Test 5 - Endocrine and Safety

The clinic nurse is taking vital signs on a client who reports being fatigued every day and gaining weight lately despite not eating much. The nurse should also ask about which symptoms? Select all that apply. 1. Cold intolerance 2. Constipation 3. Fever 4. Menstrual irregularity 5. Night sweats 6. Tachycardia

1, 2, 4 Fatigue and weight gain are classic manifestations of hypothyroidism. Features of hypothyroidism typically result from decreased metabolic rate and include cold intolerance, constipation, dry skin, irregular or prolonged menstrual periods, and mental slowing or difficulty concentrating.

The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse question? 1. 0.45% sodium chloride (NaCl) solution prescribed for a client with SIADH who has a sodium level of 120 mEq/L (120 mmol/L) 2. 0.9% NaCl solution prescribed for a client with gastrointestinal bleeding who has a hemoglobin level of 8.9 g/dL (89 g/L) 3. 1,000 mL bolus of 0.9% NaCl solution prescribed for a client with septic shock who has a white blood cell count of 18,000/mm3 (18.0 × 109/L) given over 1 hour 4. Lactated Ringer's solution prescribed for a male client with hypovolemic shock and a thermal burn who has a hematocrit level of 56% (0.56)

#1. you would not give fluid unless it were a hypertonic saline solution to increase salt levels; SIADH patients are already hyponatremic and fluid overloaded. 0.45% is hypotonic.

The nurse assesses a client with hyperparathyroidism who had a parathyroidectomy 4 hours ago. Which assessment technique should the nurse use to check for complications in this client? 1. Ask client to place backs of the hands against each other to provide hyperflexion of the wrist while the elbows remain flexed 2. Instruct client to lie down and run the heel of one foot down the shin of the other leg 3. Perform Romberg test by asking the client to stand with eyes closed and feet together 4. Place blood pressure (BP) cuff on arm, inflate to pressure > than systolic BP, and hold in place for 3 minutes

#4 (checking trousseau's sign for hypocalcemia) Chevostek's sign another early indicator of hypocalcemia, should also be assessed. It may be elicited by tapping the face at the angle of the jaw and observing for contraction on the same side of the face.

The nurse in the endocrinology clinic is reviewing phone messages from clients. Which client would be the priority to call first? 1. Client with a history of thyroidectomy who needs a refill for levothyroxine 2. Client with Addison disease who is taking corticosteroids and reports new mood swings 3. Client with diabetes who reports blood sugars of 250-300 mg/dL (13.9-16.7 mmol/L) in the past week 4. Client with hyperthyroidism who has a new temperature reading of 101.5 F (38.6 C)

#4 (possible thyroid storm) Clients with hyperthyroidism are at risk for developing thyroid storm, a life-threatening condition. Symptoms include fever, tachycardia, cardiac dysrhythmias, nausea, vomiting, diarrhea, and altered mental status. Client management includes reducing fever, maintaining hydration, and preventing cardiac compromise.

The clinic nurse is reviewing the laboratory results of a 35-year-old client who reports fatigue for the last month. Based on the laboratory results, which additional clinical manifestations would the nurse expect? Select all that apply. Labs: high TSH; low levels of T3 and T4 1. Bradycardia 2. Cold intolerance 3. Constipation 4. Hair loss 5. Warm, moist skin 6. Weight loss

1, 2, 3, 4 Clinical manifestations include weight gain, constipation, dry skin, hair loss, cold intolerance, bradycardia, and confusion.

The nurse assesses a client with Cushing syndrome. Which clinical manifestations should the nurse expect? Select all that apply. 1. Hyperglycemia 2. Hypertension 3. Hyponatremia 4. Truncal obesity 5. Weight loss

1, 2, 4 Clinical manifestations of Cushing syndrome include: weight gain, truncal obesity, moon face, skin atrophy, easy bruising, purple striae on the abdomen, muscle weakness, hypertension, and hyperglycemia. Associated androgen excess can result in acne, hirsutism, and menstrual irregularities.

In the intensive care unit, the nurse cares for a client admitted with a head injury who develops syndrome of inappropriate antidiuretic hormone. Which data should the nurse expect with the onset of this condition? Select all that apply. 1. Decreased serum osmolality 2. High serum osmolality 3. High urine specific gravity 4. Increased urine output 5. Low serum sodium 6. Decreased urine osmolality 7. Increased urine osmolality

1, 3, 5, 7 2, 4, 6 are associated with DI

A client is suspected of having Graves' disease (hyperthyroidism). Which signs and/or symptoms are expected to be present in this client? Select all that apply. 1. Anxiety 2. Bradycardia 3. Dry skin 4. Heart palpitations 5. Protrusion of the eyeballs 6. Weight gain

1, 4, 5 The symptoms are a result of the hypermetabolic rate caused by the increase in thyroid hormones. These include weight loss, heart palpitations, heat intolerance, excessive sweating, anxiety, hand tremors, diarrhea, and insomnia. Hyperthyroidism can also cause retro-orbital tissue expansion and weakness of the muscle fibers in the eye, exophthalmos, which is an irreversible protrusion of the eyeballs. It causes symptoms associated with a high metabolic rate, including weight loss, heart palpitations, heat intolerance, anxiety, hand tremors, and insomnia.

The nurse in the intensive care unit cares for a client with primary adrenocortical insufficiency (Addison's disease). The client reports nausea and abdominal pain. The blood pressure suddenly drops from 120/74 mm Hg to 88/48 mm Hg, heart rate increases from 80 to 100/min, and the client appears confused. Which action should the nurse take first? 1. Administer as-needed dose of hydrocortisone intravenous (IV) push 2. Complete a head-to-toe assessment to identify any sources of infection 3. Document the findings in the client's electronic medical record 4. Take blood pressure sitting and standing to assess for orthostatic hypotension

1. Administer as-needed dose of hydrocortisone intravenous (IV) push

In the intensive care unit, the nurse cares for a client who develops diabetes insipidus (DI) 2 days after pituitary adenoma removal via hypophysectomy. Which intervention should the nurse implement? 1. Administer desmopressin 2. Assess fasting blood glucose 3. Institute fluid restriction 4. Place the client in the Trendelenburg position

1. Administer desmopressin ADH release is impaired in neurogenic DI. As a result, ADH replacement with vasopressin (Pitressin) can be used to treat DI. However, it also has vasoconstrictive properties. Therefore, desmopressin (DDAVP), an analog without vasopressor activity, is the preferred therapy. Clients on this treatment should be monitored for urine output, urine specific gravity, and serum sodium (to avoid hyponatremia due to excess DDAVP).

The nurse cares for a client with Addison's disease who was involved in a motor vehicle accident and hospitalized for a fracture of the right femur. Which client information is most important to report to the primary health care provider (PHCP)? 1. Blood pressure change from 128/80 mm Hg to 90/50 mm Hg 2. Development of a 1st-degree atrioventricular (AV) block on electrocardiogram (ECG) 3. Reports of right femur pain of 7 on a scale of 1-10 4. Vesicular breath sounds auscultated over the lung tissue

1. Blood pressure change from 128/80 mm Hg to 90/50 mm Hg Addisonian crisis, or acute adrenocortical insufficiency, is a potentially life-threatening complication of Addison's disease. It can lead to shock and should be reported immediately to the PHCP. Addisonian crisis is triggered by stress, and its manifestations include the following: - Hypotension and tachycardia - Dehydration - Hyperkalemia and hyponatremia - Hypoglycemia - Fever - Weakness and confusion Signs and symptoms include hypotension, tachycardia, hyperkalemia, hyponatremia, hypoglycemia, fever, weakness, and confusion; these should be reported to the PHCP immediately.

The nurse assesses a female client with a diagnosis of primary adrenal insufficiency (Addison disease). The nurse recognizes which finding associated with the disease? 1. Bronze pigmentation of skin 2. Increased body or facial hair 3. Purple or red striae on the abdomen 4. Supraclavicular fat pad

1. Bronze pigmentation of skin Clients with Addison disease may also have vitiligo, or patchy/blotchy skin, which is usually present when the etiology of the disease is an autoimmune problem. The immune cells are thought to destroy melanocytes which produce melanin (or brown pigment), resulting in a patchy appearance. Other common manifestations of Addison disease include the following: - Slow, progressive onset of weakness and fatigue - Anorexia and weight loss - Orthostatic hypotension - Hyponatremia and hyperkalemia - Salt cravings - Nausea and vomiting - Depression and irritability (Options 2, 3, and 4) Purple striae, hirsutism (increased facial and body hair), and a supraclavicular fat pad (ie, buffalo hump) are characteristics of Cushing syndrome, a condition associated with excess corticosteroid production. In contrast, Addison disease is a condition of hyposecretion of glucocorticoids.

The nurse has received report on 4 patients. Which should she see first? 1. Client admitted this morning with acute pyelonephritis whose IV line is infiltrated 2. Client scheduled for surgery in 2 hours who has questions about the procedure 3. Client who had a colostomy yesterday and now has a leaking colostomy bag 4. Client w total hip replacement 3 days ago who reports not having a BM in 2 days

1. Client admitted this morning with acute pyelonephritis whose IV line is infiltrated Acute pyelonephritis is a severe bacterial infection of the kidney that causes it to swell. It can lead to permanent scarring of the kidney and can be life threatening. Initial treatment includes vigorous parenteral IV fluids and IV antibiotics. Patent IV is priority. This clients needs are the priority as treatment is dependent on patent IV access 2. Needs to speak to HCP. Nurse should arrange this asap. Second priority.

The nurse is caring for a client with suspected Graves disease. Which assessment finding requires priority intervention? 1. Current temp of 102.8; has been trending up rapidly 2. Heat intolerance 3. Pulse of 110/min, irregular rhythm 4. Red and bulging eyes

1. Current temp of 102.8; has been trending up rapidly Thyroid storm is a serious and potentially life-threatening emergency for clients with Graves disease. This condition occurs when the thyroid gland releases large amounts of thyroid hormone in response to stress (eg, trauma, surgery, infection). Characteristic features include tachycardia, hypertension, cardiac arrhythmias (eg, atrial fibrillation), and fever up to 104-106 F (40-41 C). Other findings include severe nausea, vomiting, anxiety, altered mentation, and seizures. (Option 2) Heat intolerance is an expected symptom in hyperthyroidism, including Graves disease. (Option 3) Tachycardia and arrhythmias (eg, atrial fibrillation) are commonly seen with hyperthyroidism of any cause, including Graves disease. These alone cannot differentiate whether the client has simple hyperthyroidism or life-threatening thyroid storm. (Option 4) Exophthalmos (protruding eyeball) is commonly seen in Graves disease. The eyelids do not close over the eyeballs properly, leading to excessive dryness and resultant corneal damage (exposure keratitis). Although it is important to treat exophthalmos, it is not immediately life-threatening.

The nurse cares for a client admitted to the hospital due to confusion. The client has a nonmetastatic lung mass and a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Which action(s) should the nurse expect to implement? Select all that apply. 1. Fluid bolus (normal saline) 2. Fluid restriction 3. Salt restriction in the diet 4. Seizure precautions 5. Strict record of fluid intake and output

2, 4, 5 SIADH treatment includes: - Fluid restriction to <1000 mL/day - Oral salt tablets to increase serum sodium (Option 3) - Hypertonic saline (3%) during the first few hours for clients with markedly decreased serum sodium and severe neurologic manifestations - seizure precautions d/t hyponatremia - Vasopressin receptor antagonists (eg, conivaptan) The nurse should also maintain a strict fluid intake and output chart and daily weights and carefully monitor neurologic status to evaluate for improvement or deterioration.

These victims are all what triage color: shallow lacerations across all four extremities without significant bleeding 1st and 2nd degree burns across very small portion of body that aren't significant areas (i.e., face, hands, groin) closed fractures of the arms Behavioral disorders or psychological disturbances

Green / minimal / nonurgent

When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? b. Thiazide diuretics

b. In nephrogenic diabetes insipidus, the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate (GFR) in the kidney and produce a decrease in urine output. Low-sodium diets (<3 g/day) are also thought to decrease urine output. Fluids are not restricted because the patient could easily become dehydrated.

What four routes can desmopressin (DDVAP) be given and which is most common?

intranasal (most common), PO, SubQ, and IV

3 Adrenal Gland Disorders

Addisons Disease Cushings Syndrome Pheochromocytoma

The nurse is performing an initial assessment on a client diagnosed with Addison's disease. Which assessment findings should the nurse anticipate? Select all that apply. 1. Acanthosis nigricans 2. Hirsutism 3. Hyperpigmented skin 4. Truncal obesity 5. Weight loss

3, 5 (Option 1) Acanthosis nigricans is a skin condition that occurs with obesity and diabetes and appears as velvet-like patches of darkened, thick skin. These areas typically occur around the back of the neck and in the groin and armpits. Addison's disease (chronic adrenal insufficiency) leads to hyperpigmented skin, low blood pressure, weight loss, and muscle weakness.

Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)? d. The patient has a serum sodium level of 118 mEq/L.

A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action

Catecholamines are....

Epinephrine and norepinephrine, hormones released by the adrenal medulla to initiate fight or flight response

What electrolyte imbalance: Tetany - Chvostek's and Trousseau's, perioral tinging

Hypocalcemia

How should levothyroxine be taken?

In the morning on an empty stomach, at least 30 to 60 minutes before breakfast. - 4 hours before or after prenatal vitamin

Parathyroid Gland function

Only role is to regulate serum calcium by releasing parathyroid hormone (PTH)

What color would you tag someone who requires immediate attention?

Red

What color would you take a patient in shock?

Red

2 main antidiuretic hormone disorders

SIADH Diabetes insipidus

Tolvaptan and conivaptan: which disorder and what is special about them?

SIADH and they cannot be sent home with patient d/t needing such frequent lab monitoring. AC setting only.

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find a. HTN, peripheral dependent edema, and petechiae b. weight loss, buffalo hump, and moon face with acne c. bruising, truncal obesity, and hypotension d. Hyponatremia, hyperglycemia, hyper pigmentation of the skin

a. HTN, peripheral dependent edema, and petechiae B = weight gain not loss C = hypertension not hypo D = hypernatremia not hypo

Name the most common mineralocorticoid and where it is produced

aldosterone (salt retaining hormone) the adrenal cortex

A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences c. a urine specific gravity of 1.002.

c. Normal urine specific gravity is 1.005 to 1.025 and urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of diabetes insipidus is inadequate. Headache, weight gain, and oral intake greater than urinary output are signs of volume excess that occur with overmedication. Nasal irritation and nausea may also indicate overdosage.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a. Infusing I.V. fluids rapidly as ordered b. Encouraging increased oral intake c. Restricting fluids d. Administering glucose-containing I.V. fluids as ordered

c. Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

raises blood calcium levels (by stimulating the breakdown of calcium in the bones to move into the blood)

parathyroid hormone (PTH)

SIADH and DI are disorders of what specific gland?

posterior pituitary

The following person presents post-tooth extraction. Step outside of the darn nursing toolbox and diagnosis them: -tachycardia (142) -hypertension -cardiac arrythmias (a- fib, v tach) -fever up to 104-106 -altered mental status -anxiety -seizures

thyroid storm (thyrotoxic crisis)

A client is admitted to the intensive care unit with diagnoses of a brain tumor complicated by transient diabetes insipidus. Which client data related to this complication should the nurse expect? Select all that apply. 1. Dark amber urine with sediment 2. High serum osmolality 3. Low urine specific gravity 4. Recent weight gain 5. Reports of excessive thirst

2, 3, 5 Diabetes insipidus is a condition in which antidiuretic hormone is insufficiently produced or suppressed, resulting in polydipsia and polyuria (up to 20 L/day). Urine is copious and dilute with a low specific gravity (<1.003). Fluid volume deficit can lead to dehydration, hypernatremia, high serum osmolality, and weight loss.

There has been a major disaster involving a manufacturing plant explosion. The emergency department nurse is sent to triage victims. Which client should the nurse send to the hospital first, and what tag color would you assign to each? 1. Victim who has partial-thickness burns on both hands 2. Victim who is screaming and has a left lower arm laceration 3. Victim with a broken bone protruding from a wound on the right lower leg 4. Victim with a gaping head wound and Glasgow Coma Scale score of 3

3. Victim with a broken bone protruding from a wound on the right lower leg; red tag #1 is yellow #2 is green #4 is black

Most common cause of primary adrenal insufficiency

Autoimmune Can be flared up after pregnancy and may have other autoimmune conditions

What color would you tag a patient was profound hemorrhage?

Black

What color would you tag a patient with agonal breathing?

Black

What color would you take a patient in cardiac arrest?

Black

Color: expected and allowed to die; prepare for morgue.

Black tag

In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A) That therapy typically lasts about 6 months. B) That weekly laboratory tests for T4 levels will be required. C) To report weight loss, anxiety, insomnia, and palpitations. D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations. Weight loss, anxiety, insomnia and palpitations are signs of hyperthyroidism. An adjustment in dose would need to be obtained in order to reach a therapeutic level of levothyroxine (Synthroid) in the patient with hypothyroidism.

Muscle weakness in cushings

Catabolic effects of cortisol on muscle - atrophy

Two kinds of DI- central and nephrogenic. What is the difference?

Central diabetes insipidus: posterior pituitary gland fails to synthesize, secrete or transport ADH Nephrogenic Diabetes Insipidus: kidneys fail to respond to ADH

What is desmopressin and what is it used for?

Desmopressin is often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone (ADH) levels that may result in dehydration and hypernatremia.

Main pharmacological treatment of diabetes insipidus

Desmopressin: preferred therapy, form of ADH but does not cause vasoconstriction Vasopressin can be used but is not preferred because of its vasoconstrictive properties

Name that disorder: in which there is a deficient amount of ADH released/response, causing large amounts of diluted urine to be excreted

Diabetes Insipidus

treatment of mild SIADH includes:

Fluid Restriction 500 - 1000 mL/day Oral salt tablets Loop diuretics monitor neurologic status daily weights strict fluid intake and output

2 main thyroid gland disorders

Graves Disease (Hyperthyroidism, T3 and T4 excess) Hypothyroidism (T3 and T4 deficiency) (often caused by Hashimoto's disease)

What color would you check a patient whose treatment can be delayed more than 4 hours?

Green

What color would you tag a patient with contusions?

Green

What color would you tag the walking wounded?

Green

What color would you take a patient with a closed fracture of the arm?

Green

Color: Minor injuries that do not require immediate treatment, can delay treatment more than four hours; considered the walking wounded.

Green tag

What electrolyte imbalance: Fractures, osteopenia Kidney stones Nausea, vomiting, abdo pain AMS

Hypercalcemia `

Thyroid Gland is controlled by what cascade?

Hypothalamus produces thyroid releasing hormone TRH , sends to the pituitary Pituitary Gland produces TSH when thyroid hormones drop too low Low T3 and T4= High TSH High T3 and T4= Low TSH

Treatment of high Ca

IVF first line! Calcitonin for fast improvement Bisphosphonates for long term Furosemide increases Ca excretion - only use after IVF

The nurse in an outpatient clinic is caring for a client with Addison disease who has been taking hydrocortisone 20 mg daily for the last 8 years. Which client data is most important to report to the health care provider?

Low grade fever - this is important since corticosteroids can cause weakened immune response = infection

An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is c. sleep pattern disturbance related to frequent waking to void.

Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following? a. "I need to shop for foods low in sodium and avoid adding salt to food."

Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.

In normal emergency department triage, which general findings take priority, second priority, and third priority?

Priority: ABCs and VS Second priority: abnormal labs, altered mental status, acute pain, unresolved medical issues Third priority: Chronic issues

Mass casualty disaster triage guiding principle

Provide the greatest good for the greatest number of people.

What color would you take a patient with airway obstruction?

Red

What triage color: Immediately life threatening injuries with potential for good prognosis.

Red / Emergent

These victims are all what triage color: Not breathing but have a pulse (suffocated/ asphyxiated) Open chest wounds Open long-bone fractures Airway obstruction 2nd/3rd degree burns <50% TBSA Shock Incomplete amputations

Red / Immediate / Emergent

Color: Immediate threat to life; do not delay treatment

Red tag

Which is the priority assessment for RN? 1.) Client taking metoprolol with pulse 54/min and BP 154/82 2.) Client w COPD and O2 sat 90 3.) Client w 345 mL gastric residual volume aspirated from a PEG tube before an enteral feed 4.) Client who is receiving IV fluids and has a new S3 heart sound

S3 sound is made when blood from atrium is pumped into noncompliant ventricle and it is a significant finding as it may indicate devolvement of volume overload or heart failure. May quickly progress to life threatening events (resp. compromise, cardiogenic shock). Client may be receiving excess fluids that are causing volume overload

Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)? b. Offer patient hard candies to suck on.

Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.

Weakness Weight loss Nausea and vomiting Hypotension

Suspect adrenal insufficiency If have pigmentation due to increased ACTH then its primary

The nurse is providing education to a pregnant client diagnosed with symptomatic hypothyroidism regarding levothyroxine therapy during pregnancy. Which is appropriate teaching for the nurse to include?

Symptoms should start improving in 4 weeks of starting levothyroxine

A client with primary hypothyroidism has been taking levothyroxine for a year. Laboratory results today show high levels of TSH. Which statement by the nurse to the client is appropriate?

The dosage of levothyroxine may need to be increased since the TSHH levels are high - In primary hypothyroidism, the thyroid does not produce enough hormones (T3, T4). In response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high levels of circulating TSH. Levothyroxine is usually started or increased to lead to a euthyroid (normal) state.

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a. The patient is confused and lethargic.

The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.

The nurse is planning care for a client immediately following a thyroidectomy. Why would the nurse frequently assess for facial or extremity numbness or tingling?

They are signs of hypocalcemia (eg, facial or extremity numbness or tingling, stridor, Trousseau and Chvostek signs), which may occur from parathyroid gland trauma during surgery

serious potentially life threatening emergency when the thyroid gland releases extreme amount of thyroid hormone in response to stress

Thyroid storm any slight indication of thyroid storm has to be identified immediately and treated

Man with history of HTN, anxiety and headaches Undergoes surgical procedure and develops severe tachycardia

Underlying pheochromocytoma The anaesthesia precipitates a catecholamine surge

The nurse evaluates the effectiveness of desmopressin use for diabetes insipidus in a client with a pituitary tumor. Which client assessment finding indicates that the medication is having the desired effect?

Urine output has decreased - Use of desmopressin acetate (DDAVP) in clients with diabetes insipidus will lower urinary output and cause the urine specific gravity to increase.

A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n) b. decreased serum sodium.

When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.

What color would you take a patient who needs treatment within 30 minutes to 2 hours?

Yellow

What color would you take a patient with an open fracture?

Yellow

These victims are all what triage color: Significant damage to cheek bone, eye, and eye socket (no hemorrhage) Large wounds w/o hemorrhage Stable abdominal wounds Closed fracture requiring open reduction

Yellow / Delayed / Urgent

What triage color: Significant injuries requiring treatment within 2-4 hours or loss of life or limb could occur.

Yellow / Urgent

Treatment of hyperthyroidism

antithyroid drugs and or surgical removal of thyroid gland (thyroidectomy)

three main classes of hormones produced by adrenal cortex

glucocorticoids mineralocorticoids androgens

What is exophthalmos, and it is a complication of which disorder?

hyperthyroidism / grave's disease Protrusion of the eyeballs caused by increased orbital tissue (connective, adipose and muscular) expansion and can be irreversible Exposed cornea is at risk for dryness, injury and infection

Name the disorder: tachycardia weight loss increased appetite diarrhea nervousness and irritability heat intolerance diaphoresis exophthalmos

hyperthyroidism / grave's disease think high metabolic rate and tachycardia

Name some s/s of hypothyroidism

low T3 and T4 levels, high TSH levels think low heart rate and decreased metabolism bradycardia weight gain constipation fatigue muscle aches lethargy forgetfulness depression oligo or amenorrhea infertility decreased libido cold intolerance dry and thick skin brittle nails/hair hair loss anemia

severe hypothyroidism causing a decreased LOC may progress to _________ ______

myexdema coma clients with signs of respiratory failure that have hypothyroidism require emergency endotracheal intubation and mechanical ventilation nurse should provide resp. support (ventilation with a bag valve mask) and prepare to assist with intubation

Adrenal Gland Function

releases hormones that help regulate metabolism, blood pressure, immune system, response to stress and other essential functions

7 S's of SIADH

· Stops urination · Sticky and thick urine · Soaked inside · Sodium = Low and Given · Seizures · Severe high blood pressure · Stop all fluids

A client is admitted to the intensive care unit with suspected pheochromocytoma. The client's vital signs are temperature of 99.6 F (37.5 C), blood pressure (BP) of 200/110 mm Hg, heart rate of 110/min, and respirations of 20/min. The client is sweating profusely and reports a severe headache. Which prescription should the nurse implement first? 1. Draw labs to assess electrolyte panel 2. Give acetaminophen 650 mg by mouth as needed for headache 3. Place a fan in the client's room 4. Start nicardipine IV drip

4. Start nicardipine IV drip Pheochromocytoma is a condition caused by a tumor in the adrenal medulla. This results in excess release of catecholamines such as epinephrine and norepinephrine, leading to paroxysmal hypertensive crisis. Important points to note when caring for these clients include the following: 1. Hypertension is difficult to treat and is often resistant to multiple drugs. 2. The client should avoid activities that can precipitate a hypertensive crisis (eg, bending, lifting, Valsalva maneuver). 3. Abdominal palpation should be avoided as manipulation of the adrenal gland and release of catecholamines can precipitate a hypertensive crisis. Hypertensive crisis puts the client at risk for stroke and so has the highest priority for treatment. Nicardipine (Cardene) is a calcium channel blocker and will help to quickly lower BP. (Options 1, 2, and 3) Administration of acetaminophen and use of a fan may help relieve symptoms. Drawing an electrolyte panel is appropriate. However, these are not life-saving interventions and so are not the highest priority.

The nurse in the emergency department is caring for a client recently diagnosed with Graves' disease who was admitted following a motor vehicle accident. The nurse notes the vital signs shown in the exhibit. The nurse alerts the primary health care provider that the client may be experiencing which condition? Vital Signs: increasing temp, BP, HR, and RR 1. Hypertensive crisis 2. Malignant hyperthermia 3. Serotonin syndrome 4. Thyroid storm

4. Thyroid storm Thyroid storm is a life-threatening condition that can occur in uncontrolled hyperthyroidism or Graves' disease when a stressful incident, such as this client's motor vehicle accident, triggers a sudden surge of thyroid hormone. Manifestations of thyroid storm include a rapid onset of fever, tachycardia, and elevated blood pressure. The client often feels anxious, tremulous, or restless. Confusion and psychosis can occur, as can seizures and coma. Rapid treatment is necessary. (Option 1) Hypertensive crisis alone would not cause fever. (Option 2) Malignant hyperthermia would occur in the perioperative setting in response to anesthesia. This client has no risk factors for malignant hyperthermia. (Option 3) Serotonin syndrome would occur in the client taking more than one or an overdose of antidepressant medication that increases serotonin levels. Educational objective: Thyroid storm is a life-threatening complication of Graves' disease (hyperthyroidism). Assessment findings include a rapid increase in temperature, heart rate, and blood pressure in response to stress.

A major disaster involving hundred of victims has occurred, and an emergency nurse is sent to assist with field triage. Which client should the nurse prioritize for transport to the hospital? (and what tag color would you assign to each?) 1. Victim at 15 weeks gestation with new onset spotting and pulse of 90 2. Victim with a compound femoral fracture and and oozing laceration 3. Victim with shallow respirations, a very large blunt force trauma injury to their skull with visible brain matter, and dilated pupils 4. Victim with paradoxical chest movement throughout respirations

4. Victim with paradoxical chest movement ("flail chest") throughout respirations; red "emergent" tag #3 is black #2 is yellow #1 is green Spotting at 15 weeks gestation may indicate complications of pregnancy (including miscarriage).. With stable vital signs, this client would be classified as nonurgent as the fetus is not at the age of viability and there is no evidence of risk to the mother's life.

Addision's Disease

Adrenal deficiency, deficiency in the hormones released by the adrenal gland (cortisol, aldosterone, norepinephrine and epinephrine)

Someone with Graves, what treatment?

B blockers PTU or methimazole Then surgery or radioablation

What triage color: Injuries unlikely to deteriorate within the next day

Green / Minimal / Nonurgent

What is done with black / expectant tagged victims?

Separated from the rest of triaged patients; not abandoned; comfort measures if possible

What should patients taking desmopressin be monitored for?

Their fluid and electrolyte status should be closely monitored for symptoms of water intoxication/hyponatremia (eg, headache, mental status changes, weakness). The nurse should immediately notify the health care provider (HCP) of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death (Option 4).

During care of the patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every 2 hours.

a. The patient with syndrome of inappropriate antidiuretic hormone (SIADH) has marked dilutional hyponatremia and should be monitored for decreased neurologic function and seizures every 2 hours. Sodium intake is supplemented because of the hyponatremia and sodium loss caused by diuretics. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure. A reduction in blood pressure (BP) indicates a reduction in total fluid volume and is an expected outcome of treatment.

The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? b. Decreased urinary output

b. With increased antidiuretic hormone (ADH), the permeability of the renal distal tubules is increased, so water is reabsorbed into circulation. Decreased output of concentrated urine with increased urine osmolality and specific gravity occur. In addition, fluid retention with weight gain, serum hypoosmolality, dilutional hyponatremia, and hypochloremia occur.

Which electrolyte provides: - electrical energy for our nervous system - the means for electrical impulses to travel along the nerves - electrical energy for our muscular system - strength to our skeletal system

calcium

The parenteral form of ______ is 10x stronger than the oral or intranasal forms, so drug dosage must be adjusted when changing routes

desmopressin (DDVAP) used to treat DI

Hormone class made in adrenal medulla and two primary examples thereof

epi and norepi

Pheochromocytoma

pheochromocytoma is a condition caused by a tumor on the adrenal medulla that causes excessive release of catecholamines and paroxysmal hypertensive crisis (systolic BP >180 or diastolic BP>120) patient with a phenochromocytoma should avoid activities that can cause hypertensive crisis (bending, lifting, valsalva maneuver) nurse should not palpate abdomen in a patient with a phenochromocytoma because manual manipulation of the adrenal gland can trigger the release of catecholamines

Name a few s/s of diabetes insipidus

polyuria polydipsia dehydration weight loss hypernatremia high serum osmolality

The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan?

1) Go to the optomitrist yearly to check for cataracts 2) Report even a low grade fever to the HCP immediately 3) Report signs of hyperglycemia including increased urination,hunger, and thirst

During a screening clinic, the nurse performs a health assessment on several adult clients. Which finding by the nurse is most important to report to the primary health care provider? 1. Body mass index (BMI) of 23 kg/m2 2. Round reddened face and fatty hump on back of neck 3. Fasting total cholesterol of 180 mg/dL (4.7 mmol/L) 4. Round 3x3 mm pale pink mole

2. Round reddened face and fatty hump on back of neck (cushing's) everything else is normal

The nurse is triaging victims at the site of a mass casualty incident. Which victims should be seen first? (and what tag color would you assign each?) 1. Victim with head injury and fixed, dilated pupils 2. Victim with open R femur fracture and palpable pedal pulses 3. Victim with full thickness burns covering 85% total body surface area 4. Victim with shallow lacerations over arms and legs

2. Victim with open R femur fracture and palpable pedal pulses; red "emergent" tag #1 and #3 are black "expectant" tags #4 is a green tag

treatment of moderate to severe SIADH includes:

3% NaCl infusion hypertonic solution during the first few hours for clients with markedly decreased serum sodium and severe neurologic manifestation Vasopressin antagonist o Conivaptan (IV) o Tolvaptan (PO) monitor neurologic status seizure precautions daily weights strict fluid intake and output

The nurse practicing in an out-patient clinic cares for a client recently diagnosed with hyperthyroidism. Which diet-related teaching should the nurse add to the client's plan of care? Select all that apply. 1. Emphasize the importance of a low-carbohydrate diet 2. Encourage the client to increase high-fiber foods in the diet 3. Include meals and snacks high in protein content 4. Teach avoidance of caffeine-containing liquids 5. Teach the client about consumption of a high-calorie diet of 4000-5000 calories/day

3, 4, 5 Hyperthyroidism leads to an increased metabolic rate. In clients with hyperthyroidism, teaching and learning objectives to satisfy hunger and prevent weight loss and tissue wasting include: - Adherence to a high calorie diet (4000-5000 calories per day). - Consumption of approximately 6 full meals and snacks per day. These should be packed with protein (1-2 g/kg of ideal body weight), carbohydrates, and be full of vitamins and minerals (Option 1). - Avoidance of high-fiber foods due to the constant hyperstimulation of the gastrointestinal (GI) tract. High-fiber foods may increase GI symptoms (eg, diarrhea) (Option 2). However, high-fiber diets are recommended if the client with hyperthyroidism has constipation. - Avoidance of stimulating substances (eg, caffeinated drinks: coffee, tea, soft drinks). - Avoidance of spicy foods as these can also increase GI stimulation.

The nurse assesses a client who had a thyroidectomy 8 hours ago. The nurse finds the client anxious, with tingling around the mouth and muscle twitching in the right arm. Which action is most important for the nurse to implement first? 1. Change the surgical dressing to assess for bleeding 2. Document the findings in the electronic medical record 3. Draw arterial blood gases 4. Obtain a serum calcium level

4. Obtain a serum calcium level

The nurse is caring for a 72-year-old client with hypothyroidism admitted to the emergency department for altered mental status. The client lives alone but has not taken medications or seen a health care provider for several months. Which action is the priority? Vital Signs: Temperature 95 F (35 C); Blood pressure 90/50 mm Hg; Heart rate 50/min; Respirations 10/min; SaO2 83% 1. Administer IV levothyroxine 2. Check serum TSH, triiodothyronine, and thyroxine 3. Place a warming blanket on the client 4. Prepare to aid in endotracheal intubation

4. Prepare to aid in endotracheal intubation Myxedema coma Clients with signs of respiratory failure (eg, slow or shallow breathing, low oxygen saturation) require emergency endotracheal intubation and mechanical ventilation. The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation (Option 4). (Option 1) Clients with myxedema coma require thyroid hormone replacement with IV levothyroxine to correct the hypothyroid state but only after respiratory status is secured. Improvement in clinical status may not occur for up to a week after initiation of hormone replacement.

The nurse cares for a group of clients on a medical surgical floor. The client with which condition is at highest risk for developing syndrome of inappropriate antidiuretic hormone (SIADH)? 1. Carpal tunnel syndrome 2. Diabetes mellitus 3. Sciatica 4. Small cell lung cancer

4. Small cell lung cancer Some cancer cells, particularly those of small cell lung cancer, have the ability to produce and secrete ADH, leading to SIADH. Other causes include central nervous system disorders (eg, lupus, stroke, trauma, neurosurgery) and some commonly used medications (eg, fluoroquinolones, desmopressin, carbamazepine).

A 23-year-old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? d. Administer subcutaneous DDAVP.

Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.

Adrenal Gland Hormones

Adrenal Cortex hormones: -cortisol (stress hormone) -aldosterone (salt retaining hormone) -androgens (precursor sex hormones) Adrenal Medulla hormones: Catecholamines (norepinephrine and epinephrine)

Two glands located on top of the kidneys

Adrenal Gland

Name the disorder: excessive amounts of antidiuretic hormone is released by the pituitary gland, causing fluid retention and dilutional hyponatremia

Syndrome of inappropriate antidiuretic hormone (SIADH)

The nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus. Which statement by the client is most important for the nurse to report to the health care provider? i know this isn't a complete question, it was imported like this. I'll fix it later, maybe ;)

I've recently started to experience frequent headaches - Clients taking desmopressin for diabetes insipidus are at risk for water intoxication and hyponatremia. - Client reports of headache, mental status change, and/or muscle weakness may indicate hyponatremia from water intoxication and should be reported to the health care provider immediately.

What effect does desmopressin have on urine specific gravity?

If desmopressin therapy is effective, the client's urine specific gravity will be higher due to the urine output decreasing and becoming less dilute.

Color: Major injuries that require treatment; can delay treatment two - four hours.

Yellow tag

A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: a) in the morning to prevent insomnia b) only when the client complains of fatigue and cold intolerance c) at various times during the day to prevent tolerance from occurring d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

a) in the morning to prevent insomnia Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply a) instill isotonic eye drops as necessary b) provide several, small, well-balanced meals c) provide rest periods d) keep environment warm e) encourage frequent visitors and conversation f) weigh the client daily

a, b, c, and f (a) The client with hyperthyroidism may experience exopthalmos. This requires instillation of eye drops to prevent dryness and ulceration of the cornea. (b and f) The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status. (c) The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Urine output measures more than 200 ml/hour. c. Blood pressure is 90/50 mm Hg. d. The heart rate is 126 beats/minute.

a. Fluid intake is less than 2,500 ml/day Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? a. Hypocalcemia b. Hypercalcemia c. Hypokalemia d. Hyperkalemia

a. Hypocalcemia The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in: a. Serum glucose level. b. Hair growth. c. Bone mineralization. d. Menstrual flow.

a. Serum glucose level. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). b. thyroid-stimulating hormone (TSH). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).

a. antidiuretic hormone (ADH). ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin b. furosemide (Lasix). c. regular insulin. d. 10% dextrose.

a. vasopressin (Pitressin Synthetic) Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

Which of the following assessment findings characterize thyroid storm? a) increased body temperature, decreased pulse, and increased blood pressure b) increased body temperature, increased pulse, and increased blood pressure c) increased body temperature, decreased pulse, and decreased blood pressure d) increased body temperature, increased pulse, and decreased blood pressure

b) increased body temperature, increased pulse, and increased blood pressure Thyroid storm is characterized by SNS activation. Thyroid hormones potentiate effects of cathecolamines (epinephrine/norepinephrine). Therefore, all vital signs will be increased.

A client newly diagnosed with Addison's disease is giving a return explanation of teaching done by the primary nurse. Which of the following statements indicates that further teaching is necessary? a. "I need to increase how much I drink each day." b. "I need to weigh myself if I think I am losing or gaining weight." c. "I need to maintain a diet high in sodium and low in potassium." d. "I need to take my medications each day."

b. "I need to weigh myself if I think that I am losing or gaining weight." The client needs to perform daily weights to monitor for signs of dehydration.

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Neck vein distention c. Weight loss d. Polyuria

b. Neck vein distention SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective? b. Increased urine output, increased serum sodium, and decreased urine specific gravity

b. The patient with SIADH has water retention with hyponatremia, decreased urine output, and concentrated urine with high specific gravity. Improvement in the patient's condition is reflected by increased urine output, normalization of serum sodium, and more water in the urine, thus decreasing the specific gravity.

A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences a. increased urine output, decreased serum sodium, and increased urine specific gravity b. increased urine output, increased serum sodium, and decreased urine specific gravity c. decreased urine output, increased serum sodium, and decreased urine specific gravity d. decreased urine output, decreased serum sodium, and increased urine specific gravity

b. increased urine output, increased serum sodium, and decreased urine specific gravity (rationale- the patient with SIADH has water retention with hyponatremia, decreased urine output and concentrated urine with high specific gravity. improvement in the patient's condition reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)

These victims are all what triage color: Agonal breathing (gasping as seen on TV) no pulse fixed / dilated pupils high spinal cord injuries penetrating head trauma wounds involving multiple anatomic sites and organs. 2nd/3rd degree burns in excess of 60% of TBSA. Seizures or vomiting within 24 hours of radiation exposure. Profound shock with multiple injuries

black / expectant

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: a. Hypotension. b. Thick, coarse skin. c. Deposits of adipose tissue in the trunk and dorsocervical area. d. Weight gain in arms and legs.

c. Deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

Which of the following nursing implications is most important in a client being medicated for Addison's disease? a. Administer oral forms of the drug with food to minimize its ulcerogenic effect. b. Monitor capillary blood glucose for hypoglycemia in the diabetic client. c. Instruct the client to never abruptly discontinue the replacement corticosteroid medication. d. Teach the client to consume a diet that is high in potassium, low in sodium, and high in protein.

c. Instruct the client to never abruptly discontinue the medication. The primary medical treatment of Addison's disease is replacement of corticosteroids and mineralcorticoids, accompanied by increased sodium in the diet. The client needs to know the importance of maintaining a diet high is sodium and low in potassium. Medications should never be discontinued abruptly because crisis can ensue. Oral forms of the drug are given with food in Cushing's disease.

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: a. Thyroid storm. b. Cretinism. c. Myxedema coma. d. Hashimoto's thyroiditis.

c. Myexedema coma.

The patient with diabetes insipidus is brought to the emergency department with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were drunk. What is a diagnostic test that the nurse should expect to be done to help make a diagnosis? c. Urine specific gravity

c. Patients with diabetes insipidus (DI) excrete large amounts of urine with a specific gravity of less than 1.005. Blood glucose would be tested to diagnose diabetes mellitus. The serum sodium level is expected to be low with DI but is not diagnostic. To diagnose central DI a water deprivation test is required. Then a CT of the head may be done to determine the cause. Nephrogenic DI is differentiated from central DI with determination of the level of ADH after an analog of ADH is given.

A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a) relief of pain b) signs of renal toxicity c) signs and symptoms of hyperglycemia d) signs and symptoms of hypothyroidism

d) signs and symptoms of hypothyroidism Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

In a patient with central diabetes insipidus, what will the administration of ADH during a water deprivation test result in? d. Increase in urine osmolality

d. A patient with central diabetes insipidus has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatremia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in BP.

Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

Parathyroid Gland location

four small glands located in the neck behind the thyroid gland

Name a few causes of SIADH

he said to know the bold CNS disruption (Lupus/SLE, strokes, etc) malignancies (small cell lung cancer, lymphomas) Overuse of drugs (fluoroquinalone antibiotics, TCAs, desmopressin (DDVAPT), carbamazepine) Pulmonary disorders (pneumonia, pneumothorax)

Addision's disease causes

hypofunction adrenal gland pituitary/hypothalamus impairment long term steroid use SIRS

name some s/s of myxedema coma

hypothermia hypotension macroglossia hypoventilation decreased mental status, seizure, coma

Complications of Addisons Disease

hypovolemia hypotension hypoglycemia lethargy/confusion bronze skin pigmentation

Adrenal crisis

life threatening condition that can lead to shock and should be reported immediately to the HCP severe hypotension severe tachycardia severe hypoglycemia hyponatremia and hyperkalemia severe weakness and confusion n/v dehydration fever