052 Endocrine

symptoms of acromegaly

- Thickened, oily skin - Thickened lips, Deepening voice - Enlarged hands & feet, ↑ head size - Protrusion of lower jaw - Joint enlargement & pain - Kyphosis & backache, Barrel chest - ↑ sweating, Hyperglycemia - Coarse facial features, Organomegaly - Airway narrowing, sleep apnea

Symptoms of hyperthroidism

-Intolerance to heat -Weight loss -Tachycardia -Increased body metabolism -buldging eyes -diarehhea -enlarged thyroid -fine straight hair -high systolic b/p

A. Diabetes mellitus B. Diabetes insipidus C. Hypoparathyroidism D. Hyperparathyroidism

A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders?

Hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal.

A. Related to bone demineralization resulting in pathologic fractures B. Related to exhaustion secondary to an accelerated metabolic rate C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces D. Related to tetany secondary to a decreased serum calcium level

A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?

A. Dysuria B. Leg cramps C. Tachycardia D. Blurred vision

A female client with hypothyroidism is receiving levothyroxine 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse drug effect?

A. "You'll need more insulin when you exercise or increase your food intake." B. "You'll need less insulin when you exercise or reduce your food intake." C. "You'll need less insulin when you increase your food intake." D. "You'll need more insulin when you exercise or decrease your food intake."

A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?

A. Infusing I.V. fluids rapidly as ordered B. Encouraging increased oral intake C. Restricting fluids D. Administering glucose-containing I.V. fluids as ordered

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone. Which nursing intervention is appropriate?

A. Adrenal cortex B. Pancreas C. Adrenal medulla D. Parathyroid

A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which of the following glands?

A. "Administer desmopressin while the suspension is cold." B. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." C. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." D. "You won't need to monitor your fluid intake and output after you start taking desmopressin."

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

A. prefers to take insulin orally. B. has type 2 diabetes. C. has type 1 diabetes. D. is pregnant and has type 2 diabetes.

A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client:

A. "The test needs to be repeated following a 12-hour fast." B. "It looks like you aren't following the prescribed diabetic diet." C. "It tells us about your sugar control for the last 3 months." D. "Your insulin regimen needs to be altered significantly."

A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin test result. In discussing the result with the client, what would be the most appropriate response by the nurse?

A. Encourage the client to ask questions about personal sexuality. B. Provide time for privacy. C. Provide support for the spouse or significant other. D. Suggest referral to a sex counselor or other appropriate professional.

A nurse is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, what would the most appropriate intervention be?

A. I.M. or subcutaneous glucagon. B. I.V. bolus of dextrose 50%. C. 15 to 20 g of a fast-acting carbohydrate such as orange juice. D. 10 U of fast-acting insulin.

A nurse is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: Aberrant = abnormal

A. Adrenal Cortex B. Adrenal Medulla-The adrenal medulla secretes catecholamines. C. Anterior Pituitary D. Posterior Pituitary

A patient is diagnosed with pheochromocytoma. From your nursing knowledge, you know that the patient will present with hypertension, sweating, and palpations due to excessive catecholamine production from the?

A. Low sodium and high potassium diet B. 2L fluid restriction C. Low calorie and high fiber diet D. High calorie diet

A patient is receiving treatment for pheochromocytoma. What type of diet is best for this patient?

A. "If I have hypoglycemia, I should eat some sugar, not dextrose." B. "The drug makes my pancreas release more insulin." C. "I should never take insulin while I'm taking this drug." D. "It's best if I take the drug with the first bite of a meal."

Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, the nurse would be aware of the client's need for additional teaching when the client states:

A. Initiate insulin therapy. B. Switch the client to a different oral antidiabetic agent. C. Prescribe an additional oral antidiabetic agent. D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

After taking glipizide for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?

A. Primary hypothyroidism B. Graves' disease C. Thyrotoxicosis D. Euthyroidism

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

A. Thyroid storm. B. Cretinism. C. myxedema coma. D. Hashimoto's thyroiditis.

An incoherent female client with a history of hypothyroidism is brought to the emergency department. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and non-pitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent what potential complication?

rapid acting insulin- lower blood glucose after a meal, must be taken just before or with meals. Onset: 0-15 Peak 60 min Duration 5hrs or less

Aspart (Novolog)

A. Onset to be at 2 p.m. and its peak to be at 3 p.m. B. Onset to be at 2:15 p.m. and its peak to be at 3 p.m. C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m. D. Onset to be at 4 p.m. and its peak to be at 6 p.m.

Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. The nurse should expect the dose's:

Intermediate acting (Regular insulin)

Contains a preservative to delay action. Assists in controlling blood sugar between meals. NPH insulins.* Onset: 1-4 hrs Peak: 6-10hrs Duration: 12-16hrs

A. "Be sure to take glipizide 30 minutes before meals." B. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." C. "You won't need to check your blood glucose level after you start taking glipizide." D. "Take glipizide after a meal to prevent heartburn."

Dr. Kennedy prescribes glipizide for a male client with type 2 diabetes mellitus who has been having trouble controlling his blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

A. At least once a week B. At least three times a week C. At least five times a week D. Every day

During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?

A. "The head of your bed must remain flat for 24 hours after surgery." B. "You should avoid deep breathing and coughing after surgery." C. "You won't be able to swallow for the first day or two." D. "You must avoid hyperextending your neck after surgery."

During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement?

A. Diabetic ketoacidosis B. Thyroid crisis C. Hypoglycemia D. Tetany

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F, tachycardia, and extreme restlessness. What is the most likely cause of these signs?

A. Cool, clammy skin B. Distended neck veins C. Increased urine osmolarity D. Decreased serum sodium level

For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of deficient fluid volume?

A. Hypocalcemia B. Hypercalcemia C. Hypokalemia D. Hyperkalemia

For the first 72 hours after thyroidectomy surgery, the nurse would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following?

Hypothalamus

Growth-releasing hormone = somatropin - stimulates release of GH Growth-inhibiting hormone = somatostatin - inhibits release of GH Antidiuretic hormone (ADH) - is produced and stored Thyroid releasing hormone - stimulates thyroid gland Corticotrophin releasing hormone - stimulates adrenal gland

Symptoms of Addison's disease

HYPERPIGMENTATION weight loss muscle weakness low bp hypoglycemia Hypotension hypokalemia

A. "I will have to take mineralocorticoids daily for 2 years." B. "I will have to take glucocorticoids and mineralocorticoids daily for 2 years." C. "When I experience signs of distress, I will have to take mineralocorticoids as needed." D. "I will have to take glucocorticoids and mineralocorticoids daily for life."

In regards to the previous question, you are also educating the patient about the post-opt care for a bilateral adrenalectomy. Which statement by the patient indicates they understood your instructions?

Humalog

Insulin with a rapid onset is prescribed

pituitary gland

Known as the master Gland

Rapid acting insulin- lower blood glucose after a meal must be taken just before or with meals. Onset: 0-15 Peak: 60 min Duration: 5 hrs or less

Lisopro (Humalog)

Methimazole

Medical management of hyperthyroidism can include:

combination-75/25 75% NPH and 25% lispro (Humalog® 75/25)

Onset: 0-15min Peak: 2-10 hrs Duration: 12-16hrs

Combination-70/30 70% NPH and 30% aspart (Novolog® 70/30)

Onset: 0-15min Peak: 2-10hrs Duration: 12-16hrs

Combinations:70/30 70% NPH and 30% regular (Novolin® 70/30)

Onset:30-60 min Peak: 2-10hrs Duration:12-16hrs

(Bolus types) lower blood glucose after a meal. MUST be taken just before or with meals.* Onset: 0-15 Peak:60 min Duration: 5hrs or less

Rapid acting

Best if administered 30 minutes before meals. The only insulin that can be administered IV.* Onset- 30-60 min Peak: 2-3 hrs Duration: 3-6hrs

Short-acting Insulin

Novilin (R)

Short-acting insulin Onset: 30-60 min Peak: 2-3 hrs Duration: 3-6hrs

Humalin (R)

Short-acting insulin Onset: 30-60 min, peak: 2-3 hr, duration: 3-6hrs

Symptoms of diabetic ketoacidosis

Tachycardia hypotension High blood sugar fruity breath Thristy Dehydration hyperkalemia polyuria

adrenal medulla

The body's response to stressors is known as "fight or flight." What part of the body is responsible for this phenomenon?

Urine specific gravity 1.001-1.005

The evaluation of urine and serum test results are indicated in the care of a patient suspected of diabetes insipidus. Which result is associated with this condition?

A. Oral anticoagulants B. Anabolic steroids C. Beta-adrenergic blockers D. Thiazide diuretics

The nurse administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

A. Tetany B. Hemorrhage C. Thyroid storm D. Laryngeal nerve damage

The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

A. Excessive sodium intake B. A pituitary adenoma C. Deficient potassium intake D. An adrenal adenoma

The nurse is aware that the following is the most common cause of hyperaldosteronism?

A. antidiuretic hormone (ADH). B. thyroid-stimulating hormone (TSH). C. follicle-stimulating hormone (FSH). D. luteinizing hormone (LH).

The nurse is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

A. Increasing saturated fat intake and fasting in the afternoon. B. Increasing intake of vitamins B and D and taking iron supplements. C. Eating a candy bar if lightheadedness occurs. D. Consuming a low-carbohydrate, high protein diet and avoiding fasting.

The nurse is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, what should the nurse recommend?

A. Increased appetite and weight loss B. Puffiness of the face and hands C. Nervousness and tremors D. Thyroid gland swelling

The nurse should expect a client with hypothyroidism to report which health concerns?

Glucagon

When a patient experiences a reduction in blood glucose levels, which hormone is secreted in response?

A. a blood pressure of 130/70 mm Hg. B. a blood glucose level of 130 mg/dl. C. a heart rate of 58 D. a blood pressure of 176/88 mm Hg.

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, what is the nurse most likely to detect?

A. vasopressin B. furosemide C. regular insulin. D. 10% dextrose.

When caring for a male client with diabetes insipidus, what should the nurse expect to administer?

A. Restricting fluids B. Restricting sodium C. Forcing fluids D. Restricting potassium

When instructing the female client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which of the following?

5-12 mcg/dL

When interpreting the results of the serum thyroxine test, which result is within normal range?

Sexual development will be delayed.

When providing teaching for the parents of a child diagnosed with dwarfism, which point should be included in the information presented?

Opiates

Which medication can be associated with the onset of syndrome of inappropriate antidiuretic hormone (SIADH)?

A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C. Body image disturbance related to weight gain and edema D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

A. Tetanic contractions B. Neck vein distention C. Weight loss D. Polyuria

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone secretion is experiencing complications?

A. Fluid intake is less than 2,500 ml/day. B. Urine output measures more than 200 ml/hour. C. Blood pressure is 90/50 mm Hg. D. The heart rate is 126 beats/minute.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

To compensate for the increase in body size, the caloric count of the patient should be closely monitored.

You are assigned to plan the care for a patient diagnosed with acromegaly. What considerations should be incorporated into the plan?

Acromegaly/Gigantism

________are the result of hypersecretion of growth hormone. Increased somatotropin.

diabetic ketoacidosis

acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy. Needs Fluids, Insulin, and potassium.

Long-acting (Basal type) -Insulin glargine (Lantus®)

administered once a day at bedtime. Cannot be mixed in the same syringe and should not be given with the same needle in the same place as a previous injection. This insulin has NO pronounced peak. onset: 1-2hrs Peak:none Duration: 24hrs

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol

Cushing syndrome symptoms

fatty hump between shoulders, a rounded moon face, and pink or purple stretch marks on skin, thinning fragile skin, slow healing of cuts, insect bites and infections, acne, decreased libido, decreased fertility, irregular or absent menstrual periods, fatigue, muscle weakness, cognitive difficulties, and headaches.

hyperthroidism

hyper function of the thyroid gland. Graves Disease

Novalin (N)

intermediate acting insulin or regular insulin Onset: 1-4 hours Peal: 6-10 hours Duration 12-16hrs

Humalin (N)

intermediate acting insulin or regular insulin Onset: 1-4hrs Peak:6-10hrs Duration 12-16hrs

Hypoglycemia

low blood sugar. Symptoms: anxious, sweaty, hungry, confused, blurred or double vision, shaky, irritable, cool clammy skin.

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

long-acting (Ultralente)

onset: 4-8hrs peak: 10-30hrs Duration: 36

symptoms of hypothyroidism

weigh gain, fatigue, slow heart rate and respiration rate, cold intolerance, receding hairline, brittle hair and nails, muscle aches and weakness, constipation, apathy, interolerance to cold.