Unit 6

S/sx of Diabetes

3 P'S ◦Being very thirsty (POLYDIPSIA) ◦Urinating often (POLYURIA) ◦Feeling very hungry (POLYPHAGIA) ◦Fatigue ◦Losing weight without trying ◦Having sores that heal slowly ◦Having dry, itchy skin ◦Numbness/tingling in feet (neuropathy) ◦Having blurry vision

A nurse is caring for a patient with diabetes that has a diagnosis of neuropathy. What would the nurse expect the urinalysis report to indicate? a. Albumin b. Bacteria c. Red blood cells d. White blood cells

A

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? a. Blood pressure varying between 120/86 and 240/130 mm Hg b. Heart rate of 56 to 64 bpm c. Shivering d. Reports of nausea

A

A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. Hypokalemia b. Hyperkalemia c. Hyperglycemia d. Hyponatremia

A

The nurse is caring for a patient with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? a. Lower than 50 to 60 mg/dL b. Between 60 and 80 mg/dL c. Between 75 and 95 mg/dL d. 95 mg/dL

A

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will be nurse administer? a. NPH b. Iletin II c. Humalog d. Glargine

A

The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient? a. Symptoms of acute coronary syndrome b. Dietary intake of foods with saturated fats c. Symptoms of pneumonia d. Heat intolerance

A

When the nurse is caring for a patient with diabetes who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/week approximately what should be her daily caloric intake be? a. 1000 calories b. 1200 calories c. 1500 calories d. 1800 calories

A

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? (select all that apply.) a. Leakage of fluid or serum (exudates) b. Microaneurysms c. Focal capillary single closure d. Detachment e. Blurred optic discs

A, B, C

The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What intervention does the nurse prepare to provide to reduce the calcium level? (select all that apply.) a. Administration of calcitonin b. Administration of calcium carbonate c. Intravenous isotonic saline solution in large quantities d. Monitoring the patient for fluid overload e. Administration of a bronchodilator

A, C, D

Which diagnostic test is done to determine a suspected pituitary tumor? a. Computed tomography b. Measuring blood hormone levels c. Radiography of the abdomen d. Radioimmunoassay

A: CT or MRI is used to diagnose the presence and extent of pituitary tumors.

When teaching a client diagnosed with hypothyroidism about medical interventions, which is important for the nurse to communicate? a. TH may increase the effect of digitalis presentation b. TH may decrease blood glucose concentration c. Increased resorption occurs with TH d. Normal dosages of sedative agents are prescribed

A: thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.

Which hormone is secreted by the posterior pituitary? a. Vasopressin b. Calcitonin c. Somatostatin d. Corticosteroids

A: vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.

Abnormalities of Pituitary Glands

Anterior: -excess ACTH causes Cushing syndrome -excess GH causes acromegaly or gigantism -under secretion of GH causes dwarfism Posterior: -deficiency of ADH causes diabetes insipidus

A patient comes to the clinic reporting severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the healthcare provider will provide for diagnosis? a. Complete blood count b. Fluid deprivation test c. Urine specific gravity d. Thyroid stimulating hormone test

B

A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2 degrees F. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? a. Thyroid storm b. Myxedema coma c. Diabetes insipidus d. Syndrome of inappropriate antidiuretic hormone (SIADH)

B

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What condition does the nurse suspect the patient is experiencing? a. Systemic inflammatory response syndrome b. Hyperglycemic hyperosmolar syndrome c. Multiple-organ dysfunction syndrome d. Diabetic ketoacidosis

B

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is the most likely cause of this? a. Thyrotropin b. Iodine c. Thyroxine d. Calcitonin

B

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? a. NPH b. Regular c. Lispro d. Lantus

B

What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? (Select all that apply.) a. A pulse rate slower than 90 bpm b. An elevated systolic blood pressure c. Muscular fatigability d. Weight loss e. Intolerance to cold

B, C, D

A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? a. "Do you experience skin breakouts?" b. "Has your shoe size increased recently?" c. "Have you had a recent head injury?" d. "Is there any family history of acromegaly?"

B: Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.

Cardiac effects of hyperthyroidism include a. Bradycardia b. Palpitations c. Decreased pulse pressure d. Decreased systolic blood pressure

B: cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.

A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to a. Administer an increased dose of neutral protamine Hagedorn Insulin in the evening. b. Check blood glucose at 3:00 a.m. c. Skip the evening neutral protamine Hagedorn insulin dose on days when exercising and skipping meals. d. Eat a complex carbohydrate snack in the evening before bed.

B: in the somogyi effect, the client has a normal or elevated blood glucose concentration at bedtime, which decreases to hypoglycemic levels at 2 to 3 a.m., and subsequently increases as a result of the production of counter-regulatory hormones. It is important to check blood glucose in the early morning hours to detect the initial hypoglycemia.

A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition? a. Undergo a skin graft b. Wear clothing that covers the neck c. Apply medications to remove the scar d. Consider cosmetic surgery

B: the nurse may suggest that the client wear clothing that covers the neck and assures the client that the scar is almost invisible. Application of medication, skin graft, and cosmetic surgery are not appropriate suggestions.

Which type of insulin acts most quickly? a. Regular b. Lispro c. Glargine d. NPH

B: the onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is about 6 hours.

A patient is prescribed desmopressin for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? a. A decrease in blood pressure b. A decrease in blood glucose levels c. A decrease in urine output d. A decrease in appetite

C

The nurse expects that a patient with type 1 diabetes may receive what percentage of the usual morning dose of insulin preoperatively? a. 10% to 20% b. 25% to 40% c. 50% to 60% d. 85% to 90%

C

The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient? a. D5W b. 0.9% normal saline c. 0.45% normal saline d. D5 normal saline

C

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? a. Thiazolidinediones b. Biguanides c. Sulfonylureas d. Alpha-glucosidase inhibitors

C: a functioning pancreas is needed for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

ADH is secreted by which gland? a. Adrenal b. Thyroid c. Posterior pituitary d. Anterior pituitary

C: antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secrets growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.

A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted form which gland? a. Anterior pituitary b. Thyroid c. Posterior pituitary d. Adrenal

C: antidiuretic hormone is secreted by the posterior pituitary gland.

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? a. Start administering oxygen at 2 L/min via a canula. b. Administer a sedative as ordered. c. Administer IV calcium gluconate as ordered. d. Administer an oral calcium supplement as ordered.

C: when hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a. Make sure that the patient is aware that quantity of foods will be limited. b. Ensure that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c. Determine whether the patient is on insulin or taking oral antidiabetic medication d. Review the patient's diet history to identify eating habits, and lifestyle and cultural eating patterns

D

A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? a. 50 pg/mL b. 100 pg/mL c. 100 to 300 pg/mL d. 450 pg/mL

D

Cushing Syndrome

Excessive adrenal cortical activity, high levels of cortisol causes: tumor on adrenal gland or chronic use of corticosteroid medications s/sx: buffalo hump on neck, heavy trunk, thin extremities, altered sleep pattern, weakness, "moon face", females can have masculine features such as dark facial hair and amenorrhea

HYPOPARATHYROIDISM Treatment

Goal to increase serum calcium ◦Calcium gluconate or Calcium chloride—Calcitriol ◦High calcium diet ◦Parathyroid extract ◦Diet high in calcium and vitamin D Corrected total serum calcium concentration is normally 8.5-10.2 mg/dL Synthetic PTH such as nap para is a common name, FDA approved once daily injection for treatment of low blood calcium due to hyperparathyroidism, due to potential risk of osteosarcoma (in animal studies) this drug is only available through restrictive program to people whose calcium levels can not be controlled with calcium and vitamin D supplements and who understand the risk Parathyroid issues not as common as thyroid issues

Posterior Pituitary Gland

Releases: ADH (antidiuretic hormone aka vasopressin): tells kidneys how to manage water in the body, impacts blood pressure Oxytocin: in puberty stimulates breast and uterine hormone production, and induces stretching and contractions of the cervix and uterus during labor, and impacts bonding after childbirth, and induces lactation

Normal thyroid lab levels

T3 normal levels: 80-180 nanograms/dL T4 normal levels: 4.6-12.0 nanograms/dL TSH normal levels: 0.5-6.0 nanograms/dL

THYROID STORM/Crisis

◦Abrupt onset—precipitated by stress-- release or dumping of thyroid hormone- fatal if not treated—don't palpate enlarged thyroid ◦Manifestations: ◦High fever (>101.3 F) ◦Cardiac dysrhythmias (>130 bpm) ◦Neurological impairments (delirium, psychosis, etc) ◦Exaggerated hyperthyroidism signs and symptoms Severe time when have high thyroid hormone level Causes can be hypermetabolic state as well as increase in sympathetic nervous system activity that occurs

Risk Factors for Diabetes

◦Family History ◦Obesity ◦African American, Hispanic, Native American, Asian American, Pacific Islander ◦High blood pressure ◦High cholesterol ◦History of gestational diabetes ◦Low socioeconomic class (cheaper foods are higher in carbs and are more likely processed)

THYMUS

◦Gland produces hormone that stimulates the production of a certain type of white blood cell in the bone marrow—thymocytes ◦Transported by the bloodstream to the thymus--organ "programs" the cells to attack antigens that invade the body and to not attack normal cells in the body itself. ◦Once matured, these T lymphocytes, or T cells, circulate through the bloodstream and collect in the lymph organs — the spleen and lymph nodes — for future use. ◦MS???? MS caused by T cells from thymus, demyelination

Treatment of DKA

◦IV regular insulin drip with hourly blood glucose monitoring ◦Potassium replacement ◦Hydration

HYPOPARATHYROIDISM

◦Inadequate PTH leads to hyperphosphatemia ◦Inadequate PTH leads to hypocalcemia ◦Kidneys ◦Intestines ◦Skeleton ◦Causative factors: ◦Accidental removal during thyroidectomy -most common cause ◦Trauma ◦Atrophy ◦Pseudohypoparathyroidism Decreased absorption of calcium from renal tubules, diet, and bones

HYPERTHYROIDISM--Causes

◦Incidence - More common in women ◦Graves Disease - Second most common endocrine disorder, most common cause of hyperthyroidism—autoimmune disorder ◦Cancer/tumor ◦Exposure to radiation Excessive thyroid hormone Graves is 8 times more prevalent in women than men, autoimmune disorder that leads to antibodies binding to receptors on the surface of cells and stimulate those cells to overproduce and release those hormone this results in an overactive thyroid

Type 2 Diabetes

◦Insulin resistance and some deficiency of insulin production ◦Majority of Diabetes cases ◦Slow progressive glucose intolerance ◦Usually diagnosed in adulthood (>45yr) -seeing an increase in childhood & adolescents d/t childhood obesity and processed foods.

THYROIDECTOMY

◦Nursing Care: ◦Maintain a patent airway -- why??? ◦Prevent strain on suture line ◦Assess for potential complications ◦Respiratory distress (Edema) ◦Hemorrhage ◦Laryngeal nerve injury (Difficulty speaking and swallowing) ◦Hypocalcemia ◦Infection ◦Thyroid storm To remove goiter, at risk of airway problems May intubate because need to protect airway especially because of where surgery is happening Neck is very vascular area

Diabetic Teaching

◦S/S hyper and hypoglycemia + DKA + insulin reaction ◦Oral and/or insulin administration—when/how to take (pump care if appropriate) ◦How to do finger sticks and ketone dip sticks ◦Sick day medication administration ◦Exercise and stress ◦Food intake/meal planning ◦Skin/Foot care ◦Lab interpretation—A1C , electrolytes ◦How and where to get supplies (syringes, glucose strips) ◦Need for physician follow up regarding complications (frequent eye and dental exams, neurologist, nephrologist, cardiologist) ◦Other—storage of meds, safety with needles, when to call physician, medical bracelet Can't do all at once

Diabetes insipidus

◦deficiency of ADH (vasopressin) excretion. ◦Causes: head trauma, infection, failure of renal tubules, r/t medications such as lithium ◦Signs and symptoms: 1. Polydipsia-2-20 L/day 2. Large amounts of very dilute water colored urine- > 250 mL/hour (6000 mL/day) specific gravity 1.001-1.005 (low) ◦Treatment: Replace ADH with Desmopressin (synthetic ADH) given intranasally every 12-24 hours , ensure fluid replacement (I & O), weights

A patient has been taking tricyclic antidepressants for years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? (Select all that apply.) a. Strict intake and output b. Neurologic function c. Urine and blood chemistry d. Liver function tests e. Signs of dehydration

A, B, C

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? a. Hypoglycemia b. Blurred vision c. Polyuria d. Polydipsia

A: the nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.

Long-term use of antithyroid medication is not generally recommended for elderly clients because of which events? a. Gastrointestinal complications and weight loss b. Agranulocytosis and hepatic injury c. Cardiac arrythmias and fatigue d. Renal disease and mental confusion

B: long-term use of certain and antithyroid medications, such as propylthiouracil (PTU), is not recommended for treatment of toxic nodular goiter in older clients because of the risk of side effects. Although rare, evidence indicates that PTU can result in agranulocytosis and hepatic injury. However, use of antithyroid medications versus radioactive iodine or surgery may be the client's preferred choice or the option for some older clients and other ill clients with "limited longevity" who can be monitored at least every 3 months.

HYPERTHYROIDISMTreatment

Medical mgmt—goal decrease s/s: ◦Inhibit synthesis of thyroid hormones: ◦Radioactive Iodine (I 131) Tx of choice ◦Not in pregnant women and for 6 months after tx ◦Radioactive precautions at home (review pt teaching) ◦Control symptoms -beta blockers (olol) Purpose ?????? ◦Meds: (review p. 1481 for nursing considerations) Propylthiouracil (PTU) block T4 to T3 Methimazole (Tapazole) same Propranolol (Inderal) ◦Surgery—subtotal thyroidectomy-(partial) --watch for tetany, muscle twitching and spasms—result of hypocalcemia Loss of taste and dry mouth due to salivary gland damage may be seen when we give this treatment Beta blockers: to decrease BP and HR, decrease nervousness and heat intolerance PTU: interferes with synthesis of T3 and T4 in thyroid gland and conversion of T4 to T3 in target tissues, can take several days up to 12 weeks for therapeutic effects, onset can happen with 30-40 minutes, med duration is 2-4 hours so will need to take several times a day, want to make sure taken with meals to avoid GI upset, monitor T3 and T4 and TSH, and monitor for s/sx of hypothyroidism

HYPOPARATHYROIDISM Nursing Care

Priority Diagnoses: ◦Risk for injury: tetany R/T decreased calcium ◦Goal: Prevent tetany ◦Assess response to treatment. ◦Teach signs/symptoms to report, diet and ◦Medications. Diet high in calcium Take meds same time every day

Anterior Pituitary Gland

Secretes: FSH (follicle stimulating hormone): contributes to menstrual cycle, egg production by ovaries, and testosterone levels in men LH (luteinizing hormone): triggers estrogen and progesterone production, affecting menstrual cycle and ovulation in women, affects testosterone and sperm production in men Prolactin: stimulates milk production ACTH adrenocorticotrophic hormone): stimulates release of cortisol levels from the adrenal glands affecting metabolism and blood pressure TSH (thyroid stimulating hormone): affects thyroid stimulation and metabolism GH (growth hormone aka somatotropin): impacts rate of body growth throughout our body

ADRENAL GLANDS

◦Secrete steroid hormones, such as: ◦Glucocorticoids ◦Mineralocortoids ◦Androgens (males sex hormone) The function of the adrenal glands are necessary for life. Without these steroids the peripheral circulatory system would collapse. Adrenal glands help the body adapt to stress Glucocorticoids help with glucose metabolism which affects all metabolism Mineralocortoids talking about electrolyte imbalances and metabolism Androgens talking about testosterone as well as estrogen, excess in women increases masculinization, excess in men feminization such as gynecomastia, excess in children can lead to preterm sexual development

HYPERPARATHYROIDISM Treatments

◦Surgical Intervention ◦Mild exercise ◦Diet: avoid excess calcium intake ◦Other Support Measures ◦Walker or wheelchair for mobility ◦Brace for support ◦Increased fluids (>2000 ml a day) ◦Constipation treatment ◦Adenoma - Tumor Excision ◦Adenocarcinoma - Total Parathyroidectomy ◦Observe for: ◦Tetany (muscle hypertonia, tremor, contractions- involuntary) ◦Dyspnea (shortness of breath) ◦Voice change ◦Hemorrhage ◦Hyperplasia - Removal of the cause and/or ◦surgery Surgery to remove tumor Increased fluid to help excrete the extra calcium Give fluids and stool softeners Adenoma is usually benign Adenocarcinoma is usually malignant Hyperplasia has abnormal cells in that area, need to remove them

Assessing for Diabetes

◦Symptoms ◦A1C --target A1C is less than 7. Without diabetes, normal range 4% and 5.6% Between 5.7% and 6.4% increased risk of diabetes Levels of 6.5% or higher indicate diabetes. ◦ ◦Fasting serum blood glucose ◦Blood Glucose Levels-before meals & bedtime ◦Urine Ketones Less than & keeping fairly compliant ACHS

Endocrine A&P

◦The Endocrine System involves the release of chemical substances known as hormones that regulate and integrate the body functions and metabolic activities—act on local or target sites. ◦The hormones are produced by the endocrine glands—work closely with nervous system—amount needed depends on body's needs ◦Negative feedback system—increased concentration, decreased production Endocrine system is impacted on cellular interaction, both metabolism and growth Hormones work with the nervous system as neurotransmitters Negative feedback system helps maintain levels and homeostasis: if detects low levels will increase production and if elevated levels detected will stop production Most endocrine disorders are either hypo- or hyper- functioning

Testes

◦The FSH and LH stimulate hormone production from the testes: ◦Testosterone

Ovaries

◦The FSH and LH stimulates hormone production in the ovaries: ◦Estrogen (from ovary) ◦Progesterone (from corpus lutem) - helps maintain pregnancy

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. Hypoglycemia b. Hyponatremia c. Ketonuria d. Polyphagia

A

When thyroid hormone is administered for prolonger hypothyroidism for a patient, what should the nurse monitor for? a. Angina b. Depression c. Mental confusion d. Hypoglycemia

A

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? (select all that apply.) a. May improve blood glucose levels b. Decrease the need for exogenous insulin c. Help reduce cholesterol levels d. May reduce postprandial glucose levels e. Increase potassium levels

A, B, C

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.) a. Acetaminophen b. Iodine c. Propylthiouracil d. Synthetic levothyroxine e. Dexamethasone

A, B, C

A patient is diagnosed with type I diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) a. Ketosis prone b. Little endogenous insulin c. Obesity at diagnoses d. Younger than 30 years of age e. Older than 65 years of age

A, B, D

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? a. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." b. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." c. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." d. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid."

A: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to breakdown stored fat for energy.

Which is a complication of hyperthyroidism? a. Hypothyroidism b. Acromegaly c. Myxedema coma d. Addisonian crisis

A: a potential complication of hyperthyroidism is hypothyroidism. Myxedema coma is a complication of hypothyroidism. Addisonian crisis is a complication of Addison disease. Acromegaly occurs with excess growth hormone.

Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? a. Hand flexing inward b. Cardiac dysrhythmia c. Bulging forehead d. Moon face and buffalo hump

A: carpopedal spam is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing's syndrome. A bulging forehead is a symptom of acromegaly.

Which would be including in the teaching plan for a client diagnosed with diabetes mellitus? a. An elevated glucose concentration contributes to complications of diabetes, such as diminished vision. b. The only diet change needed in the treatment of diabetes is to stop eating sugar. c. Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. d. Sugar is found only in dessert foods.

A: diabetic retinopathy is the leading cause of blindness among people between 20 and 74 years of age in the United States; it occurs in both type 1 and type 2 diabetes. When blood glucose is well controlled, the potential for complications of diabetes is reduced. Several types of foods contain sugar, including cereals, sauces, salad dressings, fruits, and fruit juices. It is not feasible, nor advisable, to remove all sources of sugar from the diet. If the diabetes has been well controlled without insulin before the period of acute stress causing the need for insulin, the client may be able to resume previous methods for control of diabetes when the stress is resolved.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? a. 3 months b. 6 months c. 1 month d. 9 months

A: glycosylated hemoglobin is a blood test that reflects average blood glucose concentration over a period of 3 months.

A client is admitted with diabetic keto acidosis (DKA). which order from the physician should the nurse implement first? a. Infuse 0.9% normal saline solution 1 L/HR for two hours. b. Administer regular insulin 000 U IV push. c. Administer sodium bicarbonate 50 mEq IV push. d. Start an infusion of regular insulin at 50 U/HR.

A: in addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. In dehydrated clients, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 L/hr for 2-3 hours.

Once digested, what percentage of carbohydrates is converted to glucose? a. 100 b. 70 c. 90 d. 80

A: once digested, 100% of carbohydrates are converted to glucose, however, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration.

Which symptom of thyroid disease is seen in older adults? a. Atrial fibrillation b. Restlessness c. Weight gain d. Hyperactivity

A: symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.

Which disorder results from excessive secretion of somatropin (growth hormone)? a. Acromegaly b. Cretinism c. Adrenogenital syndrome d. Dwarfism

A: the client with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, and feet. Cretinism occurs as a result of congenital hypothyroidism. Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.

A client with type 1 diabetes is experiencing polyphagia. The nurse knows to asses for which additional clinical manifestation(s) associated with this classic symptom? a. Altered mental state b. Muscle wasting and tissue loss c. Dehydration d. Weight gain

B: Polyphagia results from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats. Although clients with type 1 diabetes may experience polyphagia (increased hunger), they may also exhibit muscle wasting, subcutaneous tissue loss, and weight loss due to impaired glucose and protein metabolism and impaired fatty acid storage.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? a. When mixing insulin, the regular insulin is drawn up into the syringe first. b. When mixing insulin, the NPH insulin is drawn up into the syringe first. c. There is no need to inject air into the bottle of insulin before withdrawing the insulin. d. If wo different types of insulin are ordered, they need to be given in separate injections.

A: when rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin the drawn up first. The most important issues are the patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse of the desire to stop taking then because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? a. The symptoms are permanent side effects of the corticosteroid therapy b. The moon face and acne will resolve when the medication is tapered off c. Those symptoms are not related to the corticosteroid therapy d. The dose of the medication must be too high and should be lowered

B

Trousseau is elicited a. By tapping sharply over the facial nerve just in front of the parotid glans and anterior to the ear, causing spasm or twitching of the mouth, nose, and eye. b. By occluding the flow of the arm for 3 minutes with the use of a blood pressure cuff. c. After making a clenched first and opening the hand; the palm remains blanched when pressure is placed over the radial artery. d. When the foot is dorsiflexed and there is pain in the calf.

B: a positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client? a. "it does not matter what time of day I take this medication." b. "I will take this medication in the morning, with my first bite of breakfast." c. "I will take this medication in the morning, fifteen minutes before breakfast." d. "this medication needs to be taken after the midday meal."

B: alpha-glucosidase inhibitors such as acarbose and miglitol, delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation. They must be taken with the first bite of food to be effective.

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? a. Hypertonicity b. Low blood glucose concentration c. Allergic reactions d. Polyuria

B: client who switch from animal to synthesized human insulin should initially be monitored for low blood glucose concentrations because the human form of insulin is used more effectively. Human insulin causes fewer allergic reactions than insulin obtained from animal sources. Polyuria and hypertonicity are symptoms of diabetes mellitus.

Which age-related change may affect diabetes and its management? a. Hypotension b. Decreased renal function c. Increased bowel motility d. Increased thirst

B: decreased renal function affects the management of diabetes. With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys, and changes in insulin clearance occur with decreased renal function. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.

Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of a sudden withdraw of excessive amounts of catecholamines? a. Hyporeflexia b. Hypoglycemia c. Hyperglycemia d. Hypertension

B: hypotension and hypoglycemia may occur in the postoperative period because of the sudden withdraw of excessive amounts of catecholamines. Hypertension and hyporeflexia are not related to the sudden withdrawal of excessive amounts of catecholamines.

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on the diagnosis, the nurse expects which change to the client's medication regimen? a. Increasing morning dose of long-acting insulin. b. Administering a dose of intermediate-acting insulin before the evening meal. c. Changing the time of evening injection of intermediate-acting insulin from dinner time to bedtime. d. Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack.

B: insulin waning is a progressive rise in blood glucose from bedtime to morning. Treatment includes increasing the evening (before dinner or bedtime) dose of intermediate-acting or long-acting insulin or instituting a dose of insulin before the evening meal if that is not already part of the treatment regimen.

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? a. How to self-inject insulin b. How to control blood glucose through lifestyle modification with diet and exercise c. How to recognize signs of diabetic ketoacidosis d. How to monitor ketones daily

B: persons at high risk for type 2 diabetes receives standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on reducing weight by more than 7% of initially body weight and moderate-intensity physical activity. It also includes behavior modification strategies designed to help clients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk of diabetes.

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state. "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? a. "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." b. "Your body is using protein and fat for energy instead of glucose." c. "I will refer you to a dietician who can help you with your weight." d. "You may be having undiagnosed infections, causing you to lose extra weight."

B: persons with type 1 diabetes, particularly those in poor control of the condition, tend to be think because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be under-weight at the onset of type 1 diabetes because of rapid weight loss from sever hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

Which is a clinical manifestation of diabetes insipidus? a. Low urine output b. Excessive thirst c. Excessive activities d. Weight gain

B: urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? a. Carbohydrate intake b. Weight loss c. Protein metabolism d. Blood glucose level

B: weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency on the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? a. "Can you describe the amount of stress in your life?" b. "Do you experience fatigue even if you have slept a long time?" c. "Do you have to get up at night to empty your bladder?" d. "Have you experienced any headaches or sinus problems?"

B: with the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.

Thyroid Gland

Butterfly shaped gland in throat Releases the following hormones: ◦Secretes T3 (triiodothyronine) and ◦T4 (thyroxine) (thyroid hormones) ◦Calcitonin (thyrocalcitonin) (secreted in response to increased plasma calcium levels, helps calcium by increasing deposits into the bones) ◦Thyroglobulin (precursor for T3 & T4) (helps transport T3 and T4 into the blood stream) ◦Iodine is essential for hormone synthesis—salt (absorbed through GI tract through diet intake of salt) ◦Calcitonin—calcium regulation—decreases serum Ca++-- deposits calcium in bone--affects bone density ◦Main function is to control metabolic activity and ensure normal growth (T3 strong and T4 weak) —affects every cell in the body- helps the body use energy—TSH regulates T3 and T4 ◦Thyroid disorders can slow down or speed up metabolism by disrupting the production of thyroid hormones. If brain detects low T3 T4 it should be an increased in TSH production from anterior pituitary T3 is five times more potent than T4, has more rapid metabolic action T4 maintains body metabolism at a steady rate An unexplained change in weight is one of the most common signs of a thyroid disorder. Weight gain may signal low levels of thyroid hormones If the thyroid produces more hormones than the body needs, weight loss may occur unexpectedly.

An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? a. A faulty heater b. Autonomic neuropathy c. Peripheral neuropathy d. Sudomotor neuropathy

C

The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? a. The patient may have hypothyroidism b. The patient may have thyroiditis c. The patient may have hyperthyroidism d. The patient may have Cushing disease

C

Antithyroid medications are not generally recommended for elderly patients because of which side effect? a. Mental confusion b. Weight loss c. Granulocytopenia d. Fatigue

C: antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? a. The client has not been exercising. b. The client has not complied with the prescribed treatment regimen. c. The client has not eaten but continues to take insulin or oral antidiabetic medications. d. The client has eaten but has not taken or received insulin.

C: hypoglycemia occurs when a client with diabetes is not eating and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the client has not been compliant with the prescribed treatment regimen. If the client has eaten and has not taken or received insulin, diabetic ketoacidosis is more likely to develop.

A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror. Which statement by the nurse is the best response? a. "I can show you how to change your style of dress so that the changes are not so noticeable." b. "I do not think you look bad and I am sure our family loves you very much." c. "If treated successfully, the major physical changes will disappear with time." d. "I can refer you to a support group. Talking to someone may help you feel better."

C: if treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationship with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.

Which clinical characteristic is associated with type 1 diabetes? a. Obesity b. Requirement for oral hypoglycemic agents c. Presence of islet cell antibodies d. Rare ketosis

C: individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? a. Cholesterol b. Hemoglobin c. Ketones d. Creatinine

C: ketones are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not by-products of fat breakdown.

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? a. 3 hours b. 30 to 40 minutes c. 10 to 15 minutes d. 1 to 2 hours

C: the onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.

A client visits the client to seek treatment for disturbed sleep cycle and depressed mood. Which glands and hormones help to regulate sleep cycles and moods? a. Adrenal cortex, corticosteroids b. Parathyroid glands, parathormone c. Pineal gland, melatonin d. Thymus gland, thymosin

C: the pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secrets thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.

A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on which statement by the client? a. "For dinner I ate 2 ounces of sliced turkey, 1 cup mashed potatoes, half a cup of carrots, half a cup of peas, a 3-ounce dinner roll, 1 medium banana, and a diet soda." b. "For dinner I ate 2 cups of cooked pasta with 3-ounces of boiled shrimp, 1 cup plum tomatoes, half a cup of peas in garlic-wine sauce, 2 cups fresh strawberries, and ice water with lemon." c. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." d. "For dinner I ate 4-ounces of sliced roast beef on a bagel with lettuce, tomato, and onion; 1-ounce low-fat cheese; 1 tablespoon mayonnaise; 1 cup fresh strawberry shortcake; and unsweetened iced tea."

C: there are six main exchange lists: bread/starch, vegetable, milk, meat, fruit, and fat. Foods within one group (in the portion amounts specified) contain equal numbers of calories and are approximately equal in grams of protein, fat, and carbohydrate. Meal plans can be based on a recommended number of choices from each exchange list. Foods on one list may be interchanged with one another, allowing for variety while maintaining as much consistency as possible in the nutrient content of foods eaten. For example, 2 starch = 2 slices of bread or a hamburger bun, 3 meat = 3 oz lean beef patty, 1 vegetable = green salad, 1 fat = 1 tbsp salad dressing, 1 fruit = 1 cup watermelon; "free" items like diet soda are optional.

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? a. Heart rate of 62 b. Blood pressure 90/58 mm Hg c. Oxygen saturation of 96% d. Temperature of 102-degree F

D

The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What differences does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? a. "Eating the fruit is more satisfying than drinking the juice. You will get fuller faster." b. "Eating the fruit will give you more vitamins and minerals than the juice will." c. "The fruit has less sugar than the juice." d. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

D

What breakfast items would the nurse recommend when assisting with the breakfast menu for a patient with hyperthyroidism? a. Cereal with milk and bananas b. Fried eggs and bacon c. Orange juice and toast d. Pork sausage and cranberry juice

D

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? a. Between 4:00 and 6:00 p.m. b. Between 8:00 and 10:00 a.m. c. Between 7:00 and 9:00 p.m. d. This insulin has no peak action and does not cause a hypoglycemic reaction.

D: "peakless" basal or very long-acting insulins are approved by the US Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24-hours and can be given once a day. It has no peak action.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? a. Assess the client's ability to move all extremities. b. Assess for excessive sweating. c. Assess the client's ability to take a deep breath. d. Assess the client's breath odor.

D: DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacidosis. Checking the client's breath will help the nurse confirm the diagnosis.

Which statement is true regarding gestational diabetes? a. There is a low risk for prenatal complications. b. It occurs in the majority of pregnancies. c. Onset usually occurs in the first trimester. d. A glucose challenge test should be performed between 24 to 28 weeks.

D: all women of average risk should undergo a glucose challenge test between 24 to 28 weeks of gestation. It occurs in 2% to 5% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for prenatal complications.

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? a. Draw up the drug first, then add regular insulin. b. Administer the total daily dosage in 2 doses. c. Glargine is rapidly absorbed and has a fast onset of action. d. Do not mix with other insulins.

D: because glargine is a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin, it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

Dilutional hyponatremia occurs in which disorder? a. Pheochromocytoma b. Diabetes insipidus c. Addison disease d. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

D: clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

Which assessment is done by the nurse when conducting a physical examination? a. Palpate he thyroid gland repeatedly b. Examine outstretched hands for skin breaks c. Determine the client's ability to participate in the assessment d. Examine the shape and color of the nails

D: during physical examination, the nurse examines the shape and color of the nails and determines whether they are thin, thick, or brittle. The outstretched hands should be examined for tremors. Repeated palpitation of the thyroid gland may have serious implications.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? a. Glucose via a urine dipstick test b. Glucose via an oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level

D: glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to the hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.

Which clinical characteristic is associated with type 2 diabetes? a. Client is prone to ketosis b. Client demonstrate islet cell antibodies c. Client is usually thin at diagnosis d. Blood glucose can be controlled through diet and exercise

D: oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.

While the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. What is the nurse's most appropriate response? a. Palpate the thyroid gland b. Inquire about frequent urination c. Consult the institution's procedure manual d. Document the allergy and inform the physician

D: recording the health history is an important step in the diagnosis of endocrine disorders. The nurse documents an allergy to iodine, a compound of contrast dyes and seafood, and informs the physician. Repeated or forceful palpitation of the thyroid in the case of thyroid hyperactivity can result in sudden release of thyroid hormones, which may have serious implications. Consulting the institution's procedural manual and inquiring about frequent urination are nor immediate follow-up actions.

The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to a. Watch for symptoms of hyperthyroidism to disappear within 1 week. b. Continue radioactive precautions with all body secretions. c. Discontinue all antithyroid medications. d. Monitor for symptoms of hypothyroidism.

D: symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? a. Avoid the abdomen because the absorption there is irregular. b. Rotate sites from area to area every other day. c. Choose a different site at random for each injection. d. Use all available injection sites within one are.

D: systemic rotation of injection sites within an anatomic area is recommended to prevent localized changes in fatty tissue. To promote consistency in insulin absorption, the client should be encouraged to use all available injection sites within one area rather than randomly rotating sites from area to area.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? a. Numbness b. Dizziness c. Increased hunger d. Fatigue

D: the classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a. Hashimoto disease b. Addison disease c. Graves disease d. Cushing syndrome

D: the client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the over secretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.

A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? a. Refer the client to professional counseling. b. Encourage the client to participate in outside activities to boost coping strategies. c. Suggest that the client wear cosmetics to cover any changes in appearances. d. Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment.

D: the client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and the with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.

A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? a. Increased oxytocin b. A deficient amount of somatostatin c. Increased antidiuretic hormone d. Deficient production of vasopressin

D: the most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? a. Altered glucose metabolism b. Rare ketosis c. Obesity d. Presence of autoantibodies against islet cells

D: there is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.

Hypophysectomy is the treatment of choice for which endocrine disorder? a. Pheochromocytoma b. Hyperthyroidism c. Acromegaly d. Cushing syndrome

D: transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.

S/sx of DKA

Early symptoms ◦Thirst or a very dry mouth ◦ Frequent urination ◦ High blood glucose ◦ High levels of ketones in the urine Late symptoms: ◦Constantly feeling tired ◦ Dry or flushed skin ◦ Nausea, vomiting, or abdominal pain ◦ Difficulty breathing ◦Fruity odor on breath ◦A hard time paying attention, or confusion ◦Coma/death

HYPERPARATHYROIDISM

Increased secretion of PTH leads to increased calcium absorption from kidney, intestine and bone-- raises serum calcium, characterized by bone decalcification and development of renal calculi (kidney stones). ◦Etiology: ◦Primary: Enlargement of parathyroid glands, or tumor ◦Secondary hyperparathyroidism ◦Conditions that cause decreased calcium levels -renal disease, stimulate parathyroid gland-over time can develop into hyperparathyroidism 100,000 in US develop primary hyperparathyroidism every year Diagnosed most commonly 50-60 Women affected 3 times more than men 80% of time caused by benign tumors

THYROID STORM TREATMENT

Management of Symptoms: Reduce body temperature (drop fever, no salicylates given - primarily aspirin) Provide oxygen (oxygen to tissues) IV fluids (dextrose to replace glucose) PTU or methimazole (stop thyroid hormone production) Hydrocortisone (treat renal insufficiency) Iodine (decrease the output of T4 from thyroid gland)

Thyroid diagnostic tests

Serum blood testing is most common: ◦TSH - Differentiates between disease of the pituitary and disease of the thyroid. (TSH regulates T3 and T4) ◦Serum T3 & T4 (T3 more accurate indicator of hyperthyroidism) ◦Thyroglobulin ◦Radioactive Iodine Uptake Scan - radioactive iodine is injected and the scintillation counter monitors how much iodine is absorbed by the thyroid gland. ◦Fine Needle Aspiration- small gauge needle inserted into thyroid gland (nodule) for biopsy. ◦Thyroid Scan- gamma camera moves across scanned area to monitor 'hot' or 'cold' nodules on thyroid after isotopes are introduced to patient (thallium most common) Small gauge = 25 G or higher number gauge On physical assessment we want to look at neck, look for: mass/goiter/enlargement, asymmetry Radioactive iodine uptake scan worry about for hyperthyroidism, positive is usually high uptake, for hypothyroidism is low uptake, iodine is needed for hormone synthesis if that's the case Fine needle aspiration test tissue looking for malignancy, hyperplasia of those cells Thyroid scan were looking at size and shape of thyroid nodules, hot areas may indicate increased function, cold areas may indicate low function, can be used to identify tumors in attempt at differentiating between benign or malignant, some studies suggest malignant nodules are hot while benign nodules are cold

Gigantism/acromegaly

excess of GH gigantism = greater than 8 feet tall in children acromegaly = increased in growth of body parts (such as bones, chin, nose, forehead, hands, feet) in adults due to pituitary tumor creating the over production of GH, can cause headache or vision changes

Dwarfism

underproduction of GH Possibly linked to gene mutation under 4'10" in adulthood

HYPOTHYROIDISM Nursing Diagnoses

◦Activity intolerance ◦Alteration in body temperature regulation ◦Ineffective breathing pattern ◦Alteration in thought process ◦Alteration in elimination; constipation ◦Alteration in skin integrity ◦Risk for cardiac complications ◦Knowledge deficit

Oral Antidiabetic Agents

◦Alpha-Glucosidase Inhibitors: Precose, Glyset ◦*Biguanides- Metformin (Glucophage), only drug in this class ◦Incretin enhancers: Victoza (injectable), Tradjenta, Januvia ◦Meglitinides: Prandin and Starlix ◦*Sulfonylureas (first & second generation)-second gen use more d/t less drug interactions: Glipizide, glyburide, glimepiride ◦Thiazolinediones: Actos, Avandia

Type 1 Diabetes

◦Autoimmune destruction of beta cells in pancreas. ◦Absence of insulin production ◦Strong Genetic Predisposition ◦Usually diagnosed in children/young adults ◦Approximately only 5% of diabetic cases* ◦Insulin Dependent ◦Higher risk for DKA

THyroid Tumor

◦Benign or malignant ◦Called goiter if large enough to cause swelling in neck Iodine deficient—most common type

Pituitary Gland

◦Commonly known as the 'master gland' because it influences the secretions of hormones from other endocrine glands—pea sized ◦Divided into two sections: Anterior and Posterior ◦Controlled by hypothalamus of the brain

HYPERTHYROIDISM Nursing Diagnoses

◦Decreased cardiac output ◦Alteration in body temperature regulation ◦Activity intolerance ◦Ineffective coping ◦Alteration in nutrition ◦Risk of injury

HYPERPARATHYROIDISM Diagnosis

◦Elevated calcium; Decreased phosphorus ◦Sulkowitch test (urine test to measure Ca+ excreted) ◦Skeletal X-rays (monitor for Ca+ in bones) ◦EKG (cardiac dysrhythmias) ◦Ultrasound ◦MRI ◦Biopsy PTH normal levels: 10-65 X-ray look for bone demineralization Imaging evaluates parathyroid and were looking for masses

HYPOTHYROIDISM COMPLICATIONS

◦Hashimoto's thyroiditis- low levels of thyroid hormones due to autoimmune disorder and thyroid nodules may be present. Patient will present with hypothyroid s/s that may be exaggerated. ◦Myxedema- extremely low levels of thyroid hormones and may be life threatening event. Respiratory depression leading to alveolar hypoventilation and carbon dioxide retention, necrosis and then coma will follow. All will result in cardiovascular collapse - if untreated. ◦ **Treat with IV infusion of thyroid hormone to maintain metabolic activity.** Can be caused by abruptly stopping of thyroid replacement medication (due to cost, surgery/procedure needing or thinking they need to hold) Start with depression or lethargy to changes of cognitive status, then develop respiratory depression then coma to cardiac arrest, Myxedema has 30-40% mortality rate

Nutrition for Diabetes

◦Healthy Carbs ◦High Fiber ◦"good" fats

HYPOPARATHYROIDISM Signs/Symptoms

◦Hypocalcemia leads to irritability of neuromuscular system ◦Tetany (involuntary muscle contractions)—most common symptom ◦Carpopedal spasm ◦ + Trousseau's sign (test by occluding blood flow to arm) ◦ + Chvostek's sign (tapping of the face of nerve causes pain, twitch) ◦Numbness and tingling of extremities ◦Spontaneous tonic contractures ◦Laryngospasm and/or Bronchospasm ◦Prolonged QT interval

HYPOTHYROIDISM

◦Incidence; more common in women age 30-60 ◦Mild to severe decrease in thyroid hormone ◦Primary hypothyroidism - 95% of cases ◦Hashimoto's thyroiditis-- develops with tenderness of thyroid with palpation ◦Secondary hypothyroidism ◦Pituitary disorder Primary is thyroid gland Hashimoto's is an autoimmune disorder where the immune system attacks the thyroid gland, is most common cause of hypothyroidism in US Secondary is due to lack of TSH production in the pituitary s/sx: ◦Fatigue-- common ◦Hypothermia (easily chilled) ◦Decreased heart rate and respirations ◦Decreased mental acuity/irritability (can't make sense of thoughts) ◦Dry skin, brittle nails & hair loss (alopecia) ◦Numbness & tingling of extremities ◦Menstrual irregularities ◦Constipation (abnormal stool pattern) ◦Slowed reflexes and speech ◦Weight gain ◦Flat affect—puffy face ◦Diagnosis made by lab results of: - Decreased T3 & T4

Patho of Diabetes

◦Insulin=hormone secreted by beta cells in pancreas. ◦After eating insulin is secreted and moves glucose from blood into muscle, liver and fat cells. ◦Responsible for metabolizing glucose for energy, storing glucose in liver & muscle, and signals to stop release of glucose.

PARATHYROID Anatomy/Physiology

◦Location and Size: 4 small glands posterior to the thyroid ◦Function: Regulates calcium and phosphorus ◦Excretes Parathormone (PTH) ◦Maintenance of normal phosphorus levels (2.4-4.1 mg/dL) ◦Maintenance of normal calcium levels (9-11mg/dL) ◦Role of Calcium Role of calcium is for bone health PTH increases calcium and raises calcium levels

Diabetes Management

◦Medication ◦Nutrition ◦Exercise ◦Skin Care ◦Preventative management-routine eye and dental care ◦Routine follow up with PCP Nutrition: low carb, carb count, 45-60 carbs per meal Skin care: check feet for skin breakdown, risk of infection (osteomyelitis, leads to amputation)

Definition of Diabetes

◦Metabolic disorder characterized by elevated glucose levels in the body ◦3 kinds Type 1 Type 2 Gestational

Insulin Administration

◦Needles, lancets and how to dispose ◦SQ injection-syringe vs. pen ◦Self dosing pumps ◦Medication storage Store in refrigerator Self dosing pump based off carbs

THRYOID TESTING PATIENT EDUCATION

◦Obtain a medication history from the patient—allergic to iodine, contrast dye, shellfish??? ◦Avoid any medications with iodine prior to testing (review p. 1473 and table 52-2). ◦Consent will need to obtained for diagnostic scanning procedures ◦IV access will be required for scanning due to injection of isotopes, etc. ◦Need precautions after test if radioactive isotope is injected Recommend IV at AC with 20G because it is best, largest IV location, need to make sure will work Precautions after test because will be radioactive after Shellfish allergy do not necessarily put patient at risk for iodine allergy, shellfish do contain iodine, but thought allergy caused by tropomyosin but still a consideration Amiodarone contains iodine Precautions: excretions will be contaminated with radioactive isotopes, need to be in place for 24-48 hours if sent home or in hospital ,avoid contact with pregnant women and young children, do not breastfeed, recommend to get pregnant for 6 months due to ovarian exposure to radiation

HYPERPARATHYROIDISM Signs & Symptoms

◦Over half of pts have no symptoms ◦General—apathy, fatigue, irritability, ◦Kidney stone ◦Polydipsia & Polyuria-flank pain ◦Osteoporosis ◦Weakness and deformity ◦Shortening of the long bones ◦Bone tumors; Epulis ◦Pain and tenderness on weight bearing ◦GI - N/V and Constipation ◦Ulcers ◦Cardiac-dysrhythmias Kidney stones due to increased calcium levels and buildup in the kidneys so have polydipsia and polyuria as body tries to excrete the excess calcium Osteoporosis due to demineralization of bones due to tumors overgrowth and increased serum calcium levels For cardiac, increased calcium increases the heart rate and shortens the QT interval

Endocrine Glands

◦Pituitary - Master gland ◦Thyroid ◦Thymus ◦Parathyroid ◦Adrenals ◦Pancreatic islets (review diabetes) ◦Ovaries & Testes

Gestational Diabetes

◦Placental hormones can create insulin resistance to develop. ◦Test glucose tolerance at 24-28 weeks of pregnancy-earlier if high risk. ◦High risk: obesity, previous hx of gestational diabetes, family hx of diabetes, previous child born >9lbs.

HYPOTHYROIDISMTreatment

◦Replacement therapy ◦Levothyroxine, Levothyroid (Synthroid)- most common and requires regular monitoring—take it for life ◦Check T3 & T4 annually ◦Patient teaching; report cardiac signs or symptoms ◦Signs/symptoms to report- low heart rate, difficulty breathing, etc. Report: increase depression or lethargy, weight gain with no lifestyle changes, low HR, difficulty breathing Trying to prevent myxedema Meds need to be taken for a while to see effects Take on empty stomach, best absorbed 1-3 weeks for full therapeutic effects If known cardiac disorder may slowly taper up over 4-6 weeks Potential adverse effects are: palpitations, dysrhythmias, anxiety, heat intolerance Make sure taken orally every day, preferably in AM to prevent insomnia

Endocrine abnormalities

◦Result from over secretion (hypersecretion) or under secretion of any of the hormones secreted by the gland

Complications of Diabetes

◦Retinopathy ◦Neuropathy ◦Nephropathy ◦Non-healing wounds, amputation ◦Miscarriage ◦DKA

HYPERPARATHYROIDISM Nursing Diagnoses

◦Risk for injury ◦Risk for development of renal stones ◦Alteration in elimination; constipation ◦Risk for cardiac arrhythmias ◦Activity intolerance ◦Alteration in thought process ◦Knowledge deficit

HYPERTHYROIDISM Signs and Symptoms

◦Thyrotoxicosis (group of signs and symptoms related to excessive thyroid hormone): ◦Nervousness --a classic sign ◦Hyperactivity and irritability (mind is racing) ◦Chronic fatigue and weakness ◦Heat intolerance (always warm) ◦Increased cardiac rate (tachycardia-~130 bpm) ◦Warm moist skin ◦Exophthalmos (protruding or bug eyes) ◦Weight loss (~10 lbs average) but increased appetite ◦Hyperflexia (fast reflexes of extremities) ◦Diagnosis by serum lab levels of - Elevated T3 & T4 May have vision, blurred or acuity changes due to inflammation of tissue of eyes and around the eyes

DKA

◦When cells don't get the glucose they need for energy, body begins to burn fat for energy, which produces ketones. ◦When ketones build up in the blood, they make it more acidic—metabolic acidosis. ◦DKA can develop slowly, But when vomiting occurs, this life-threatening condition can develop in a few hours (4-10hrs).