Adult Health 1 Exam #2
While completing an endocrine focused health assessment interview of an older adult, the nurse recognizes which of the following as an expected change related to thyroid function? a. inability to tolerate heat and cold b. enlarged nose, hands and feet c. indigestion and intolerance of fatty foods d. increased facial hair
a. inability to tolerate heat and cold
Which of the following should the nurse include when assessing a patient who is demonstrating signs of an endocrine disorder?(Select all that apply.) a. skin, hair, and nails b. height and weight c. musculoskeletal system d. respiratory system e. deep tendon reflexes
a. skin, hair, and nails b. height and weight c. musculoskeletal system e. deep tendon reflexes
Which medication for diabetes is classified as a sulfonylureas and is take once a day with their 1st meal?
Glyburide
What is the most common cause of hyperthyroidism?
Graves' disease (an autoimmune disorder)
Pt has high BG levels in morning. What intervention will MD request to determine Somogyi effect vs Dawn phenomenon?
Have the patient's BG be drawn at 0300 Rationale: If somogyi effect the patient BG will be low (hypoglycemia) if dawn phenomenon the patient BG levels will be normal.
An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus?
Ketones
What organ is responsible for making clotting factors necessary for thrombus formation?
The Liver
In a thyroid storm what might beta blockers be used to treat?
The symptoms of high blood pressure (HTN) and tachycardia.
Which class of diabetic medications has a black box warning for increased cardiovascular events? Which medications are includes in this class?
Thiazolidinediones (TZD) ~Avandia ~Actos
Propylthiouracil (PTU) is used to manage hyperthyroidism. How long does it take to become effective and when does treatment peak?
1-2 weeks; 1-2 months
1. Radioactive Iodine Precautions includes: use ________ bathroom, flush ______ times, laundry is _______, minimize food _________ and NO contact with ________________. It takes up to ______ months to see the full effect of this therapy.
1. Radioactive Iodine Precautions includes: use separate bathroom, flush 2-3 times, laundry is separate, minimize food handling and NO contact with children or pregnant women. It takes up to 3 months to see the full effect of this therapy.
In impaired fasting glucose (IFG) what are the glucose values to meet the criteria of prediabetes?
100 to 125 mg/dL
In impaired glucose tolerance (IGT) what are the 2 hour oral glucose values to meet the criteria of prediabetes?
140 to 199 mg/dL
In the Hgb-A1C what value would qualify as pre-diabetes?
5.7% to 6.4%
In a thyroidectomy what complications need to be monitored? (hint:BOWTIE)
Bleeding Open airway (respiratory distress) Whisper Trache set (laryngeal nerve damage Incision Emergency (thyroid storm, hypocalcemia-Tetany)
In Parkinson's disease the loss of dopamine leads to an imbalance of ____________.
Acetylcholine
In a patient with exophthalmos what education should be provided?
Artificial tears and wearing sunglasses may be necessary to manage.
What device is used as a temporary management and prevention complications related to hip fractures?
Buck's Traction (Skin Traction)
What complication develops because of liver cirrhosis due to high levels of ammonia in the blood?
Hepatic Encephalopathy
Insulin resistance causes several comorbid conditions such as obesity, coronary heart disease, dyslipidemia, HTN, microalbuminuria (protein in urine), and increased risk of blood clots. What are these comorbidities collectively referred to as?
Metabolic Syndrome (insulin-resistance syndrome or syndrome X)
Who is most at risk for developing Multiple Sclerosis (MS).
Caucasians, living in colder climates
What is Suppurative Thyroiditis caused by and what is the treatment?
Caused by a bacterial infection of thyroid gland. Treatment includes antibiotic therapy.
What is Subacute Thyroiditis caused by and what is the treatment?
Caused by a viral infection of thyroid gland. Manage with fluids, rest and ASA.
Patient is being treated for diabetic ketoacidosis (DKA) what potential complication does the nurse need to monitor for?
Hypokalemia
In Tertiary thyroid dysfunction this results from problems with the _______________.
Hypothalamus gland
Prediabetes is defined as ________________, __________________, or both.
Impaired glucose tolerance (IGT); impaired fasting glucose (IFG)
How does insulin work in our body?
Insulin attaches to our cells and allows them to uptake glucose in order to fuel their normal physiological functions.
What type of insulin is NPH? When is the onset, peak, & duration?
Intermediate acting Onset = 1-2 hrs Peak = 4-12 hrs Duration = 18-24 hrs
What instruction needs to be provided to the patient about taking Levothyroxine?
It needs to be taken in the morning on an empty stomach.
What important education needs to be provided related to the use of Biguanides (Metformin) and imaging requiring contrast?
Metformin must be stopped 1-2 days prior to contract media and for 2 days after.
The Hgb-A1C indicates the average serum glucose level over what period of time?
Over 3 months
What gland uses PTH to regulate calcium and phosphorus?
Parathyroid gland
What is the definitive therapy for hyperparathyroidism?
Parathyroidectomy
During ROM exercises, patient presents with cogwheel rigidity. What is the likely cause?
Parkinson's disease
With rapid acting insulins such as lispro and aspart what needs to happen within 15 minutes of injection?
Patient's meal will need to be ready and they will need to eat within 15 minutes of receiving the insulin injection.
In secondary thyroid dysfunction this results from problems with the ______________.
Pituitary gland
What complication of liver cirrhosis is a result of obstructed blood flow in and out of the liver?
Portal Hypertension
What classification of MS is a gradual progression from onset with no relapses or remissions.
Primary Progressive MS (PPMS)
What classification of MS is a steady decline since onset with super-imposed attacks?
Progressive Relapsing MS (PRMS)
____________ can impair function of Levodopa.
Protein
What test needs to be performed in a person with Graves' disease?
RAIU (radioactive iodine uptake)
Which insulin can be given IV?
Regular insulin ONLY
What classification of MS has unpredictable attacks which may or may not leave permanent deficits followed by periods of remission.
Relapsing/Remitting MS (RRMS)
What classification of MS presents as initial RRMS that suddenly begins to decline w/o periods of remission and relapses.
Secondary Progressive MS (SPMS)
What type of gait is most commonly seen in patients with Parkinson's disease?
Shuffling gait
Pt awakes w/ high BG levels in morning. MD decreases their evening long-acting insulin. What condition is MD treating?
Somogyi effect Rationale: Caused by hypoglycemia episodes happening during sleep because of to much insulin given in the evening the body over responses causing hyperglycemia in the morning
What generally causes a thyroid storm, which is considered a medical emergency.
Stress or Infection
Client presents with Malaise, Fatigue and Depression. Lab tests show elevated TSH and normal T3/T4 levels? What is the likely diagnosis?
Subclinical hypothyroidism
What are the diagnosis criteria for Diabetes?
Symptomology and ~random blood sugar > 200 mg/dl OR ~Fasting blood glucose > 126 OR ~2 hr plasma glucose > 200 during OGTT ~Hgb-A1C >greater than 6.5%
Diagnosis of hyperthyroidism includes a decreased ____ levels and increase ____&____ levels
TSH; T3 & T4
What are the signs and symptoms of a patient with a blood glucose levels of 55 mg/dL?
This indicates hypoglycemia symptoms include: Cold, clammy skin Bradycardia Nervousness Slurred speech Diaphoresis Confusion Drowsiness Headache
In primary thyroid dysfunction this results from problems with the ____________.
Thyroid gland
Hyperthyroidism is too much of what hormone?
Thyroid hormone (T4-thyroxine & T3 - Triiodothyronine)
What procedure can be done to treat Portal Hypertension that involves creating a channel through the liver with a stent.
Transjugular Intraheptic Portosystemic Shunt (TIPS)
What are the common side effects of Biguanides (Metformin)?
a. Abdominal bloating, cramping, fullness b. Nausea c. Diarrhea d. Lactic Acidosis (rare) e. Metallic taste, reduced vitamin B12 levels
What treatment will be done to correct diabetic ketoacidosis?
a. Aggressive fluid hydration via IV b. Regular insulin given via bolus then continuous infusion c. Replacement of potassium (K+)
What are the clinical manifestations of Type 1 Diabetes?
a. Asymptomatic until 80 to 90% of beta cells destroyed b. Polyuria (increased urination) c. Polydipsia (increased thirst) d. Polyphagia (increased appetite) e. Vaginal yeast infections f. Delayed wound healing g. Weight loss h. Blurred vision i. N&V j. Abdominal pain
Which injectable medications are Glucagon-like Peptide-1 (GLP-1) which act like incretin?
a. Byetta (daily injection) b. Victoza (daily injection) c. Trulicity (weekly injection) d. Tanzeum (weekly injection)
What are the signs and symptoms of hyperthyroidism?
a. weight loss b. increased appetite c. diaphoresis (increased sweating) d. heat intolerance e. insomnia f. anxiety g. bulging eyes (exophthalmos) h. Tachycardia (palpitations, increased HR, chest pain) i. thin hair j. increased BP k. diarrhea l. tremors
A nurse is acting as a preceptor for a new graduate nurse. One of the patients assigned to their care is a 41-year-old patient whose laboratory test results reveal a fasting serum blood glucose level of 125 mg/dL. The graduate nurse asks the nurse what this means. Which of the following statements by the nurse is most correct? a. "These results must be called to the physician." b. "These results are normal." c. "The results are consistent with prediabetes." d. "This patient has diabetes."
c. "The results are consistent with prediabetes."
An adolescent who has just been found to have type 1 diabetes asks the nurse about exercise. Which is the best response by the nurse? a. Exercise should be restricted b. Exercise will increase blood glucose c. Extra snacks are needed before exercise d. Extra insulin is required during exercise
c. Extra snacks are needed before exercise Rationale: Exercise lowers the blood glucose level; an extra snack can prevent hypoglycemia.
Patient was just educated on diabetic foot care. Which statement made by the patient requires further education? a. I will use lotion to prevent dry skin and cracking b. I will inspect my feet daily for any open wounds c. I will wear properly fitting and supportive shoes when I leave my home d. I will report any non-healing wounds to my physician
c. I will wear properly fitting and supportive shoes when I leave my home Rationale: Patient's should wear properly fitting shoes even in their home to prevent injury
When measuring the blood pressure of a patient with hypoparathyroidism, the nurse notes spasms of the patient's hand. The nurse documents this clinical manifestation as which of the following? a. Cullen's sign b. Chvostek's sign c. Trousseau's sign d. Turner's sign
c. Trousseau's sign
Which of the following statements would indicate that discharge instructions to a patient recovering from a total thyroidectomy were not effective? a. "My doctor will be checking my T3 and T4 levels in the near future." b. "I'll be glad when I get my energy back." c. "I know I will be on medication for the rest of my life." d. "A blood test for aldosterone will be done in a month."
d. "A blood test for aldosterone will be done in a month."
Which lab findings would point to ketoacidosis in a type 1 diabetic? a. 7.20 and 60 mg/dL b. 7.50 and 60 mg/dL c. 7.50 and 460 mg/dL d. 7.20 and 460 mg/dL
d. 7.20 and 460 mg/dL Rationale: With ketoacidosis the pH is decreased (normal 7.35 to 7.45) and the blood glucose level is increased (normal 90 to 110 mg/dL)
The results of a patient's oral glucose tolerance test are reviewed by the nurse. What is the correct interpretation of these results? Oral Glucose Tolerance Test Results Fasting = 67 mg/mL 30 minutes = 128 mg/mL 1 hour = 151 mg/mL 2 hours = 102 mg/mL 3 hours = 70 mg/mL a. The results are inconsistent; therefore the test will need to be repeated. b. The findings indicate hyperinsulinism. c. The patient should be evaluated for diabetes mellitus. d. Results are within normal range.
d. Results are within normal range.
What medication is used to treat Hepatic Encephalopathy by binding to ammonia in the GI tract?
Lactulose (Enulose)
In the Hgb-A1C what would be a normal value?
Less than 5.6%
What dopamine precursor medication is used to manage symptoms of Parkinson's disease?
Levodopa with Carbidopa
Medications are the main means of controlling hypothyroidism. What medication is commonly used to treat hypothyroidism?
Levothyroxine (synthroid)
What are signs and symptoms of hypothyroidism?
a. Cold intolerance b. Weight gain c. Edema d. Dull blank expressions e. Fatigue f. Brittle hair & nails g. Menstrual disturbance h. Apathy i. Lethargy j. Constipation
How does the Biguanides (Metformin) work to treat diabetes?
a. Decreases production of glucose by the liver b. Decreases intestinal absorption of glucose c. Stimulates uptake of glucose using insulin on cells NOTE: does NOT increase insulin secretion from pancreas (does not cause hypoglycemia!)
What are the causes of hyperthyroidism?
a. Graves' disease b. toxic multinodular goiter c. thyroiditis d. high levels of iodine e. early Hashimotos' disease
What are the causes of hypothyroidism?
a. Hashimoto's disease b. Thyroiditis c. Goiter d. Over medication for hyperthyroidism and/or the result of treatment of hyperthyroidism such as RAI or complete/partial thyroidectomy
What types of abnormalities in the hands would be seen with a patient diagnosed with OA?
a. Heberden's Nodes b. Bouchard's Nodes
What are potential side effects of sulfonylureas (glipizide & glyburide)?
a. Hypoglycemia b. Weight gain c. Nausea d. Heartburn e. Epigastric fullness f. Hematological effects
What are symptoms of dumping syndrome?
a. Hypovolemia b. Hypotension (dizziness) c. Diarrhea (abdominal cramping) d. Weakness e. Diaphoresis f. Tachycardia
What is the action of sulfonylureas (glipizide & glyburide) in the treatment of diabetes?
a. Lowers blood glucose levels by increasing insulin levels by stimulating insulin secretion from beta cells b. Improves sensitivity to insulin in tissues
In subclinical hypothyroidism what lab findings support this diagnosis?
a. Normal T3/T4 levels b. High TSH c. Dyslipidemia (high triglycerides & high cholesterol
What are the characteristics of Type 1 Diabetes Mellitus?
a. Presents in early to mid adolescents b. Autoimmune disorder (genetic abnormality) c. Pancreas unable to produce insulin due to immune cells destroying beta cells (responsible for secreting insulin) in the pancreas
What medications are used to treat hyperthyroidism?
a. Propylthiouracil (PTU) - 1st line of treatment b. Tapazole (Thiamazole) c. Lithium (less likely to be used)
What types of abnormalities in the hands would be seen with a patient diagnosed with RA?
a. Swan Neck b. Boutonniere
What are characteristics of type 2 diabetes?
a. Typically related to obesity b. Cells become Insulin resistant (due to increased oral intake of glucose insulin receptors on the cells stop responding because they are constantly being over stimulated; beta cells become exhausted and start to fail) c. Increased glucose production by liver d. Pancreas produces less insulin
What symptoms are seen in diabetic ketoacidosis (DKA)?
a. Weakness b. Blurred vision c. Polyuria & Polydipsia d. Dehydration e. Abdominal pain & Vomiting f. Metabolic acidosis g. Kussmaul's respirations h. Fruity acetone breath
Which of the following age-related endocrine changes is seen in the elderly patient diagnosed with type 2 diabetes mellitus? a. decreased sensitivity to insulin b. intolerance of fatty foods c. lower and prolonged blood glucose levels d. more rapid insulin release
a. decreased sensitivity to insulin
Which of the following would the nurse assess in a patient who is demonstrating signs of exophthalmos? a. enlarged thyroid gland b. decreased reflexes c. dry skin d. dry, thick nails
a. enlarged thyroid gland
In management of fractures nurses should always assess what for neurovascular dysfunction?
Distal pulses and sensation
Patient is 1 day post-op from a THR. They present with AMS, dyspnea, tachypnea, tachycardia, and a petechial rash. What is the likely diagnosis?
Fat Embolism Syndrome
What complication is most common after fractures of the pelvis, femur, tibia, crush injuries or THR?
Fat Embolism Syndrome
What are the flexion limitations for a patient with a THR?
Flexion limited to 60 degrees for 1 week Flexion limited to 90 degrees for 2-3 months
Which insulins are considered long acting? What is the onset, peak & duration?
Glargine and Detemir Onset = 1-2 hrs Peak = 6-8 hrs Duration = 24 hrs
Pt awakes w/ high BG levels every morning. MD increases their evening dose of insulin. What condition is MD treating?
Dawn phenomenon Rationale: Caused by counter regulatory hormones in predawn hours so body needs higher insulin requirements at night to regulate
Diagnostic tests for hypothyroidism will show a decreased ______ levels and possible T4 __________.
Decreased T4 levels and possible T4 antibodies.
A patient who is scheduled to have a hemoglobin A1C level drawn asks the nurse about the purpose of the test. Which of the following would be an appropriate response for the nurse to make to this patient? a. "It's a blood test to check for menopausal symptoms." b. "It's to check for thyroid functions." c. "It's a blood test to check for kidney functioning." d. "It's to check for pancreas functioning."
d. "It's to check for pancreas functioning."
Which clinical findings support the diagnosis of diabetic ketoacidosis (DKA)? a. Nervousness and tachycardia b. Erythema toxicum rash and pruritus c. Diaphoresis and altered mental state d. Deep respirations and fruity odor to the breath
d. Deep respirations and fruity odor to the breath Rationale: Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid.
When assessing the patient diagnosed with hypothyroidism, the health assessment interview question that provides information would be which of the following? a. Is your skin smooth or flushed? b. Does your skin feel clammy? c. Do you have brown, shiny patches on the lower extremities? d. Do you have rough, dry skin?
d. Do you have rough, dry skin?
The nurse is reviewing the laboratory report of an adolescent with type 1 diabetes. Which test is considered the most accurate in the evaluation of the effectiveness of diet and insulin therapy over time? a. Blood pH b. Serum protein level c. Serum glucose level d. Glycosylated hemoglobin (GHb)
d. Glycosylated hemoglobin (GHb) Rationale: The glycosylated hemoglobin (GHb) test provides an accurate long-term index of the child's average blood glucose level for the 10- to 12-day period before the test; the more glucose the red blood cells were exposed to, the greater the GHb percentage. A high blood pH may indicate developing ketoacidosis, but it reflects short-term variations. Serum protein readings do not reflect the effectiveness of glucose management. Serum glucose readings reflect short-term (hours) variations.
Patient was recently started on Glipizide and education was provided about when to take the medication. Which statement supports that the patient understood the information? a. I will take this only with my first meal of the day b. I will take this before going to bed c. I will take this 30 minutes after each meal d. I will take this 30 minutes before meals
d. I will take this 30 minutes before meals
Which of the following assessment techniques would the nurse use to assess the thyroid gland of an adult patient? a. Stand in front of the patient and palpate the thyroid. b. Have the patient flex the neck forward and palpate the thyroid. c. Place the patient supine and palpate one side of the neck at a time. d. Stand behind the patient and palpate the thyroid.
d. Stand behind the patient and palpate the thyroid.
A patient comes into the clinic demonstrating symptoms of hypocalcemic tetany. Which of the following assessments should the nurse conduct to determine the patient's condition? a. Place a tuning fork over one of the patient's fingers. b. Measure the patient's blood pressure. c. Measure capillary blood. d. Tap a finger in front of the patient's ear at the angle of the jaw.
d. Tap a finger in front of the patient's ear at the angle of the jaw.
Which information would the nurse provide a client with diabetes mellitus (DM) regarding alcohol consumption? a. Before meals b. One drink per week c. Complete abstinence d. With or shortly after meals
d. With or shortly after meals Rationale: A person with DM should only drink alcohol with or shortly after meals to prevent alcohol-induced delayed hypoglycemia. Alcohol should not be consumed before meals. The client with DM does not need to limit to one drink per week nor completely abstain from drinking.
A nurse assesses a patient who has a scaphoid abdomen and a serum albumin level of 2.0 g/dL. These findings are most likely related to a diagnosis of which of the following? a. type 2 diabetes mellitus b. Crohn's disease c. diverticulosis d. malnourishment
d. malnourishment
Which of the following laboratory values would the nurse assess in the patient diagnosed with Graves' disease? a. calcium b. urine-specific gravity c. cortisol d. thyroxine
d. thyroxine
What glucose level may result in diagnosis of Diabetes for a fasting blood glucose?
greater than 126 mg/dL
What glucose level would be a criteria for a diagnosis of Diabetes in the 2 hr plasma glucose test during OGTT?
greater than 200 mg/dL
Super Saturated Potassium Iodine (SSKI) is not effective for ________________ therapy.
long term
Lispro and Aspart are ________ acting insulins, with an onset of ________, a peak of ________, and a duration of __________.
rapid; <15 minutes, 1-1 1/2 hrs; 3-5 hrs
Regular insulin is a ________ acting insulin, with an onset of ________, a peak of ________, and a duration of __________.
short; 30-60 minutes, 2-5 hrs; 6-8 hrs
What are the main differences between DKA and HHKN?
~BG levels (DKA is >250 mg/dL and HHKN >600 mg/dL) ~Insulin production (DKA = no insulin production and HHKN = insulin production still present) ~Ketones (DKA = presence of ketones and HHKN = no ketones)