ordered 30 minutes before breakfast. b. Hold the drug, and check the order with the prescriber. c. Give a reduced dose of the drug with breakfast. d. Give the drug, and monitor for adverse effects.

ANS: B There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 521 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. What extra equipment should the nurse provide at the bedside of a new postoperative thyroidectomy patient? a. Large bandage scissors b. Tracheotomy tray c. Ventilator d. Water-sealed drainage system

ANS: B There should be a suction apparatus and tracheotomy tray available for emergency use. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

14. The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? a. 30 minutes before breakfast b. With the first bite of each main meal c. 30 minutes after breakfast d. Once daily at bedtime

ANS: B When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 521 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

41. The nurse would instruct a patient who is hypocalcemic from hypoparathyroidism about a diet that should include (select all that apply): a. High phosphorus foods b. Canned fish with the bones c. Cucumbers d. Tofu e. Bananas f. Vitamin D supplements

ANS: B, C, D, F The hypocalcemic patient should eat a high-calcium, low-phosphorus diet that includes canned fish, cucumbers, tofu, and vitamin D supplements as an aid to the absorption of the calcium. PTS: 1 DIF: Cognitive Level: Application REF: Page 1737 OBJ: 5 TOP: Diet for hypocalcaemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

1. Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which potential adverse effect occurs? (Select all that apply.) a. Fatigue b. Chest pains c. Palpitations d. Drowsiness e. Rapid heart rate f. Constipation

ANS: B, C, E Some of the more serious adverse effects of the thyroid drugs include tachycardia, palpitations, and chest pains. The other options are not adverse effects of thyroid replacement drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 508 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

40. The nurse would instruct a patient with hyperthyroidism (Graves disease) to select which of the following nutritious foods because of the increased metabolism related to the disease. (Select all that apply.) a. Coffee with cream b. Lean meat c. White bread d. Leafy green vegetables e. Supplemental vitamin D

ANS: B, D, E Nutritious food sources, such as food high in protein (e.g., lean meat), sources of vitamin B (e.g., leafy green vegetables), and vitamin D supplements are helpful to meet the metabolic needs of the patient with hyperthyroidism. PTS: 1 DIF: Cognitive Level: Application REF: Page 1737 OBJ: 5 TOP: Diet for hyperthyroidism KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

39. What should the nurse include in provisions for the postoperative care of the patient who had a thyroidectomy? (Select all that apply.) a. Assessing ability to speak by asking him or her to recite name and address every hour b. Maintaining anatomic position of the head when moving a patient c. Assisting a patient to hyperextend the head to assess for muscle damage d. Doing voice check every 2 hours e. Turning, coughing every hour f. Checking for bleeding at the sides and the back of the head

ANS: B, D, F The nurse should hold the head in an anatomic position when moving the patient to prevent tension on the suture line, do a voice check every 2 to 4 hours by asking the patient to say "ah"; the patient is not turned nor is coughing recommended immediately after a thyroidectomy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1738 OBJ: 7 TOP: Postoperative thyroidectomy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

QUESTION: Name the three types of steroids released by the adrenal glands.

ANSWER: Mineralcorticoids Glucocorticoids Sex hormones

2. Which hormones are responsible for blood calcium levels? 1. Calcitonin and parathyroid hormone 2. Estrogen and progesterone 3. Melatonin and follicle-stimulating hormone (FSH) 4. Thyroxine and parathyroid hormone

1(Check back of book if this doesn't match up)

OVER PRODUCTION OF PARATHORMONE RESULTS IN INCREASED LEVELS OF WHAT ELECTROLYTE IN THE BLOOD?

CALCIUM

Cosyntropin (Cortrosyn)

11. Cosyntropin (Cortrosyn) is used for the diagnosis of adrenocortical insufficiency, not for treatment. Once a diagnosis is made, the actual drug treatment gener- ally involves replacement hormonal therapy using drug forms of the deficient corticosteroid hormones. (Lilley, 122012)

What type of insulin can be classified by the following? ~ Types: Ultralente, Humulin U, Lantus ~ Onset: 1 - 2 hours ~ Peak: No defined peak ~ Duration: 24 hours

Long acting insulin

The *overproduction of somatotropin (GH) in adults* causes idiopathic hyperplasia of the anterior pituitary gland causing what condition marked by the following manifestations? ~ Hepatomegaly ~ Cardiomegaly ~ Splenomegaly ~ Joints may hypertrophy and become stiff and painful ~ Male patients often become impotent ~ Female patients may develop a deepened voice, increased facial hair and amenorrhea

*Acromegaly*

19. The nurse is providing care to a patient with SIADH. What can most likely be anticipated to be included in the health care provider's orders? 1. Increased fluid intake to 3000 mL/day 2. Fluid restriction to 800 to 1000 mL/day 3. Discontinue the ordered diuretics 4. Antiemetics for complaints of nausea

2(Check back of book if this doesn't match up)

Anaplastic thyroid cancer

(ATC) is a very rare, but very aggressive cancer

WHAT IS THE MEDICAL CARE FOR A PATIENT WITH HYPOPARATHYROIDISM

-CALCIUM GLUCONATE -ET -BRONCHODILATORS -VIT D -HIGH CA, LOW PO4 DIET

List three clinical manifestations of Diabetes Insipidus?

-Polyuria -Urine specific gravity <1.005 -Hypernatremia

What is the disorder caused by secretion of insufficient amounts of antidiuretic hormone (ADH)? 1Diabetes insipidus 2Diabetes mellitus 3Syndrome of inappropriate ADH secretion (SIADH) 4Hyperthyroidism

1 The disorder caused by secretion of insufficient amounts of antidiuretic hormone (ADH) by the posterior pituitary is called diabetes insipidus. This condition may be primary, or it may be secondary to other conditions, such as head injury, intracranial tumor, intracranial aneurysm, or infarct. It is characterized by marked polyuria (of a very dilute urine) and intense polydipsia. Diabetes mellitus is a disorder of carbohydrate metabolism caused by a failure of the beta cells of the Islets of Langerhans in the pancreas. It is characterized by polyuria (caused by elevated glucose levels), polydipsia, polyphagia, and weight loss. Syndrome of inappropriate ADH secretion, or SIADH, is a disorder caused by the secretion of excessive amounts of ADH. In this disorder, the kidneys reabsorb more water, thus decreasing urine output and expanding the body's fluid volume. The patient experiences hyponatremia, hemodilution, and fluid overload without peripheral edema. Hyperthyroidism is a condition characterized by increased activity of the thyroid gland with overproduction of the two thyroid hormones. As a result, all of the patient's metabolic processes are exaggerated.REF: Page 1732

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce 1a positive inotropic, positive chronotropic, and positive dromotropic effect. 2a positive inotropic, negative chronotropic, and negative dromotropic effect. 3a negative inotropic, positive chronotropic, and positive dromotropic effect. 4a negative inotropic, negative chronotropic, and negative dromotropic effect.

1 Adrenergic stimulation of the beta1-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect).

The physician has ordered dopamine to treat the patient's hypovolemic shock secondary to severe blood loss. For the medication to be effective, the physician must also order 1fluid replacement. 2beta-stimulating drugs. 3antibodies. 4fluid restriction.

1 Dopamine increases blood pressure secondary to vasoconstriction, which has a limited effect if there is not enough volume within the circulatory system.

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient? 1"Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." 2"Mixing insulins will help increase insulin production." 3"Rotate sites at least once weekly." 4"Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption."

1 Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.

Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)? 1"I will take this medication in the morning so as not to interfere with sleep." 2"I will double my dose if I gain more than 1 pound per day." 3"I will stop the medication immediately if I lose more than 2 pounds in a week." 4"I can expect to see relief of my symptoms within 1 week."

1 I will take this medication in the morning so as not to interfere with sleep." Levothyroxine increases basal metabolism and thus wakefulness. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.

Which is a rapid-acting insulin with an onset of action of less than 15 minutes? 1insulin glargine (Lantus) 2insulin aspart (NovoLog) 3regular insulin (Humulin R) 4insulin detemir (Levemir)

1 Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

The nurse would suspect excessive thyroid replacement in a patient taking levothyroxine (Synthroid) when the patient is exhibiting which adverse effect? 1Depression 2Intolerance to cold 3Weight gain 4Irritability

1 Irritability is a symptom of hyperthyroidism. The other choices are signs of hypothyroidism.

Pramlintide (Symlin) is added to the treatment plan for a patient with type 1 diabetes. What information about the action of this medication does the nurse include in the patient teaching? 1Pramlintide slows gastric emptying. 2Pramlintide increases glucagon excretion. 3Pramlintide works to prevent side effects of insulin. 4Pramlintide is an oral drug administered 15 minutes before meals.

1 Pramlintide is a synthetic form of the naturally occurring hormone amylin. It works by slowing gastric emptying, suppressing glucagon secretion, and centrally modulating appetite and satiety. It is only administered subcutaneously.

10. The nurse is educating a patient who has had type 1 diabetes for the past year. Which statement demonstrates his need for additional teaching? 1. "If I want to lose weight, all I have to do is increase my dose of insulin." 2. "I can have an occasional beer if it's calculated into my diet." 3. "I will maintain better control of my blood sugar if I eat regular meals." 4. "It is important that I eat properly, exercise regularly, and take my insulin injections."

1(Check back of book if this doesn't match up)

11. The nurse is caring for a patient diagnosed with Addison's disease (adrenal hypofunction). The nurse's assessment reveals postural hypotension, fatigue, nausea, vomiting, and poor skin turgor. Which of these nursing diagnoses is of greatest priority at this time? 1. Risk for infection 2. Risk for imbalanced body temperature 3. Risk for acute pain 4. Risk for fluid volume deficit

1(Check back of book if this doesn't match up)

17. In the syndrome of inappropriate antidiuretic hormone (SIADH), what best describes the body's secretions? 1. Too much antidiuretic hormone 2. Too little antidiuretic hormone 3. Too much diuretic hormone 4. Too little diuretic hormone

1(Check back of book if this doesn't match up)

What is considered the "master gland," which exerts control over the other glands? 1Pituitary gland 2Pancreas 3Thyroid gland 4Adrenal gland

1 The pituitary gland is known as the "master gland," because it exerts control over the other glands through a negative feedback system. It is one of the most powerful glands in the body. It works closely with the hypothalamus of the brain and is located in the cranial cavity in a small saddle-like depression in the sphenoid bone. It consists of the anterior pituitary, which secretes six major hormones (five tropic hormones plus prolactin), and a posterior pituitary, which secretes two hormones (oxytocin and antidiuretic hormone, or ADH). The pancreas is an elongated gland that lies posterior to the stomach. It has both endocrine and exocrine tissue. The endocrine portion contains the Islets of Langerhans, which secrete insulin and glucagon. The thyroid gland has a butterfly shape, with a lobe on either side of the trachea. It secretes thyroxine and triiodothyronine, two hormones that regulate growth and development, metabolism, and activity of the nervous system. The adrenal glands are small glands that lie atop each kidney. Both contain an outer portion, the adrenal cortex, and an inner section, the adrenal medulla. The adrenal cortex secretes mineralocorticoids, glucocorticoids, and sex hormones; the adrenal medulla secretes epinephrine and norepinephrine.REF: Page 1725

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? 1desmopressin (DDAVP) 2corticotrophin (Acthar) 3octreotide (Sandostatin) 4somatropin (Humatrope)

1 Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone.

What would the nurse assess when monitoring for the therapeutic effectiveness of vasopressin? 1Fluid balance 2Patient's pain scale 3Serum albumin levels 4Adrenocorticotropic hormone (ACTH) levels

1 Vasopressin causes decreased water excretion in the renal tubule, thus decreasing urine output. It is used to treat diabetes insipidus, which presents with polyuria and dehydration.

When assessing for potential toxicity to PTU, the nurse will monitor the patient for changes in which laboratory test? 1CBC 2BNP 3Serum electrolytes 4Renal function tests

1 With antithyroid medications, the nurse should monitor for possible toxic reactions such as agranulocytosis, pancytopenia, and life-threatening hepatitis. An abnormal CBC would indicate bone marrow dysfunction.

21. The nurse is teaching a diabetic education class in the community. What information should the nurse include in the educational plan? 1. Exercise leads to a decreased need for insulin. 2. Insulin should be adjusted on the basis of the amount of protein ingested at each meal. 3. During illness, the patient should avoid all insulin injections. 4. Slow-healing wounds are expected and do not need to be reported to the health care provider.

1 (Check back of book if this doesn't match up)

22. What is an appropriate nursing intervention for a patient admitted into the hospital with signs and symptoms of diabetic ketoacidosis? 1. Obtain blood glucose immediately. 2. Administer NPH insulin intravenously. 3. Give intravenous glucagon. 4. Take vital signs every 4 hours.

1 (Check back of book if this doesn't match up)

The nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4). a. Glargine insulin b. Aspart insulin c. Regular insulin d. NPH insulin

1. A 2. B 3. C 4. D 1. ANS: B DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies NOT: Aspart insulin, a rapid-acting insulin, has a duration of action of 3 to 5 hours; regular insulin, a short-acting insulin, has a duration of 6 to 10 hours; NPH insulin, an intermediate-acting insulin, has a duration of 10 to 18 hours; glargine insulin, a long-acting insulin, has a duration of 24 hours. 2. ANS: C DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies NOT: Aspart insulin, a rapid-acting insulin, has a duration of action of 3 to 5 hours; regular insulin, a short-acting insulin, has a duration of 6 to 10 hours; NPH insulin, an intermediate-acting insulin, has a duration of 10 to 18 hours; glargine insulin, a long-acting insulin, has a duration of 24 hours. 3. ANS: D DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies NOT: Aspart insulin, a rapid-acting insulin, has a duration of action of 3 to 5 hours; regular insulin, a short-acting insulin, has a duration of 6 to 10 hours; NPH insulin, an intermediate-acting insulin, has a duration of 10 to 18 hours; glargine insulin, a long-acting insulin, has a duration of 24 hours. 4. ANS: A DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies NOT: Aspart insulin, a rapid-acting insulin, has a duration of action of 3 to 5 hours; regular insulin, a short-acting insulin, has a duration of 6 to 10 hours; NPH insulin, an intermediate-acting insulin, has a duration of 10 to 18 hours; glargine insulin, a long-acting insulin, has a duration of 24 hours.

14. Diabetes insipidus is a metabolic disorder of the posterior pituitary in which ________________________ is deficient (1730)

14. antidiuretic hormone (ADH)

15. In nondiabetic patients, the beta cells are stimulated by increased blood glucose levels; insulin secretion reaches peak levels about _______ minutes after meals and returns to normal in _______ hours. (1752)

15. 30; 2 to 3

16. In type 2 diabetes, the main problem is an abnormal resistance to ______________________ action. (1752)

16. insulin

What is a true statement about diabetes mellitus type 2? 1It is thought to be an autoimmune disease. 2The main problem in this disease seems to be abnormal resistance to insulin action. 3It was formerly called "juvenile diabetes." 4The patients with this type of diabetes usually are required to take insulin injections from the moment of diagnosis.

2 The primary problem in diabetes mellitus type 2 seems to be abnormal resistance to insulin action. Various factors (decreased tissue responsiveness to insulin, overproduction of insulin early in the disease followed by decreased secretion later in the disease, and abnormal hepatic glucose regulation) result in peripheral insulin resistance. Diabetes mellitus type 1 is thought to be an autoimmune disease, probably stimulated by a virus. There is a progressive destruction of beta cells, and it is thought that an individual may have a genetic predisposition to developing the disease. Diabetes mellitus type 1 was formerly called "juvenile diabetes," as it is usually diagnosed before the age of 30 (in contrast to diabetes mellitus type 2, which is usually diagnosed after age 30). Patients with diabetes mellitus type 2 often are treated first with oral hypoglycemic agents. They usually have some circulating insulin—and in early stages of the disease they may even have hyperinsulinemia—and the oral medications (along with dietary changes and weight loss) can often help them maintain a normal blood glucose level. Type 2 diabetic patients may require insulin at some point in their illness; however, it is typically not right away.REF: Page 1751-1752

A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response? 1"Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." 2"Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." 3"Propylthiouracil helps your thyroid gland use iodine and synthesize hormones better." 4"Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland."

2 "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Propylthiouracil is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.

Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? 1"I will have to isolate myself from my family for 1 week so as not to expose them to radiation." 2"This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism." 3"This drug will help decrease my cold intolerance and weight gain." 4"I will need to take this drug on a daily basis for at least 1 year."

2 "This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism." Radioactive iodine is an antithyroid medication that is administered orally for one or two doses only. It concentrates in the thyroid gland, enabling the radiation to destroy the hyperplastic cells.

The nurse is providing education to a patient about the time to take glipizide (Glucotrol). For maximum benefit, the nurse will tell the patient to administer glipizide at which time? 1 In the morning 2 30 minutes before a meal 3 15 minutes postprandial 4 At bedtime

2 Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? 1insulin glargine (Lantus) 2insulin glulisine (Apidra) 3regular insulin (Humulin R) 4NPH insulin

2 Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is short acting.

Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect? 1Cardiac arrhythmias 2Increased risk of bleeding 3Excessive weight loss 4Increased risk of deep vein thrombosis

2 Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding.

The nurse is caring for a patient with Addison disease. What signs and laboratory values would the nurse expect to see in this patient? 1Hypertension 2Postural hypotension 3Increased serum sodium 4Decreased serum potassium

2 Patients with Addison disease, or adrenal hypofunction, tend to have postural hypotension. They may experience vertigo, weakness, and syncope. In addition, they may complain of severe headache, disorientation, abdominal pain, or lower back pain, which could signal an impending adrenal crisis. Patients with Addison disease tend to have hypotension rather than hypertension. They tend to have hypovolemia, which is the basis for the hypotension. They can, however, develop hypertension as a result of treatment (i.e., Florinef therapy) if they are overtreated for the disease. Patients with Addison disease usually have a low serum sodium. The low serum sodium is one of the reasons they also tend to be hypovolemic. Patients with Addison disease usually have an increased, not decreased serum potassium.REF: Page 1748

The nurse would question an order for somatrem (Protropin) in a patient with which condition? 1dwarfism 2Acromegaly 3Growth failure 4Hypopituitarism

2 Somatrem is a synthetic form of growth hormone. Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated.

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure? 1acarbose (Precose) 2metformin (Glucophage) 3repaglinide (Prandin) 4pioglitazone (Actos)

2 he concurrent use of metformin and iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure.

12. The nurse is caring for a patient who states the health care provider is prescribing an insulin that "takes effect in less than half the time of regular (short-acting) insulin." The nurse is aware that this patient has been prescribed which type of insulin? 1. Humulin R, Novolin R 2. Lispro (Humalog), aspart (NovoLog) 3. Humulin N, Novolin N 4. Humulin 70/30, Novolin 70/30

2(Check back of book if this doesn't match up)

13. The nurse is aware that the polydipsia and polyuria experienced by a patient with poorly controlled diabetes are caused primarily by which phenomena? 1. The release of ketones from cells during fat metabolism 2. Fluid shifts resulting from the osmotic effect of hyperglycemia 3. Damage to the kidneys from exposure to high levels of glucose 4. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin

2(Check back of book if this doesn't match up)

What is the range for UO in a patient with DM?

30mL/hr - 100mL/hr

24. Which nursing interventions should be employed for a patient with diabetes insipidus? (Select all that apply.) (1734) 1.Assessment of skin turgor 2.Daily weight measurement 3. Fluid restriction 4.Monitor intake and output 5. Frequent ambulation

24. Answer 1, 2, 4: Nursing assessment and intervention for patients with diabetes insipidus is focused on fluid loss and dehydration. Fluids should not be restricted. Patients should be assisted to ambulate because they may be tired. It is likely that they are frequently walking to the bathroom during the day and at night; thus, encouraging additional ambulation is not necessary.

25. Which patient has the greatest risk for developing syndrome of inappropriate antidiuretic hormone (SIADH)? (1735) 1.Has malignant cancer 2.Has dormant tuberculosis 3.Suffered head trauma 4.Received opiate medication

25. Answer 1: For any of these patients, the nurse would be aware of the possibility of developing SIADH; however, malignancies are the most common cause of SIADH; cancerous cells are capable of producing, storing, and releasing ADH

26. The nurse is caring for a patient who is diagnosed with SIADH. Which assessment finding indicates that the disorder has progressed to neurologic involvement? (1735) 1. An increase urge to drink fluids 2.A decrease in serum sodium 3.Progression to shock symptoms 4.A change in mental status

26. Answer 4: Brain edema will result in a change in mental status, progressive lethargy, or changes in personality. These symptoms are followed by seizures and loss of deep tendon reflexes.

27. For the patient with SIADH, the health care provider orders fluid restriction. Which finding best indicates that the therapy is working? (1735) 1.Patient reports that he feels better. 2.Vital signs are at patient's baseline. 3.Serum sodium is gradually increased. 4.Diuretics are gradually discontinued.

27. Answer 3: All of the findings are positive; however, a gradual increase of serum sodium is the purpose of the therapy.

28. The nurse is caring for a patient who had a thyroidectomy. Which routine postoperative intervention would the nurse clarify with the health care provider? (1739) 1.Inspect dressing for bleeding and drainage. 2.Give clear liquids; progress to soft diet. 3. Encourage coughing and deep breathing 4.Observe surgical site for signs of infection.

28. Answer 3: In the postsurgical period, patients who have had thyroidectomy surgery are encouraged to deep-breathe, but the nurse would check with the health care provider about coughing, because of potential strain on the suture line.

29. The patient tells the nurse that the health care provider wants to test her for Graves' disease. What symptoms is the patient most likely to exhibit? (1737) 1.Weight loss, increased appetite, and nervousness 2.Intolerance to cold, constipation, and lethargy 3. Skeletal pain, pain on weight bearing, and paranoia 4.Polyphagia, polydipsia, and polyuria

29. Answer 1: Graves' disease is hyperthyroidism, so the symptoms that manifest reflect an increased metabolism. Intolerance to cold, constipation, and lethargy are symptoms of hypothyroidism. Skeletal pain, pain on weight-bearing, and paranoia are seen in hyperparathyroidism. Polyphagia, polydipsia, and polyuria are characteristics of diabetes mellitus.

23. Which is a principal clinical manifestation in the patient with pheochromocytoma? 1. Darkly pigmented skin and mucous membranes 2. Moonface and buffalo hump 3. Severe hypertension 4. Carpopedal spasms

Which intervention would be most appropriate for the patient with hypothyroidism? 1Keep the patient's room at a cool temperature. 2Encourage a low-fiber diet. 3Encourage fluids. 4Encourage the patient to take medications when the patient feels that thyroid levels are low.

3 Appropriate nursing care for the patient with hypothyroidism would include the encouragement of fluids. Patients with hypothyroidism are prone to constipation, which can be severe. Fluids will help to minimize or prevent constipation. Appropriate nursing care for the patient with hypothyroidism would include keeping the room at a warm temperature—68° to 74° F. The patient with hypothyroidism tends to feel cold, as the metabolic rate is slowed. Also, the nurse should take care not to allow the patient to become chilled during the bath or other procedures. Appropriate nursing care for the patient with hypothyroidism would include encouraging a high-fiber diet. Patients with hypothyroidism are prone to constipation, which can be severe. A high-fiber diet (high in protein, low in calories) will help to minimize or prevent constipation. In addition, the physician may order bulk laxatives and/or stool softeners. The patient with hypothyroidism is usually prescribed thyroid hormones that are to be taken for the remainder of his or her life. The nurse should teach the patient with hypothyroidism not to stop taking his or her medication without consulting the prescribing physician.REF: Page 1740

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at what time? 1 10:00 AM 2 2:00 PM 3 5:00 PM 4 8:00 PM

3 Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? 1Risk for injury 2Acute pain 3Excess fluid volume 4Deficient knowledge regarding medication

3 Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.

Which insulin can be administered by continuous intravenous infusion? 1insulin glargine (Lantus) 2insulin aspart (Novolog) 3regular insulin (Humulin R) 4insulin detemir (Levemir)

3 Regular insulin is the only insulin used for intravenous therapy.

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? 1acarbose (Precose) 2metformin (Glucophage) 3repaglinide (Prandin) 4pioglitazone (Actos)

3 Repaglinide is known as the "Humalog of oral hypoglycemic drugs." The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.

The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against? 1Milk 2Eggs 3Seafood 4Chicken

3 Seafood contains high amounts of iodine. The other choices do not.

What is a feature of Cushing syndrome? 1Adrenal hypofunction 2Decreased secretion of glucocorticoids, mineralocorticoids, and sex hormones 3Increased susceptibility to infection 4Hyperkalemia

3 the patient with Cushing syndrome has an increased susceptibility to infection because of excess circulating glucocorticoids. Symptoms of an infection may not be easily detected until the infection is at an advanced stage that might be life threatening. Nursing assessment for signs and symptoms of infection is extremely important. Cushing syndrome is characterized by adrenal hyperfunction not hypofunction. With adrenal hyperfunction, there is excess secretion of the adrenal hormones. The overabundance of hormones produces the signs and symptoms commonly associated with the disease, including a "moon face" and "buffalo hump," with arms and legs becoming thin because of muscle wasting. In Cushing syndrome, there is excess, not decreased, secretion of the adrenal hormones: glucocorticoids, mineralocorticoids, and sex hormones. In Cushing syndrome, there is usually hypokalemia, not hyperkalemia.REF: Page 1746

30. The nurse is reviewing the patient's medication orders and sees that the patient is prescribed levothyroxine (Synthroid). Which laboratory (1741) 1.Blood glucose less than 250 mg/dL 2.Normalization of urine specific gravity 3.Gradual improvement of serum sodium 4.Normalization of TSH level

30. Answer 4: Levothyroxine (Synthroid) is a replacement therapy for patients with hypothyroidism; thus, normalization of TSH levels indicates that the therapy is working. Normalization of urine specific gravity would be a therapeutic goal for diabetes insipidus Gradual improvement of serum sodium is the treatment goal for SIADH. A blood glucose of 250 mg/dL is used as a target to initiate intravenous dextrose solutions for patients who are being treated for diabetic ketoacidosis.

35. The LPN is assisting an RN with a patient who needs emergency administration of calcium gluconate for hypoparathyroid tetany. The RN is preparing the medication. What task should the LPN/LVN perform under the supervision of the RN? (1746) 1.Assess the patient for medication allergies. 2.Place the patient on electrocardiographic monitoring. 3.Assess the patency of the intravenous access. 4.Verify the order for calcium gluconate.

35. Answer 2: In this emergency situation, the LPN/LVN recognizes that IV calcium can precipitate hypotension, serious cardiac dysrhythmias, or cardiac arrest. Thus electrocardiographic monitoring is indicated when administering calcium. Assessing for allergies, verifying medication orders, and checking patency of the site are responsibilities of the nurse who is administering the drug. (Note to student: When patients become unstable or critical, the LPN/LVN should notify the health care provider and RN and the RN should assume care and responsibility for the patient. The LVN/LPN uses knowledge and skills during a crisis to contribute to care of patients under the supervision of the RN.)

36. For patients who have hypoparathyroidism, why is it important for the nurse to encourage foods such as soy milk, white rice, jam, honey, lemon-lime soda, cumbers, lettuce, peppers, tomatoes, and non-organ meats(1746) 1.These foods supply extra calcium, which is needed to treat hypocalcemia. 2.These foods are low in phosphorus, and serum phosphorus is elevated. 3.These foods supply vitamin D, which improves the absorption of calcium. 4.,These foods are low in fat and will not be metabolized into ketones.

36. Answer 2: Foods that are low in phosphorus are encouraged because calcium and phosphorus levels are reciprocal. In other words, if the serum phosphorus level is lower, the calcium level will increase, which is desirable for these patients.

37. Urine excreted by a patient with diabetes insipidus will exhibit which characteristics? (1733) 1. Dilute with a specific gravity of 1.005-1.030g/mL 2. Dilute, with a specific gravity of 1.001-1.005g/mL 3. Concentrated, with specific gravity of 1.005-1.030g/mL 4.Concentrated, with specific gravity of 1.001-1.005g/mL

37. Answer 2: Diabetes insipidus causes production of urine with a very low (dilute) specific gravity.

38. A patient asks what causes his unsightly goiter. Based on knowledge of pathophysiology, what does the nurse tells the patient? (1742) 1. The growth is harmless, like a fluid-filled cyst that can be drained 2. There is fluid retention in the face and neck because of a blockage 3.The gland usually enlarges because of lack of iodine in the diet. 4.The surrounding tissue becomes inflamed and swollen because of infection.

38. Answer 3: Simple goiter is usually caused by a dietary insufficiency of iodine.

39. Cortisol is responsible for what bodily function? (1728) 1.Regulates sodium levels 2.Regulates potassium levels 3.Provides energy during stress 4.Responds to decreased glucose levels

39. Answer 3: Cortisol is a glucocorticoid that provides extra reserve energy in times of stress. Aldosterone, the principal mineralocorticoid, regulates sodium and potassium levels by affecting the renal tubules. Glucagon is a pancreatic hormone, which responds to decreased levels of glucose in the blood.

In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), which intervention would be most appropriate? 1Blood glucose level checks every 4 hours 2Intake and output measurement every shift 3IV of 0.9% NaCl at KVO (keep vein open) rate 4Insulin IV via infusion pump

4 In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), insulin must be administered in a precise, easy to control manner. It will be administered via an IV infusion, which is adjusted frequently based on blood glucose values. In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), blood glucose level checks must be performed every hour. In addition, monitoring of serum potassium is also done on a frequent (usually every hour) basis and replaced as necessary. Diabetic ketoacidosis is a medical emergency, and must be treated in a very aggressive manner for the best patient outcome. In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction, intake and output is usually performed hourly. A Foley catheter is usually inserted for accurate and timely output measurement. In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction, large amounts of IV fluids are required (1 L/hr), because the patient is very dehydrated. Urine output and blood glucose values are followed hourly to guide the fluid resuscitation. The IV solution begins as 0.9% NaCl; dextrose is added when the blood sugar approaches 250 mg/dL.REF: Page 1767

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with 1beta blockers. 2diuretics. 3alpha1 blockers. 4monoamine oxidase (MAO) inhibitors.

4 Adrenergic drugs combined with MAO inhibitors can lead to extreme hypertension. All the other drugs listed are used to treat hypertension.

The nurse will advise the patient to treat hypoglycemia with which drug? 1propranolol (Inderal) 2glucagon 3acarbose (Precose) 4bumetanide (Bumex)

4 Glucagon stimulates glycogenolysis, raising serum glucose levels.

After administering somatropin (Serostim), the nurse would assess for adverse effects by monitoring which parameters? 1Serum potassium levels 2Mental status 3Respiratory rate 4Serum glucose levels

4 Hyperglycemia and hypoglycemia are potential adverse effects of somatropin therapy.

The nurse would include which statement when teaching a patient about insulin glargine? 1"You should inject this insulin just before meals because it is very fast acting." 2"The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day." 3"You can mix this insulin with NPH insulin to enhance its effects." 4"You cannot mix this insulin with regular insulin and thus will have to take two injections."

4 Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins.

The nurse admitting a patient with acromegaly anticipates administering which medication? 1desmopressin (DDAVP) 2corticotropin (Acthar) 3somatropin (Nutropin) 4octreotide (Sandostatin)

4 Octreotide suppresses growth hormone, the culprit of acromegaly.

14. The nurse is planning care for an elderly patient with type 2 diabetes admitted to the hospital with pneumonia. What should the nurse understand about this patient? 1. Must receive insulin therapy to prevent the development of ketoacidosis 2. Has islet cell antibodies that have destroyed the ability of the pancreas to produce insulin 3. Has minimal or absent endogenous insulin secretion and requires daily insulin injections 4. May have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar coma

4(Check back of book if this doesn't match up)

5. The nurse is caring for a patient recovering from a total thyroidectomy. The first night the patient experiences signs and symptoms of postoperative tetany. Which medication should the nurse anticipate will be ordered by the health care provider? 1. Sodium iodide PO 2. Potassium chloride IV 3. Magnesium sulfate IM 4. Calcium gluconate IV

4(Check back of book if this doesn't match up)

7. The nurse is assessing a patient who was recently diagnosed as having acromegaly. Given the pathophysiology of this condition, the patient's laboratory test results will probably show elevated levels of: 1. FSH 2. LH 3. TSH 4. GH

4(Check back of book if this doesn't match up)

9. The nurse is reviewing the plan of care for a patient newly diagnosed with type 1 diabetes mellitus. Which is the greatest priority in the care plan? 1. Teach the patient the effect of diet, exercise, and insulin on the blood glucose level. 2. Refer the patient to the hospital dietitian for intense education about dietary needs. 3. Instruct the patient on SMBG, observe return demonstrations, and correct the technique as needed. 4. Review with the patient the desired effects of his medication, as well as possible side effects.

4(Check back of book if this doesn't match up)

40. What type of insulin administration is indicated in the management of hyperglycemia related to diabetic ketoacidosis? (1767) 1.Lente insulin given subcutaneously 2. Ultralente insulin given subcutaneously 3.NPH 70/30 given intravenously 4.Regular insulin given intravenously

40. Answer 4: Regular insulin is given via the intravenous route for hyperglycemia.

41.A Pt is diagnosed with corticosteroid induced Cushing's syndrome. Which statement by the patient indicates a need for additional patient teaching? (1748) 1. "I would like to try a dose reduction" 2. "I am going to stop taking the medication" 3. "I prefer trying gradual discontinuation" 4. "I am changing to alternate-day regimen"

41. Answer 2: Corticosteroids should never be abruptly discontinued because of the risk inducing adrenal insufficiency. The other options could be done under the supervision of the health care provider.

42. The patient with Cushing's syndrome has high risk for impaired skin integrity. What instructions will the nurse give to the UAP to prevent skin impairment? (1748) 1. Handle very gently to prevent bruising and ecchymosis. 2. Assess for signs of erythema, edema, or infection. 3. Frequently wash the skin to prevent irritation. 4. Assist females to remove extra hair with a safety razor.

42. Answer 1: The skin is very thin and fragile and easily torn; thus, gentle handling is necessary. The nurse must assess the skin; this cannot be delegated. Frequent washing or shaving could contribute to skin damage.

43. The nurse is caring for a patient who is admitted with Addison's disease. During the AM assessment, the nurse notes very high temperature and orthostatic hypotension. Laboratory results show hyponatremia and hyperkalemia. How does the nurse interpret these findings(1749) 1. These are expected findings for this disorder; continue routine assessment. 2. The frequency of assessment should be increased; reassess status every 1-2 hours 3. These are signs of impending Addisonian crisis; notify the health care provider. 4. These should be documented as abnormal findings; compare data for trends

43. Answer 3: These are signs of impending addisonian crisis, which is potentially lifethreatening and the health care provider should be notified immediately. The frequency of assessment will increase because of acuity. Documentation is always appropriate, but the patient's condition must be addressed first.

44. The principal manifestation of pheochromocytoma is severe hypertension. What other symptoms are likely to accompany the excessive secretion of catecholamines (i.e., epinephrine and norepinephrine)? (1751) 1. Lethargy, constipation, and depression 2. Tachycardia, diaphoresis, and anxiety 3. Kussmaul's respiration, hypotension, and drowsiness 4. Excessive thirst, increased urine output, and lethargy

44. Answer 2: Recall that epinephrine and norepinephrine are involved in the fight or flight response. Lethargy, constipation, and depression could be evident in many disorders; however, hypothyroidism could cause these symptoms. Kussmaul's respiration, hypotension, and drowsiness are seen in patients with diabetic ketoacidosis. Excessive thirst, increased urine output, and lethargy are seen in diabetes insipidus.

45. Which diagnostic test is the best for monitoring long term compliance for patientswith diabetes mellitus? (1755) 1.Fasting blood glucose (FBG) 2.Postprandial (after a meal) blood glucose (PPBG) 3. Patient self-monitoring of blood glucose (SMBG) 4.Glycosylated hemoglobin (HbA1c)

45. Answer 4: The glycosylated hemoglobin (HbA1c) blood test measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte; these levels are reported as a percentage of the total hemoglobin. Because glycosylation occurs constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of diabetes therapy for the preceding 8-12 weeks. The other tests give limited results related to current status.

46. Which patient needs to test the urine for ketones as part of their self-care management? (1753) 1. Gestational diabetic who has started insulin 2. Type 2 diabetic who is preparing to exercise 3. Type 1 diabetic who has a febrile infection 4. An older diabetic who cannot perform SMBG

46. Answer 3: Type 1 diabetics have the greatest risk for diabetic ketoacidosis, which can be brought on by minor illness. Presence of ketones should be reported to health care provider.

What is the *normal range for blood glucose*?

70 - 120 mg/dl

38. The adrenal cortex secretes glucocorticoids. The most important is cortisol. What is it involved in? (Select all that apply.) a. Glucose metabolism b. Releasing androgens and estrogens c. Providing extra reserve energy during stress d. Decreasing the level of potassium in the blood stream e. Increasing retention of sodium in the blood stream

ANS: A, C Cortisol is involved in glucose metabolism and provides extra reserve energy in times of stress. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1727 OBJ: 3 TOP: Adrenal cortex KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

36. Which of the following are signs and symptoms of hypoglycemia? (Select all that apply.) a. Irritability b. Dry mouth c. Tremors d. Diaphoresis e. Fruity breath f. Deep respirations

ANS: A, C, D Hypoglycemic reaction: rapid shallow respirations, irritability, tremors, excessive perspiration, and possibly loss of consciousness. PTS: 1 DIF: Cognitive Level: Application REF: Page 1765, Table 50-6 OBJ: 9 TOP: Hypoglycemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

37. What are the three major life-threatening complications postoperatively of a thyroidectomy? (Select all that apply.) a. Hemorrhaging b. Seizures c. Tetany d. Hypoglycemia e. Thyroid crisis (storm) f. SIADH

ANS: A, C, E The nurse must be alert for signs of internal or external bleeding. In addition to hemorrhage, two significant postoperative complications exist after thyroidectomy. The first is tetany. The second is thyroid crisis. Manipulation of the thyroid during surgery may cause the release of large amounts of thyroid hormones into the blood stream, creating a thyroid crisis (storm). PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

1. The nurse notes in a patient's medication history that the patient has been taking desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which disorder? a. Diabetes mellitus b. Diabetes insipidus c. Adrenocortical insufficiency d. Carcinoid tumor

ANS: B Desmopressin is used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus. The symptoms are caused by a deficiency of endogenous antidiuretic hormone. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 496 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? a. Volume restoration b. Increased blood pressure c. Decreased urine output d. Reduced anxiety

ANS: B For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase blood pressure. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase. These drugs do not reduce anxiety. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 310 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. What is a long-term complication of diabetes mellitus? a. Diverticulitis b. Renal failure c. Hypothyroidism d. Hyperglycemia

ANS: B Long-term complications of diabetes include blindness, cardiovascular problems, and renal failure. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1763 OBJ: 15 TOP: Diabetes mellitus KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

15. A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? a. To increase the pancreatic secretion of insulin b. To decrease insulin resistance c. To increase blood glucose levels d. To decrease the pancreatic secretion of insulin

ANS: B Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 520 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct? a. "It will probably require surgery for a cure to happen." b. "The full therapeutic effects may not occur for 3 to 4 weeks." c. "Is it possible that you did not take your medication as instructed?" d. "Let's review your diet; it may be causing absorption problems."

ANS: B Patients need to understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 508 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions? a. Using iodized salt when cooking b. Avoiding foods containing iodine c. Restricting fluid intake to 2500 mL per day d. Increasing intake of sodium- and potassium-containing foods

ANS: B Patients on antithyroid therapy need to avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 508 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy? a. "I will call my doctor right away." b. "I will give myself the regular insulin." c. "I will take an oral form of glucose." d. "I will rest until the symptoms pass."

ANS: C Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 525 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

30. A patient with a history of Graves disease is admitted to the unit with shortness of breath. The nurse notes the patient's vital signs: T 103° F, P 160, R 24, BP 160/80. The nurse also notes distended neck veins. What does the patient most likely have? a. Pulmonary embolism b. Hypertensive crisis c. Thyroid storm d. Cushing crisis

ANS: C In a thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. Additionally, the patient may develop nausea, vomiting, severe tachycardia, severe hypertension, and occasionally hyperthermia up to 41° C (106° F). Extreme restlessness, cardiac arrhythmia, and delirium may also occur. The patient may develop heart failure and may die. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 8 TOP: Hyperthyroidism KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

34. The nurse is caring for a patient who is receiving calcium gluconate for treatment of hypoparathyroid tetany. Which assessment would indicate an adverse reaction to the drug? a. Increase in heart rate b. Flushing of face and neck c. Drop in blood pressure d. Urticaria

ANS: C Indications of an adverse effect of calcium gluconate are dyspnea, bradycardia, and hypotension. PTS: 1 DIF: Cognitive Level: Application REF: Page 1745 OBJ: 5 TOP: Calcium gluconate for tetany KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

11. A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse's next action? a. Have the patient eat glucose tablets. b. Have the patient consume fruit juice, a nondiet soft drink, or crackers. c. Administer intravenous glucose (50% dextrose). d. Call the lab to order a fasting blood glucose level.

ANS: C Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 525 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The patient is a 20-year-old college student who has type 1 diabetes and normally walks each evening as part of an exercise regimen. The patient plans to enroll in a swimming class. Which adjustment should be made based on this information? a. Time the morning insulin injection so that the peak action will occur during swimming class. b. Delete normal walks on swimming class days. c. Delay the meal before the swimming class until the session is over. d. Monitor glucose level before, during, and after swimming to determine the need for alterations in food or insulin.

ANS: D Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1755 OBJ: 11 TOP: Diabetes mellitus KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. The nurse is teaching a group of patients about self-administration of insulin. What content is important to include? a. Patients need to use the injection site that is the most accessible. b. If two different insulins are ordered, they need to be given in separate injections. c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first. d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.

ANS: D If mixing insulins in one syringe, the clear (regular) insulin is always drawn up in to the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 527 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient has returned to his room after a thyroidectomy with signs of thyroid crisis. During thyroid crisis, exaggerated hyperthyroid manifestations may lead to the development of the potentially lethal complication of: a. severe nausea and vomiting. b. bradycardia. c. delirium with restlessness. d. congestive heart failure.

ANS: D In thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. The patient may develop congestive heart failure and die. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. Why would a patient with hyperthyroidism be prescribed the drug methimazole (Tapa-zole)? a. To limit the effect of the pituitary on the thyroid b. To destroy part of the hyperactive thyroid tissue c. To stimulate the pineal gland d. To block the production of thyroid hormones

ANS: D Medical management for hyperthyroidism may include administration of drugs that block the production of thyroid hormones, such as propylthiouracil or methimazole. PTS: 1 DIF: Cognitive Level: Application REF: Page 1736, Table 50-2 OBJ: 5 TOP: Hyperthyroidism KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

2. A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid). When the nurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more "natural" forms of drugs. What will the nurse explain to him about the advantages of levothyroxine? a. It has a stronger effect than the natural forms. b. Levothyroxine is less expensive than the natural forms. c. The synthetic form has fewer adverse effects on the gastrointestinal tract. d. The half-life of levothyroxine is long enough to permit once-daily dosing.

ANS: D One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 504 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct? a. "Patients with type 2 diabetes will never need insulin." b. "Oral antidiabetic drugs are safe for use during pregnancy." c. "Pediatric patients cannot take insulin." d. "Insulin therapy is possible during pregnancy if managed carefully."

ANS: D Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 517-518 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A pituitary drug is prescribed for a patient with a hormone deficiency, and the nurse provides instructions about the medication. Which statement by the patient indicates a need for further instruction? a. "I will not stop the drug unless my doctor tells me to stop it." b. "I will call my doctor if I have a fever or sore throat." c. "I will have to stop drinking my nightly glass of wine." d. "I am looking forward to a cure for my condition with this hormone replacement."

ANS: D The medication does not lead to a cure but does help to alleviate the symptoms of the disease for which it is being given. The patient needs to avoid alcohol while taking any of the pituitary drugs. Instruct the patient not to discontinue this drug abruptly because of possible negative consequences to the patient and the levels of pituitary hormones. Any fever, sore throat, joint pain, or muscular pain needs to be reported to the prescriber immediately. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: pp. 498-499 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

22. The nurse teaching a patient with type 1 diabetes mellitus (IDDM) about early signs of insulin reaction would include information about: a. abdominal pain and nausea. b. dyspnea and pallor. c. flushing of the skin and headache. d. hunger and a trembling sensation.

ANS: D The patient should be instructed to notify a member of the nursing staff if any signs of hypoglycemic (low insulin) reaction occur: excessive perspiration or trembling. PTS: 1 DIF: Cognitive Level: Application REF: Page 1765, Table 50-6 OBJ: 9 TOP: Insulin reaction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

31. What is the master gland of the endocrine system? a. Thyroid b. Parathyroid c. Pancreas d. Pituitary

ANS: D The pituitary gland, located in the brain, is the master gland of the endocrine system. It has been called the "master gland" because through the negative feedback system, it exerts its control over the other endocrine glands. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1725 OBJ: 1 TOP: Pituitary gland KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. Which response by the nurse is correct? a. "You can stop the medication if your symptoms have improved." b. "You need to stay on the medication for at least 1 year before a decision about stopping it can be made." c. "You need to stay on this medication until you become pregnant." d. "Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication."

ANS: D These medications must never be abruptly discontinued, and lifelong therapy is usually the norm. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 508 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

QUESTION: Propylthioruracil (PTU) is used for:

ANSWER: Propylthiouracil (PTU) is used for hyperthyroidism.

QUESTION: While discussing thyroid replacement therapy and establishing treatment goals with a patient, the nurse explains that knowing to look for certain adverse effects ahead of time will help her to respond to them before they become serious problems. Some of the adverse effects to discuss with her are:

ANSWER: Some of the more serious adverse effects of the thyroid drugs include tachycardia, dysrhythmias, weight loss, and fever.

QUESTION: The primary treatment for hypothyroidism is: a. Levothyroxine. b. Radioactive iodine. c. Propylthiouracil. d. Methimazole.

ANSWER: a. Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine replaces both hormones. Levothyroxine (Synthroid) is considered the drug of choice for hormone replacement in hypothyroidism. b. Radioactive iodine is used to treat hyperthyroidism. c. Propylthiouracil is used to treat hyperthyroidism. d. Methimazole is used to treat hyperthyroidism

QUESTION: The nurse is administering lispro insulin, and should keep in mind that this insulin is: a. A rapid-acting insulin b. An intermediate-acting insulin c. A long-acting insulin d. A short-acting insulin

ANSWER: a; Lispro insulin is a rapid-acting insulin.

QUESTION: A 48-year-old is diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The purpose of the metformin, in this situation, is to: a. Increase the pancreatic secretion of insulin. b. Decrease insulin resistance. c. Increase blood glucose levels. d. Decrease the pancreatic secretion of insulin.

ANSWER: b. Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance

QUESTION: Which nursing diagnosis may appear on a hyperthyroid patient's care plan? a. Imbalanced nutrition: more than body requirements. b. Constipation. c. Disturbed sleep pattern. d. Ineffective airway management.

ANSWER: c. Hyperthyroidism is caused by an excess amount of thyroid hormones. Patients typically exhibit the following symptoms: rapid, bounding pulse (even during sleep); cardiac enlargement; palpitations; and dysrhythmias. Patients are nervous and easily agitated. Reflexes are hyperactive and the patient typically experiences insomnia. A nursing diagnosis of "Disturbed sleep pattern" would be a common problem. a. The patient with hyperthyroidism is likely to consume less than body requirements. b. The patient with hyperthyroidism is not likely to be constipated as a result of the disease. d. Ineffective airway management is not a common problem of patients with hyperthyroidism.

QUESTION: When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, which are: a. Hypothermia and seizures. b. Nausea and diarrhea. c. Irritability and confusion. d. Fruity, acetone odor to the breath.

ANSWER: c. Irritability and confusion are early signs of hypoglycemia.

QUESTION: Which is NOT a component of proper IV calcium gluconate administration? a. Administer at no greater than 1mL/min. b. Monitor for signs of extravasation. c. Administer vitamin D to help with calcium absorption. d. Administer rapidly via IV push.

ANSWER: d. Calcium is administered slowly. It can irritate the vessel and poses an extravasation risk. Vitamin D is commonly administered to help increase calcium absorption.

QUESTION: The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include? a. Patients should use the injection site that is the most accessible. b. During times of illness, patients should increase their insulin dosage by 25%. c. When mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first. d. When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first.

ANSWER: d. If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill.

The following lab values and diagnostic tests are used to diagnose what disease? ~ Adrenal angiography ~ 24hr urine ~ Abdominal CT ~ Ultrasound ~ *Hyperglycemia* ~ *Hypernatremia* ~ *Hypokalemia* ~ Plasma cortisol elevated ~ Plasma ACTH may be increased or decreased depending on location of a tumor

Cushing's Syndrome (Adrenal Hyperfunction)

Which of the following hormones secreted by the anterior pituitary (adenohypophysis) stimulates the adrenal cortex to increase in size and to secrete its hormones? ~ Growth Hormone (GH) ~ Thyroid Stimulating Hormone (TSH) ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Adrenocorticotropin Hormone (ACTH)

Question: What are two priority Nursing diagnoses?

Answer: Body Image altered and non-compliance

Question: In the postoperative period following an adrenalectomy, the patient is closely monitored for signs and symptoms of hemorrhage, atelectasis and pneumothorax. Why are these signs and symptoms a concern?

Answer: Because the adrenals are located close to the diaphragm and inferior vena cava.

6 When checking a patient's fingerstick blood glucose level, the nurse obtains a reading of 42 mg/dL. The patient is awake but states he feels a bit "cloudy-headed." After double-checking the patient's glucose level and getting the same reading, which action by the nurse is most appropriate? a Administer two packets of table sugar. b Administer oral glucose in the form of a semisolid gel. c Administer 50% dextrose IV push. d Administer the morning dose of lispro insulin.

In the postoperative period following an adrenalectomy, the patient is closely monitored for signs and symptoms of *hemorrhage, atelectasis and pneumothorax*. Why are these signs and symptoms a concern?

Because the adrenals are located close to the diaphragm and inferior vena cava

2 Which statement is appropriate for the nurse to include in patient teaching regarding type 2 diabetes? a "Insulin injections are never used with type 2 diabetes." b "You don't need to measure your blood glucose levels because you are not taking insulin injections." c "A person with type 2 diabetes still has functioning beta cells in his or her pancreas." d "Patients with type 2 diabetes usually have better control over their diabetes than those with type 1 diabetes."

3 The nurse monitoring a patient for a therapeutic response to oral antidiabetic drugs will look for a fewer episodes of diabetic ketoacidosis (DKA). b weight loss of 5 pounds. c hemoglobin A1C levels of less than 7%. d glucose levels of 150 mg/dL.

4 A patient who is about to be given octreotide is also taking a diuretic, IV heparin, ciprofloxacin (Cipro), and an opioid as needed for pain. The nurse will monitor for what possible interaction? a Hypokalemia due to an interaction with the diuretic b Decreased anticoagulation due to an interaction with the heparin c Prolongation of the QT interval due to an interaction with ciprofloxacin d Increased sedation if the opioid is given

4 A patient with type 2 diabetes is scheduled for magnetic resonance imaging (MRI) with contrast dye. The nurse reviews the orders and notices that the patient is receiving metformin (Glucophage). Which action by the nurse is appropriate? a Proceed with the MRI as scheduled. b Notify the radiology department that the patient is receiving metformin. c Expect to hold the metformin the day of the test and for 48 hours after the test is performed. d Call the prescriber regarding holding the metformin for 2 days before the MRI is performed.

The over production of parathormone results in increased levels what electrolyte in the blood? (Hint: Causes Renal Calculi)

Calcium

What mineral matches the following? ~ Primary element which makes muscles contract & gives bones rigidity ~ Normal conduction of electrical currents along nerves ~ Essential element of the clotting process ~ *Vitamin D aids in absorption*

Calcium

Cereals, spinach, or rhubarb may decrease the absorption of what supplement? (Hint: Can be used to *reduce chance of renal calculi in case of over supplementation*)

Calcium supplements

What is known as a spectrum of clinical abnormalities caused when *plasma levels of adrenocortical hormones are increased* resulting in the body's protective feedback mechanism to fail. In addition, the *excess secretion of the adrenal hormones: glucocorticoids, mineralocorticoids, and sex hormones* will cause the following s/s: ~ Hypertension ~ Muscle wasting ~ Moon face ~ Buffalo hump ~ Thin/fragile Skin ~ Weight Gain ~ Loss of libido ~ Severe backache ~ Increased Appetite

Cushing's Syndrome (Adrenal Hyperfunction)

*Congenital hypothyroidism, most commonly found in children*, where if led untreated can lead to mental retardation is known as what?

Cretinism

7. When assessing a patient who is receiving octreotide (Sandostatin) therapy, the nurse will closely monitor which assessment finding? a. Blood glucose levels b. Pulse c. Weight d. Serum potassium levels (Lilley, 122012)

The *overproduction of somatotropin (GH) in childhood* before closure of the epiphyses causes idiopathic hyperplasia of the anterior pituitary gland, what condition is marked by the following manifestations? ~ Overgrowth of the long bones that result in the attainment of great height ~ Increased muscle and visceral development ~ Weight increase ~ Body proportions are usually normal ~ Despite their size, these pts are usually weak

Gigantism

What type of diabetes is most likely to occur at 24 weeks gestation?

Gestational Diabetes

Which of the following hormones secreted by the anterior pituitary (adenohypophysis) stimulates the ovaries to grow, causes ovulation where a mature follicle will rupture expelling a ripe ovum, causes formation of corpus luteum in ruptured follicle, and stimulates corpus luteum to secrete progesterone and estrogen? ~ Growth Hormone (GH) ~ Thyroid Stimulating Hormone (TSH) ~ Adrenocorticotropin Hormone (ACTH) ~ Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH) ~ Melanocyte Stimulating Hormone (MSH) ~ Prolactin (PRL)

Follicle Stimulating Hormone (FSH) & Luteinizing Hormone (LH)

Which blood glucose test listed below can by classified by the following: Measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte. Because glycosylation occurs constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks. ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

Glycosylated hemoglobin (HbAlc)

Lente

Injection Time (before meal) -30 min Risk for Hypoglycemic Reaction -3-6hr after injection injection Peak action -1-3 hr Duration -6-12 hr

Regular Humulin R Novolin R

Injection Time (before meal) -30 min Risk for Hypoglycemic Reaction -Delayed meal or 3-4 hr after injection Peak action -30-60 min Duration -2-4 hr

NPH/Regular Mix 70/30 Humulin Mix 70/30

Injection Time (before meal) -30 min Risk for Hypoglycemic Reaction -Delayed meal or 3-4 hr after injection Peak action -30-60 min Duration -6-12 hr

Ultralente

Injection Time (before meal) -30min Risk for Hypoglycemic Reaction -6hr after injection Peak action -4-6hr Duration -18 hr

Lispro (Humalog)

Injection Time (before meal) -5-15 min Risk for Hypoglycemic Reaction -No meal within 30 min Peak action -15-30 min Duration -1-2 hr

Glargine (Lantus)

Injection Time (before meal) -Usually take at 9 pm, once daily Risk for Hypoglycemic Reaction -Starting dose should be 20% less than total daily dose of NPH Peak action -1-2 hr Duration -No pronounced peak (Confuses me too)

What hormone can be classified by the following? ~ Secreted by beta cells in the pancreas ~ Promotes the conversion of glucose to glycogen ~ Promotes the conversion of amino acids to proteins in muscle ~ Stimulates triglyceride formation ~ Inhibits the release of free fatty acids (Note: Found in Beef/Pork)

Insulin

What organ is responsible for the following? ~ Changes glycerol and fatty acids into glucose ~ Changes glucose into triglycerides as needed ~ Stores glucose in the form of glycogen ~ Can be converted back to glucose when needed for energy

Liver

Should antithyroid agents be used for a patient with additive bone marrow depression, *antineoplastics treatment, or radiation therapy*?

Which of the following posterior pituitary (neurohypophysis) hormones effects the uterus smooth muscles and mammary glands promoting the release of milk and stimulates uterine contractions during labor? ~ Anti-diuretic Hormone (ADH) ~ Oxytocin

Oxytocin

What is the name of the hormone secreted by the parathyroid gland?

PARATHORMONE

Which of the following diagnostic tests is the definitive way to test for Acromegaly? ~ Patient's history ~ Clinical manifestations ~ Computed Tomography (CT Scan) ~ Cranial radiographic evaluation ~ Laboratory tests of elevated GH ~ Oral Glucose Challenge

Oral Glucose Challenge (Reasoning: Normally GH concentration falls during an oral glucose challenge test, but in acromegaly these levels do not fall)

What medication classification are compounds that stimulate the beta cells to produce insulin but is not a substitute for insulin and requires the presence of insulin to be effective such as the following five classes of oral drugs? ~ Sulfonylureas ~ Meglitinides ~ Alpha-glucosidase inhibitors ~ Thiazolidinediones ~ Biguanide (Hint: *Used to treat Type II DM*)

Oral Hypoglycemics

What is the risk involved in needle biopsy?

Possibility of "seeding" adjacent tissue with cancer cells causing metastasis.

Do the following disorders manifest due to the posterior or anterior pituitary? ~ Diabetes Insipidus (DI) ~ Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)

Posterior Pituitary

The health care provider orders calcium chloride in 5% dextrose and 0.45% sodium chloride (D5 1/2 NS). *What effect may saline solution have on calcium chloride*? ~ It may increase the effects of calcium. ~ It has little or no effect on the calcium additive. ~ Calcium additives should always be added to IV solution containing NaCl. ~ Sodium encourages calcium loss; calcium should never be mixed with a saline solution.

Sodium encourages calcium loss; calcium should never be mixed with a saline solution (Reasoning: Calcium for IV use should be mixed with D5W, not a saline solution)

Which blood glucose test listed below can by classified by the following: *Absent in type 1 diabetes mellitus & normal to high in type 2 DM* ~ Fasting blood glucose (FBG) ~ Oral glucose tolerance test (OGTT) ~ Serum insulin ~ Postprandial blood glucose (PPBG) ~ Patient self-monitoring of blood glucose (SMBG) ~ Glycosylated hemoglobin (HbAlc) ~ C-peptide test

Serum insulin

What type of insulin can be classified by the following? ~Types: Regular, Semilente, Humulin R, Velosulin ~ Onset: 30 - 60 min ~ Peak: 2 - 3 hours ~ Duration: 4 - 6 hours

Short Acting Insulin

What develops when the thyroid gland enlarges in response to *low iodine levels* in the bloodstream or when it is *unable to utilize iodine properly* resulting in the following? ~ Difficulty swallowing ~ Hoarseness (Hint: *Eat iodine rich foods and salt*)

Simple Colloid Goiter

What maybe required for a insulin dependent patients medication administration who is exposed to the following: ~ Stress ~ Fever ~ Trauma ~ Infection ~ Surgery

Sliding Scale

*Which of the following is NOT a form of medical management for Hypoparathyroidism*? ~ Calcium gluconate ~ Calcium chloride ~ Vitamin D ~ Sodium phosphates IV ~ Bronchodilators ~ Endotracheal intubation ~ Mechanical ventilation

Sodium phosphates IV

What position should a patient receiving Pheochromocytoma Agents be in during parenteral administration?

Supine

WHAT IS THE SOLE PURPOSE OF THE PARATHYROID GLAND??

TO REGULATE CALCIUM LEVELS

WHAT IS THE MOST COMMON CAUSE OF HYPOPARATHYROIDISM?

TRAUMA

If a dose of a Antithyroid Agents is missed what should be done?

Take it as soon as you remember or x2 if too close to next dose

3. A patient is to be placed on an insulin drip to control his high blood glucose levels. The nurse knows that the type of insulin that would be used for this intra- venous infusion would be which of these? a. Regular b. Lispro c. NPH d. Glargine

3. Patient teaching for a patient taking antithyroid med- ication will include the need to avoid which foods? a. Soy products and seafood b. Bananas and oranges c. Dairy products d. Processed meats and cheese

5. The nurse will instruct a patient taking desmopressin acetate as a nasal spray for the treatment of diabetes insipidus to perform which action to obtain maxi- mum benefit from the drug? a. Clear the nasal passages before spraying the medication. b. Blow his nose after taking the medication. c. Take an over-the-counter preparation to control mucus if nasal congestion occurs. d. Press on the pump once to prime it before delivering the dose.

5. When will the nurse administer the drug acarbose (Precose)? a. With the first bite of a meal b. 15 minutes before a meal c. 30 minutes before a meal d. 1 hour after eating

6. A patient taking glipizide (Glucotrol) asks the nurse, "How does my insulin pill work, anyway?" Which information will the nurse provide to the patient re- garding the mechanism of action of glipizide? a. "It increases insulin production." b. "It helps the body use insulin." c. "It decreases the amount of glucose made by the liver." d. "It decreases the amount of glucose the body takes in from food."

7 A patient is taking metformin for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects, the nurse will include information about: (Select all that apply.) a Abdominal bloating b Nausea c Diarrhea d Headache e Weight gain f Metallic taste

a,b,c,f

The nurse is reviewing the medication orders of a newly admitted patient who has an infusion of the adrenergic drug dopamine. Which of these drugs or drug classes, if also given to the patient, may cause an interaction? (Select all that apply.) a. Tricyclic antidepressants b. Monoamine oxidase inhibitors (MAOIs) c. Anticoagulants d. Corticosteroids e. Antihistamines (Lilley, 122012)

a,b,d

15. Dennis takes glipizide (Glucotrol). He comes to the emergency department late one Sunday evening complaining that he feels weak, he vomited earlier, he has a headache, and his face "feels hot." You note that Dennis has profound flushing and is sweating. (Lilley, 122012) a. What do Dennis's signs and symptoms indicate? b. What will you assess immediately? c. What may have caused this?

a. Disulfiram-type reaction b. In addition to assessing vital signs, assess his blood glucose level immediately. c. Dennis may have been drinking alcohol. Sulfo- nylureas may interact with alcohol in a way that is similar to the interaction with disulfiram, which is used to deter alcohol ingestion in people with chronic alcoholism. This disulfiram-type reaction includes vomiting and hypertension. In addition, the alcohol taken with the sulfonylurea may en- hance the action of the antidiabetic drug, causing increased hypoglycemia. (Lilley, 122012)

11. What is the mechanism of action of each drug? a. pramlintide (Symlin) b. metformin (Glucophage) (Lilley, 122012)

a. Pramlintide, an incretin mimetic, given by subcu- taneous injection, works by mimicking the action of the natural pancreatic hormone amylin. Amylin is secreted along with insulin in response to food intake and influences postmeal glucose levels by slowing gastric emptying, suppressing gluca- gon secretion (which reduces the liver's glucose output), and increases the sense of satiety. As a result, blood glucose levels are reduced. b. Metformin works primarily by inhibiting hepatic glucose production and increasing the sensitiv- ity of peripheral tissue to insulin, thus lowering blood glucose levels. (Lilley, 122012)

3. thyroxine (thyroid) (1728)

d. Growth and development; metabolism

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