Final Exam Endocrine

Ms. S is a 70-kg woman admitted with severe dehydration resulting from diabetic ketoacidosis (DKA) with a serum glucose of 842. Her serum sodium is 154 mEq/L. Which of the following intravenous orders would be appropriate at this time? A. 1000 mL 0.9% saline bolus followed by 0.9% saline infusion B. 1000 mL 0.9% saline bolus followed by 0.45% saline infusion Correct C. 1000 mL Ringer lactate bolus followed by 0.9% saline infusion D. 1000 mL Ringer lactate bolus followed by a 5% dextrose infusion

B. 1000 mL 0.9% saline bolus followed by 0.45% saline infusion For a severely dehydrated patient, 1 L of normal saline is infused immediately

A nurse is teaching the diabetic patient about insulin therapy. Which of the following statements by the patient indicates the teaching was effective? a."I will take my long-acting insulin before a meal." b. "I will monitor my blood sugar weekly." c. "If I am not going to eat right away, it is okay to take my short-acting insulin anyway." d. "I need to rotate the site I use to obtain blood for glucose monitoring."

D."I need to rotate the site I use to obtain blood for glucose monitoring."---Sites should be rotated to avoid trauma and bruising. Long-acting insulin is administered once or twice daily. Blood sugar should be monitored at least daily in the diabetic patient and probably more often depending on therapy. Short-acting insulin should be taken before a meal.

diabetes insipidus medication management

DDVAP. 1.5 mcg desmopressin acetate (DDAVP) subcutaneously every 12 hours

Pyrexia in patient experiencing thyroid Storm

Decrease the temperature with hypothermia measures. cooling blanket, tepid sponge baths, cold packs, Circulating fan at the bedside, and acetaminophen.

Gluconeogenesis occurs when Insulin is:

Deficient; Fat is converted into glucose. The byproduct of fat metabolism is the release of fatty acids, which are rapidly reduced to ketones, producing acidosis

Order of Treatment for Severe Dehydration from Diabetic Ketoacidosis

For a severely dehydrated patient, 1 L of normal saline is infused immediately. If the serum osmolality is elevated and serum sodium is high (hypernatremia), infusions of hypotonic sodium chloride (0.45) follow the initial saline replacement. Dextrose is added to replenish depleted cellular glucose as the circulating serum glucose decreases to 200 mg/dL.

Pathophysiologic process of severe acidosis of diabetic ketoacidosis (DKA)

Increased glucagon production, breakdown of fats, and gluconeogenesis

Role of the adrenal gland in hypoglycemia

It releases cortisol, which triggers gluconeogenesis. Stimulated by low glucose levels, the body's receptors cause the adrenal cortex to secrete cortisol, which increases fat and protein metabolism.

Myxedema coma -unarousable; Weight gain, depression, and cold intolerance. Also Has respiratory acidosis and hypoventilation. The nurse anticipates which of the following treatments?

Levothyroxine 100 mcg IV followed by 75 mg/day

Aspirin Contraindicated in treating pyrexia in a patient experiencing a Thyroid storm because

Salicylates (aspirin) are contraindicated because they prevent protein binding of T3 to T4, increasing the free, metabolically active thyroid hormone

Mr. G is admitted with diabetic ketoacidosis (DKA), and an insulin drip is begun. The insulin drip should be continued until which of the following occurs?

Serum ketones are absent and a normal serum pH is achieved.

Thyroid Storm ( Thyrotoxicosis) is treated with:

Sodium iodine, reserpine, and propranolol

Goal when treating DKA is to achieve a

Steady decline in glucose levels of 50 to 70 mg/dL/hr. When serum glucose levels have reached 200 mg/dL, 0.9% saline is changed to 5% dextrose as fluid replacement. The insulin drip is continued until serum ketones are absent and a normal pH is achieved.

Hypoglycemia Treatment guidelines

When a finger-stick glucose of less than this is obtained, verification with the laboratory is required in most protocols. Administration of replacement glucose depends on the patient's clinical condition and may be given orally or parenterally as appropriate

hypoglycemia Definition

a serum glucose less than 70 mg/dL

risk factors for developing metabolic syndrome?

high fasting blood sugar. waist greater than 40 inches in men and greater than 35 inches in women, triglycerides greater than 150, HDL less than 40 for men and less than 35 for women Genetics, African American, Native American, Hispanic, Asian America