Immune and Endocrine

Which psychosocial problem should be included in the plan of care for a female client diagnosed with Cushing's syndrome? 1. Altered glucose metabolism. 2. Body image disturbance. 3. Risk for suicide. 4. Impaired wound healing.

2. Body image disturbance. moon face, buffalo hump, truncal obesity, hirsutism, and striae and bruising

Which nursing intervention is most important for a patient with diabetes insipidus? 1. Providing dietary education 2. Monitoring fluid intake and output 3. Assessing for constipation every day 4. Obtaining a finger-stick blood glucose level

2. Monitoring fluid intake and output

The client is admitted to rule out Cushing's syndrome. Which laboratory tests should the nurse anticipate being ordered? 1. Plasma drug levels of quinidine, digoxin, and hydralazine. 2. Plasma levels of ACTH and cortisol. 3. A 24-hour urine for metanephrine and catecholamine. 4. Spot urine for creatinine and white blood cells (WBCs).

2. Plasma levels of ACTH and cortisol.

The nurse teaches the staff ensuring that standard precautions should be used when providing care for which type of patient? a. All patients regardless of diagnosis b. Pediatric and gerontologic patients c. Patients who are immunocompromised d. Patients with a history of infectious diseases

a. All patients regardless of diagnosis

Type 1: Rapid Hypersensitivity Reaction

-Also called atopic allergy -Most common type -Some reactions occur only in areas of antigen exposure-Caused by increased production of immunoglobulin E (IgE) antibody class - Angioedema -Examples: -Inhalation (pollens, spores, animal dander, dust, grass, ragweed)-Ingestion (foods, food additives, drugs) -Injection (bee venom, drugs, biologic substances) -Contraction (latex, pollens, foods, environmental proteins)(hay fever, allergic asthma, anaphylaxis, angioedema)

Manifestations of SIADH

-Dilutional hyponatremia (sodium <135mEq/L) -Crackles in lungs *there will be NO peripheral edema manifestations -Personality changes, hostility- GCS changes (due to hypnotremia)

Diabetes Insipidus (DI)

-Dysfunction of the Posterior Pituitary GlandDeficiency of antidiuretic hormone (ADH) also known as vasopressino I -In the absence of ADH renal tubules become impermeable to H2O. -Results in large of amounts of diluted urine, excessive thirst and excessive fluid intake -Cardiac output decreases with loss of fluid; everything starts to shut down

DI nursing interventions

-Monitor VS, Lab values, I/O -Promote safety -Treat constipation• Promote intact skin and MM -Encourage PO fluids -Medical Alert bracelet

Nursing care/monitoring for SIADH

-Monitor for indications of heart failure, which can occur from fluid overload. Use of a loop diuretic can be indicated. -Monitor I&O. Report decreased urine output. -Monitor vital signs for increased blood pressure,tachycardia, and hypothermia. -Monitor for decreased serum sodium/osmolarity and elevated urine sodium/osmolarity.

Type II hypersensitivity

-Tissue-specific reactions -Blood transfusion

The nurse is planning the care of a client diagnosed with Addison's disease. Which intervention should be included? 1. Administer steroid medications 2. Place the client on fluid restriction 3. Provide frequent stimulation 4. Consult physical therapy for gait training

1. Administer steroid medications

Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? 1. Serum sodium. 2. Serum calcium 3. Urine glucose. 4. Urine white blood cells.

1. Serum sodium.

Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? 1. Decreased hematocrit 2. Decreased serum osmolality 3. Increased serum sodium 4. Increased urine specific gravity

3.Increased serum sodium due to fluid restriction indicates effective therapy. Hemoconcentration is a result of hypovolemic hyponatremia caused by SIADH and diabetes insipidus. Plasma osmolality is decreased as a result of SIADH. Urine specific gravity is decreased with diabetes insipidus and is increased with SIADH.

The nurse is assessing the elimination patterns of a patient. Which finding needs further evaluation to rule out the possibility of diabetes insipidus (DI)? 1. The first morning sample of urine is pale yellow and clear. 2. The patient reports excessive thirst and increased frequency of urination. 3. The total urine output is slightly less than the total fluid intake in 24 hours. 4. The specific gravity of the urine is 1.005

2.The patient who reports excessive thirst and increased frequency of urination must be evaluated for DI. The patient with increased urination frequency will wake up frequently at night to urinate. Normal urine is pale yellow and clear. A patient with DI will record a total urine output more than the total fluid intake in 24 hours. The amount of urine may vary from 4 L to 30 L per day, often leading to dehydration. The urine is dilute and the specific gravity is less than 1.005 in a patient with DI.

The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess? 1. Moon face, buffalo hump, and hyperglycemia 2. Hirsutism, fever, and irritability 3. Bronze pigmentation, hypotension, and anorexia 4. Tachycardia, bulging eyes, and goiter

3. Bronze pigmentation, hypotension, and anorexia

The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client? 1. Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed. 2. Teach the client regarding sexual functioning and androgen replacement therapy. 3. Explain the signs and symptoms of infection and when to call the health-care provider. 4. Demonstrate turn, cough, and deep-breathing exercises the client should perform every two (2) hours.

3. Explain the signs and symptoms of infection and when to call the health-care provider.

A registered nurse (RN) is providing instructions to an unlicensed assistive personnel (UAP) assigned to give a bed bath to a client who is on contact precautions. The RN instructs the UAP to use which protective item when giving the bed bath? A. A gown and gloves

A. A gown and gloves

A patient has been admitted to the ED with bilateral eyelid swelling and subsequent difficulty seeing. What is the priority nursing assessment? A. Airway B. Nasal cavity C. Home medications D. History of visual disturbances

A. Airway

Which nursing interventions address the immediate priority of care for a client experiencing a severe hypersensitivity reaction? (select all that apply) A. Assess respiratory status continuously B. Administer subcutaneous epinephrine as prescribed C. Monitor urine output D. Teach the client when and how to use an anaphylactic kitE. Administer oxygen via nasal cannula at the prescribed rate

A. Assess respiratory status continuously B. Administer subcutaneous epinephrine as prescribed E. Administer oxygen via nasal cannula at the prescribed rate

When planning care for a client admitted with a hypersensitivity reaction, the nurse addresses the potential problem of airway clearance. Which intervention will assistantships in addressing this potential problem? (Select all that apply) A. Assessing level of consciousness B. Administering oxygen C. Auscultating lung sounds D. Placing the client in a supine position E. Administering epinephrine

A. Assessing level of consciousness B. administering oxygen C. Auscultating lung sounds E. Administering epinephrine

What is the MOST important step a nurse can take to prevent anaphylactic shock in a patient? A. Assessing, documenting, and avoiding all the patient allergies B. Administering Epinephrine C. Administering Corticosteroids D. Establishing IV access

A. Assessing, documenting, and avoiding all the patient allergieS

Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 'F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply:* A. Blood pressure of 70/34 after the fluid bolus B. Serum lactate less than 2 mmol/L C. Patient needs Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement D. Central venous pressure (CVP) of 18

A. Blood pressure of 70/34 after the fluid bolus C. Patient needs Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement

The nurse clarifies that a patient with HIV does not necessarily have AIDS until: A. CD4 cell level drops to 200. B. Two or more opportunistic infections are diagnosed. C. Kaposi sarcoma appears. D. Tested positive for enzyme-linked immunosorbent assay (ELISA). A. CD4 cell level drops to 200.

A. CD4 cell level drops to 200.

The nurse is teaching the client about how to monitor therapy effectiveness for the syndrome of inappropriate antidiuretic hormone (SIADH). What will the nurse tell the client to look for? A. Daily weight gain of less than 2 lbs B. Dry mucous membranes C. Increasing heart rate Incorrect D. Muscle spasms

A. Daily weight gain of less than 2 lbs Correct: The client needs to monitor daily weights because this assesses the degree of fluid restriction needed. A weight gain of 2 lbs or more daily or a gradual increase over several days is cause for concern.

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? A. Desmopressin (DDAVP) B. Dopamine hydrochloride (Intropin) C. Prednisone D. Tolvaptan (Samsca)

A. Desmopressin (DDAVP)

You're explaining to a group of outpatients about the signs and symptoms that may present with osteoarthritis. Select all the signs and symptoms that may present with this condition: A. Herberden's Node B. Morning stiffness for less than 30 minutes C. Soft, tender, warm joints D. Fever E. Anemia F. Hard and bony joints G. Crepitus H. Bouchard's Node

A. Herberden's Node B. Morning stiffness for less than 30 minutes F. Hard and bony joints G. Crepitus H. Bouchard's Node

A 50-year-old man has been taking prednisone (Deltasone) as part of treatment for bronchitis. He notices that the dosage of the medication decreases. During a follow-up office visit, he asks the nurse why he must continue the medication and why he cannot just stop taking it now that the feels better. What is the rationale behind tapering the doses? A. Sudden discontinuation of the medication may result in adrenal insufficiency. B. The patient would experience withdrawal symptoms if the drug were discontinued abruptly. C. Cushing's syndrome may develop as a reaction to a sudden drop in serum cortisone levels. D. When the symptoms have started to disappear, lower dosages are needed.

A. Sudden discontinuation of the medication may result in adrenal insufficiency.

A patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment secondary to a traumatic injury and infection. The nurse plans case for the patient knowing that the patient is most susceptible to A. candidiasis B. aspergillosis C. histoplasmosis D. coccidioidomycosis

A. candidiasis

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.

1. The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin

ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

ANS: D The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.

A nurse is administering a new medication intravenously to a patient. The patient becomes short of breath and begins to experience itching and hives. What is the priority nursing response? A. Assess blood pressure B. Stop the intravenous infusion C. Discuss anxiety with the patient D. Review the patient's allergies

B. Stop the intravenous infusion

The nurse has educated the patient with a shellfish allergy about signs and symptoms of angioedema. Which patient statement requires further nursing education? A. "I can eat shrimp because it is not a shellfish." B. "There is an epinephrine injector in my purse at all times." C. "Symptoms of angioedema include swelling of eyes, lips, and tongue." D. "When I see a new physician, I will report that I have a shellfish allergy."

Answer: A Rationale: Shrimp is a shellfish, and should not be consumed by patients with shellfish allergies. This statement therefore requires further teaching by the nurse. The patient should carry an epinephrine injector at all times. Symptoms of angioedema include swelling of eyes, lips, and tongue. Patients should report all allergies to health care providers.

Which is the nurse's PRIORITY action when managing a client experiencing a type I hypersensitivity? A. Management of arthralgia B. Airway management C. Stopping the blood transfusion D. Decreasing a fever

B. Airway management

The nurse is planning care for a patient with human immunodeficiency virus (HIV). Which priority nursing action will most help the patient prevent complications? A. Encourage the patient to eat three high-protein meals each day. B. Educate the patient about the importance of adherence to drug therapy C. Plan an exercise regimen for the patient to adhere to three times a week. D. Obtain a prescription for the patient to take antibiotics prophylactically to prevent infections.

B. Educate the patient about the importance of adherence to drug therapy

A patient with a history of asthma develops shortness of breath and stridor and becomes hypotensive during allergy skin testing. Which medication would the nurse expect to administer in this situation? A. Zileuton B. Epinephrine C. fexofenadine D. Cromolyn sodium

B. Epinephrine

A client calls the nurse in the emergency department and states that he was just stung by a bumblebee while gardening. The client is afraid of a severe reactions because the client's neighbor experienced such a reaction just 1 week ago. Which action should the nurse take? A. advise the client to soak the site in hydrogen peroxide B. ask the client if he ever sustained a bee sting in the past C. tell the client to call an ambulance for transport to the emergency department D. tell the client not to worry about the sting unless difficulty with breathing occurs

B. ask the client if he ever sustained a bee sting in the past(in some types of allergies, a reaction occurs only on the second and subsequent contacts with the allergen)

A nurse is caring for a client who is HIV positive and is one day postoperative following an appendectomy. The nurse should wear a gown as personal protective equipment when taking which of the following actions? A) Talking to the client at the bedside B) Administering an intermittent IV bolus medication C) Completing a dressing change D) Administering an IM injections

C) Completing a dressing change

An erythrocyte sedimentation rate (ESR) determination is prescribed for a client with a connective tissue disorder. The client asks the nurse about the purpose of the test. What should the nurse tell the client about the purpose of the test? A. Determines the presence of antigens B. Identifies which additional tests need to be performed C. Confirms the diagnosis of a connective tissue disorder D. Confirms the presence of inflammation or infection in the body

D. Confirms the presence of inflammation or infection in the body

How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? A. Blocks reabsorption of sodium B. Increases blood pressure C. Increases cardiac output D. Works as an antidiuretic hormone (ADH) in the kidneys

D. Works as an antidiuretic hormone (ADH) in the kidneys Desmopressin is a synthetic form of ADH that binds to kidney receptors and enhances reabsorption of water, thus reducing urine output. Desmopressin does not have any effect on sodium reabsorption. It may cause a slight increase or a transient decrease in blood pressure, but this does not affect urine output. Desmopressin does not increase cardiac output.

Causes of SIADH

Malignancies; pulmonary disorders (infections); CNS disorders( Head injuries, CVA); Alcohol, lithium carbonate, phenytoin; Trauma, pain or stress

Primary means of HIV infection for health care workers.

Needle stick or "sharps" injuries

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Vasopressin (ADH) secreted even in presence of low or normal plasma osmolality; Feedback mechanism not functioning properly; Hyperfunction of the posterior pituitary; Hypersecretion of ADH; Excess ADH leads to renal absorption of H20 and suppression of renin-angiotensin mechanism

Which of the following statements accurately describes HIV infectionsSelect all that apply a. HIV infection has inevitable and predictable course of progression b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS) c. Untreated HIV infection can remain in the early chronic stage for a decade or more d. Untreated HIV infection usually remains in the early chronic stage for `1 year or less e. Opportunistic diseases occur more often when the CD4+ T cell count is low and viral load is low.

a. HIV infection has inevitable and predictable course of progression b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS) c. Untreated HIV infection can remain in the

During care of the patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every 2 hours. b. Teach the patient receiving treatment with diuretics to restrict sodium intake. c. Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release. d. Notify the health care provider if the patient's blood pressure decreases more than 20 mm Hg from baseline.

a. Monitor neurologic status at least every 2 hours.

Anurse cares for a client with chronic hypercortisolism. Which action should the nurse take? a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the client's daily chest x-ray.

a. Wash hands when entering the room.

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. a. Monitor daily weight. b. Monitor intake and output c. Assess extremities for edema .d. Maintain a high-sodium diet.e. Maintain a low-potassium diet.

a. monitor daily weight b. monitor intake and output c. assess extremities for edemaThe client with Cushing's syndrome and a problem of excess fluid volume should be on daily weights and intake and output and have extremities assessed for edema. He or she should be maintained on a high-potassium, low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water.

Which example should the nurse use to explain an infant's "passive immunity" to a new mother? a. Vaccinations b.Breastfeeding c. Stem cells in peripheral blood d. Exposure to communicable diseases

b. Breastfeeding

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse should expect an excess of which substance? a. Calcium b. Cortisol c. Epinephrine d. Norepinephrine

b. Cortisol

6. The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? a. Decreased body weight b. Decreased urinary output c. Increased plasma osmolality d. Increased serum sodium levels

b. Decreased urinary output

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile(select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

b. Gown c. Gloves

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the clients fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

b. Restrict the clients fluid intake to 600 mL/day.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/uL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

c. "The patient has developed acquired immunodeficiency syndrome (AIDS)."

Of the following, which is the most appropriate nursing intervention to help an HIV infected patient adhere to a treatment regimen a. set up a drug pillbox for the patient every week b. give the patient a videotape and a brochure to view and read at home c. tell the patient that the side effects of the drugs are bad but that they go away after a while d. assess the patients routines and find adherence cues that fit into the patients life and circumstances

d. assess the patients routines and find adherence cues that fit into the patients life and circumstances

What is active artificial immunity?

immunization with vaccines (seasonal flu vaccine).

Diagnostic tests for DI

urine chemistry (think dilute); serum chemistry (think concentrated)