272 PrepUs - Week 4

Syndrome of inappropriate antidiuretic hormone (a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema.)

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?

Rickets

A 16-month-old boy has a normal weight for his age but a height far below the normal range. His list of symptoms includes a protruding abdomen, lethargy, bow legs, muscle weakness, and irritability. His teeth have not yet developed and he has difficulty standing. What is the child's most likely diagnosis?

Corticotropin-secreting pituitary adenoma

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:

Regular insulin (Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.)

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer?

body temperature control.

A client experienced a stroke that damaged the hypothalamus. The nurse should anticipate that the client will have problems with:

"You may experience noticeable weight gain while taking this medication." (Weight gain is a common side effect of the atypical antipsychotics, particularly clozapine and olanzapine, which can cause a weight gain of up to 20 pounds within 1 year. Orthostatic hypotension may occur with this drug.)

A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family?

Antidiuretic hormone (ADH) and oxytocin

A client has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretions of:

Hypoxia

A client is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which aspect of this abnormality?

The client takes digoxin 0.125 mg daily. (Potassium iodide will cause the client to move from hyperthyroidism to hypothyroidism, thus altering the client's metabolism. Digoxin has a small margin of safety that could be altered by a change in thyroid function.)

A client is seen in the clinic and diagnosed with hyperthyroidism. Before administering the prescribed potassium iodide, the nurse reviews the client's health record. What finding would cause the nurse to alter the plan of care?

Short acting (regular) insulin is used to facilitate metabolism of the food that is being eaten.)

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Metformin medication

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

a low-protein diet with a prescribed amount of water (Although dialysis removes water, creatinine, and urea from the blood, the client's diet must still be monitored. A high-protein diet is not recommended for renal clients. Eating too much protein may cause urea to build up more quickly.)

A client with diabetes mellitus has had declining renal function over the past several years. Which diet regimen should the nurse recommend to the client on days between dialysis?

"Maintain a moderate exercise program." (Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated.)

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?

The stress of the event caused the release of adrenal cortical hormones.

A client with long-standing type 2 diabetes is surprised to see high blood sugar readings while recovering from an emergency surgery. Which factor may have contributed to the client's inordinately elevated blood glucose levels?

carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia. (people with diabetes are usually aware that delayed hypoglycemia can occur after exercise.)

A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increased risks associated with exercise, the health care provider should encourage the client to:

The most common cause of Cushing's syndrome in women ages 20 to 40

A corticotropin-secreting pituitary adenoma

Fine-needle biopsy of the thyroid gland (often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected.)

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

A nurse explains to a client that the nurse will administer the client's first insulin dose in the client's abdomen. How does absorption at the abdominal site compare with absorption at other sites?

Small intestine

A nurse explains to her client that food is moved along the gastrointestinal (GI) tract with intermittent contractions that mix the food and move it along. These movements are found in which organ?

Most tumors produce too much of one or more hormones.

A nurse helps a patient recently diagnosed with a pituitary adenoma understand that:

ECG changes low body temperature bradycardia

A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate?

"Internal secretion of hormones is the function of the endocrine pancreas." "The endocrine pancreas secretes hormones through a ductless gland." "The exocrine pancreas secretes hormones from excretory ducts." "The exocrine pancreas secretes pancreatic enzymes into the GI tract."

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas?

99.6 degrees F

A patient comes to the clinic at 8 a.m. for a scheduled visit. The nurse obtains the patient's temperature orally. Which finding would the nurse interpret as a potential indicator of a problem?

8.5% (A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention.)

A pregnant woman with diabetes is having a glycosylated hemoglobin (HgbA1C) level drawn. Which result would require the nurse to revise the client's plan of care?

Delirium related to underlying medical problem

An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status?

Diabetes insipidus (Normally, antidiuretic hormone (ADH) from the posterior pituitary gland causes the renal tubule to reabsorb water and sodium. When too little ADH is secreted, the client will lose large amounts of fluid and become dehydrated. Despite fluid volume deficit, the urine output will be dilute and in large amounts.)

An adult client presents to the emergency department after an episode of syncope. Blood pressure is low and the pulse is thready and rapid. The client frequently voids large amounts of pale, clear urine. Lung sounds are clear and skin turgor is inelastic. Which endocrine disorder is the likely cause of these manifestations?

Hypothyroidism (Thyroid hormone is necessary for metabolism at all ages, as well as growth and development during childhood. Uncorrected thyroid insufficiency in childhood leads to cretinism, a condition with marked physical and intellectual disability.)

An infant whose mother had myxedema during the pregnancy has failed to meet standards for growth and is developmentally delayed. Which hormonal imbalance is this child exhibiting?

Osteogenesis imperfecta (OI) is a hereditary bone disease and caused by

Caused by deficiencies in the synthesis of type I collagen.

Hypopituitarism

Defined as the condition of diminished hormone secretion from the anterior pituitary gland

Myxedema

Defined as, an extreme deficiency of thyroid secretion; also known as adult hypothyroidism

Derangements in glucose metabolism.

Elevation of glucocorticoid levels (i.e., cortisol), such as during stressful events, can lead to:

Adrenal cortex secretion

Excessive secretion of aldosterone from this location, is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions.

These tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client.

Hemoglobin A1c tests

Unexplained pruritus (The earliest symptoms are unexplained pruritus or itching, weight loss, and fatigue, followed by dark urine and pale stools.)

Primary biliary cirrhosis is an autoimmune disease that destroys the small intrahepatic bile ducts causing cholestasis. It is insidious in onset and is a progressive disease. What are the earliest symptoms of the disease?

A diurnal variation of 1 or 2 degrees in body temperature is normal throughout the day.

Temperature is usually lowest in the morning and increases during the day to between 99 to 99.5 degrees F and then decreases during the night. Therefore, an early morning temperature of 99.6 degrees would suggest a potential problem, because this temperature would then increase as the day goes on. Early morning temperatures of 97.2 degrees, 98.0 degrees, and 98.4 degrees would not be a cause for concern.

Diabetic Retinopathy

The body's inability to effectively cope with carbohydrate, fat, and protein metabolism over a long period of time results in a thickening of the basement membrane in large and small blood vessels. This thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly diffuse across the membrane to the tissues of the eye.

Hypothalamus

The body's thermostat is located here; therefore, injury to that area can cause problems with body temperature control.

Inability of oxygen to diffuse to tissues in the eye

The client, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurse's best response?

Norepinephrine (NE) (Central to the neural component of the neuroendocrine response to stress is an area of the brain stem called the locus caeruleus (LC). The LC is densely populated with neurons that produce norepinephrine.)

The locus caeruleus (LC) is an area in the brain stem that produces which hormone?

maintenance of homeostasis. (The hypothalamus maintains internal homeostasis by sensing blood chemistries and by stimulating or suppressing endocrine, autonomic, and CNS activity. The negative feedback system is one way homeostasis is maintained, but it is not the overall goal or purpose of the system.)

The main purpose of the hypothalamus in regulating the central nervous system (CNS), autonomic nervous system (ANS), and endocrine system is the:

decreased urine output (Desmopressin produces its antidiuretic activity in the kidneys, causing the cortical and medullary parts of the collecting duct to become permeable to water, thereby increasing water reabsorption and decreasing urine formation. These activities reduce plasma osmolarity and increase blood volume.)

The nurse administers desmopressin (DDAVP) to the client to treat diabetes insipidus. What assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect?

Ensure that lower drug dosages or an increased interval between doses is scheduled. (The liver metabolizes most drugs; however, the immaturity of the neonatal and infant liver results in decreased or incomplete metabolism of many drugs, which may necessitate lower drug dosages or an increased interval between doses to achieve appropriate blood levels.)

The nurse is administering a drug metabolized in the liver to an infant. Because of the immaturity of the infant liver, what does the nurse determine should be done for dosing of this drug?

Reflects the amount of glucose stored in hemoglobin over past several months.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order?

Neuromuscular

The nurse is learning about mitochondrial DNA mutations. She learns that they generally affect which tissues and organs?

NPH (Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin.)

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?

Gigantism

The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as what?

"What time each day does your child take his growth hormone?" (Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature.)

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?

Kidney stones

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?

Vitamin D and parathyroid hormone

The small, but vital, amount of ECF calcium, phosphate, and magnesium is directly or indirectly regulated by this

Metformin

This medication, is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently.

Syndrome of inappropriate antidiuretic hormone

This syndrome is defined as the overproduction of the antidiuretic hormone ADH, leading to bloating, water retention, and electrolyte imbalance

A glycosylated hemoglobin test

This test measures the amount of glucose (sugar) in your blood.

Tetany And may result if the parathyroid glands are excised or damaged during thyroid surgery

This, can cause muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area.

Diabetes insipidus

This, is characterized by polyuria. Antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

Endarterectomy

This, is defined as the surgical removal of plaque from the inner layer of the carotid artery

-Genetic predisposition -Environmental triggering event -T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Parathyroid hormone

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

Levothyroxine (This client's signs and symptoms are characteristic of hypothyroidism. Levothyroxine, a synthetic salt of thyroxine, is the most frequently used replacement hormone to treat hypothyroidism because of its predictable bioavailability and reliability.)

What drug would the nurse appropriately administer (when prescribed) to a client exhibiting depression, cold intolerance, bradycardia, and fatigue?

the storage and packaging of substances that are converted into secretory granules

What is the primary function of a Golgi complex?

Increased blood pressure (Stimulation of the sympathetic nervous system activates the renin-angiotensin-aldosterone system, which mediates an increase in vascular tone and renal retention of sodium and water. This causes an increase in blood pressure.)

What will the nurse assess as the end result of activation of the renin-angiotensin-aldosterone system?

Hyperglycemia (Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.)

When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease?

Anyone with an eating disorder. (Having an eating disorder places clients at increased risk due to malabsorption of medications.)

Which clients should the nurse assess to determine if they have premature osteoporosis?

High production of melanin

Which factor is genetically determined and primarily responsible for dark skin tone?

Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed (Because of the loss of insulin response, all people with immune-mediated type 1 diabetes require exogenous insulin replacement to reverse the catabolic state, control blood glucose levels, and prevent ketosis.)

Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?

hyperparathyroidism

defined as hypersecretion of the parathyroid glands, can caused by a tumor