N406: Unit 11 - Exam 3
Thyroid Diagnostic Tests
- TSH: thyroid stimulating hormone - high TSH can indicate that it does not make enough thyroid hormone, and low TSH means the thyroid is making too much - high TSH = hypothyroidism - low TSH = hyperthyroidism
Aldosterone
- "salt-retaining hormone" which promotes the retention of Na+ by the kidneys - na+ retention promotes water retention, which promotes a higher blood volume and pressure
Clinical Manifestations of diabetes
- 3 Ps - fatigue - weakness - vision changes - tingling or numbness in hands or feet - dry skin - skin lesions or wounds that heal slowly - recurrent infections - type 1 can have sudden weight loss
Posterior Pituitary Gland Hormones
- ADH, vasopressin, Oxytocin - Hyper: SIADH** - Hypo: DI - Tumors: 95% benign - Surgery: hypophysectomy
Hypoglycemia
- Abnormally low blood glucose level (below 50 to 60 mg/dL) - caused by too much insulin or oral hypoglycemic agents, excessive physical activity, and not eating enough food - Signs and symptoms can include: - sweating, tremors, tachycardia, palpitations, nervousness, hunger, inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness - Severe hypoglycemia: disorientation, seizures, loss of consciousness, death - Treatment: Give 15 g of fast-acting, concentrated carbohydrate - Three or four glucose tablets - 4 to 6 oz of juice or regular soda (not diet soda) then retest blood glucose in 15 minutes; retreat if >70 mg/dL or if symptoms persist more than 10 to 15 minutes and testing is not possible - Provide a snack with protein and carbohydrate unless the patient plans to eat a meal within 30 to 60 minutes - If the patient cannot swallow or is unconscious: Subcutaneous or intramuscular glucagon (1 mg) then 25 to 50 mL of 50% dextrose solution IV
Adrenocorticol insufficiency
- Addison's Disease - adrenal suppression by exogenous steroid use
Hypoparathyroidism
- Causes: - abnormal parathyroid development -destruction of the parathyroid glands (surgical removal or autoimmune response) -vitamin D deficiency
Type 1 Diabetes
- Diabetes of a form that usually develops during childhood or adolescence and is characterized by a severe deficiency of insulin, leading to high blood glucose levels - Risk Factors: early-onset, familial, genetic predisposition, possible immunologic or environmental (viral or toxins) factors
Anterior Pituitary Gland Hormones
- FSH, LH, prolactin, ACTH, TSH, GH - Hyper: Cushing syndrome, gigantism, acromegaly - Hypo: dwarfism, panhypopituitarism
Adrenal Medulla
- Functions as part of the autonomic nervous system - fight or flight - Catecholamines; epinephrine and norepinephrine - increases the heart rate and blood pressure, preparing the body to fight or flee
Management of Hypoparathyroidism
- Increase serum calcium level to 9 to 10 mg/dL - Calcium gluconate IV - Pentobarbital to decrease neuromuscular irritability - Parathormone may be administered; potential allergic reactions - Quiet environment; no drafts, bright lights, or sudden movement - Diet high in calcium and low in phosphorus - Vitamin D
Long term complications of diabetes
- Macrovascular: accelerated atherosclerotic changes, coronary artery disease, cerebrovascular disease, and peripheral vascular disease - Microvascular: diabetic retinopathy and nephropathy - Neuropathic: peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction
What are the signs and symptoms of hyperthyroidism?
- Nervousness/anxiety - irritability - rapid pulse - heat intolerance - tremors - skin flushed, warm, soft, and moist - increased appetite - weight loss - elevated systolic BP - cardiac dysrhythmias
Parathyroid hormone
- PTH - peptide - increases blood calcium levels
Medical Management of Hyperthyroidism
- Radioactive iodine radiation therapy; Iodine should be mixed with juice or water administered with straw after meals; not with milk; note for iodine toxicity - First Line Drugs: Propylthiouracil (PTU); take 3 times daily and Tapazol (Methimazole) once daily - Dexamethasone - Beta blockers to reduce heart rate: propranolol (Inderal) and atenolol (Tenormin) - see effects in 50 days - Surgical: subtotal thyroidectomy preferred - Nutrition: high calorie diet, frequent feedings, no spicy or high fiber and caffeine containing foods
Thyroid Hormones
- T3, T4, Calcitonin - iodine contained in thyroid hormone - TSH from the anterior pituitary controls the release of thyroid hormone - Controls cellular metabolic activity - T3 is more potent and rapid-acting than T4 - Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone
Pituitary Gland
- The endocrine system's most influential gland - often called the "master gland" because its hormones control other parts of the endocrine system which are the thyroid gland, adrenal glands, ovaries, and testes - Under the influence of the hypothalamus, this regulates growth and controls other endocrine glands.
Adrenal Cortex
- Think: salt, sugar, sex - secrete glucocorticoids, mineralocorticoids, androgens
Cushing Syndrome
- a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time - Cortisol helps maintain blood pressure and regulate blood glucose - majority of cases diagnosed today are the result of administering high doses of corticosteroid drugs for various health conditions (e.g., autoimmune disease). - Common corticosteroids prescribed include prednisone, prednisolone, and methylprednisolone.
Addisonian Crisis
- a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium - give oral corticosteroids
Adrenal Glands
- a pair of endocrine glands that sit just above the kidneys - produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions - have 2 parts: cortex and medulla - when these do not produce enough hormones, this can lead to adrenal insufficiency (S's disease)
Thyroid Storm
- a relatively rare, life threatening condition caused by exaggerated hyperthyroidism - Increased HR, palpitations, dyspnea on mild exertion, weight loss, warm smooth moist skin, fine hair, heat intolerance, nervousness
Chvostek Sign
- a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye - found in patients with hypocalcemia
Diabetic Ketoacidosis (DKA)
- absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat - most common in type 1 diabetics - Blood glucose levels > 300 - Ketoacidosis is reflected in low serum bicarbonate, low pH; low PCO2 reflects respiratory compensation (Kussmaul respirations) - Ketone bodies are in blood and urine - Electrolytes vary according to degree of dehydration; increase in creatinine, Hct, BUN - Treatment: - Rehydration with IV fluid - IV continuous infusion of regular insulin - Reverse acidosis and restore electrolyte balance - Monitor blood glucose, renal function and urinary output, ECG, electrolyte levels, VS, lung assessments for signs of fluid overload
ACTH
- adrenocorticotropic hormone - Stimulates the adrenal gland to produce a hormone called cortisol - also known as corticotrophin
Hyperparathyroidism
- an endocrine disorder with multiple etiologies and is characterized primarily by excessive secretion of parathyroid hormone (PTH) from one or more parathyroid glands - Hypercalcemia, hypophosphatemia (i.e., low concentrations of serum phosphate), increased excretion of both calcium and phosphate by the kidneys, demineralization of bone, pathologic fractures, and a host of complications associated with high concentrations of serum and urinary calcium result from elevated PTH levels
Tetany
- an increased excitability of the nerves due to hypocalcemia - general muscle hypertonia - tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements
ADH
- antidiuretic hormone - kidneys controls the blood fluid and mineral levels in the body by affecting water retention by the kidneys - This hormone is also known vasopressin or argenine vasopressin (AVP)
Dexamethasone Suppression Test
- blood analysis for cortisol levels after administration of synthetic glucocorticoid - After you take a dose of it, your body should make less cortisol - That's the idea behind the test -- take some dexamethasone and see whether your cortisol level drops - Usually, the test is done overnight, but it can also be done over 2 days - low-dose test helps you find out if you have Cushing syndrome or not; you typically get 1 mg of dexamethasone - You'd get the high-dose test once you know you have Cushing syndrome - It's done to find out whether it's caused by a tumor on your pituitary gland - The high dose is typically 8 mg.
Trousseau Sign
- carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff - found in hypocalcemia
Hyperglycemia Hyperosmolar Syndrome
- caused by a lack of sufficient insulin; ketosis is minimal or absent - Hyperglycemia causes osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased osmolality - Manifestations include hypotension, profound dehydration, tachycardia, extremely high blood glucose levels, and variable neurologic signs caused by cerebral dehydration - high mortality rate - treatment: Rehydration Insulin administration Monitor fluid volume and electrolyte status Prevention BGSM Diagnosis and management of diabetes Assess and promote self-care management skills
LH and FSH
- control ovulation/the menstrual cycle in women and sperm production in men - Controls reproductive functioning and sexual characteristics - Stimulates the ovaries to produce estrogen and progesterone and the testes to produce testosterone and sperm
Signs and Symptoms of Cushing Syndrome
- hyperglycemia - central-type obesity with "buffalo hump" - heavy trunk and thin extremities - fragile, thin skin - ecchymosis - striae - weakness - sleep disturbances - osteoporosis - muscle wasting - hypertension - "moon-face" - acne - increased serum sodium - decreased serum potassium
Acute Complications of Diabetes
- hypoglycemia - DKA - hyperglycemic hyperosmolar syndrome (HHS)
Signs and Symptoms of Addison's Disease
- hyposecretion of aldosterone and cortisol causes: - Muscle weakness - anorexia - GI symptoms n/v - fatigue - orthostatic hypotension - dark pigmentation of skin and mucosa - hypotension - low serum sodium due to low aldosterone - high serum potassium due to low aldosterone - hypoglycemia due to low cortisol - emotional lability - confusion
Signs and Symptoms of Hyperparathyroidism
- the patient may have no symptoms or may experience signs and symptoms resulting from involvement of several body systems - Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias may occur
Hypothalamus Key Processes
- involved in many functions of the autonomic nervous system, as it receives information from nearly all parts of the nervous system - Regulates: Heart rate and blood pressure - Body temperature - Fluid and electrolyte balance, including thirst - Appetite and body weight - Glandular secretions of the stomach and intestines - Production of substances that influence the pituitary gland to release hormones - Sleep cycles
Hypothalamus
- located at the base of the brain near the pituitary gland - plays a crucial role in many important functions including releasing hormones and regulating body temperature - Two hormones are produced by this and then stored in the posterior pituitary gland before being secreted into the bloodstream - These are: anti-diuretic hormone (also called vasopressin), which controls water balance and blood pressure - is highly involved in pituitary gland function - When it receives a signal from the nervous system, the hypothalamus secretes substances known as neurohormones that start and stop the secretion of pituitary hormones
Androgens
- male sex hormones - Excess amounts can cause a problem, resulting acne, hirsutism (excess hair growth in "inappropriate" places, like the chin or upper lip) and thinning of hair on the head (balding) - low levels can cause low libido, fatigue, osteoporosis
Postoperative Care for Thyroidectomy
- monitor RR; potential airway impairment - monitor for potential bleeding and hematoma formation - assess pain and give meds - semi fowler position - SUPPORT head and neck! - assess voice, discourage talking - potential hypocalcemia so check for Trousseu's and Chvostek's sign
Hyperthyroidism
- occurs when your thyroid gland produces too much of the hormone thyroxine - autoimmune disorder - affects women eight times more than men - Graves Disease is the most common cause - Thyrotoxicosis: excessive output of thyroid hormone (thyroid storm)
Endocrine System
- plays a vital role in maintaining homeostasis; orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions - regulates other body activities such as reproduction and growth - made up of ductless glands which release hormones directly into the bloodstream from where they're carried to every cell within the body - hormones act on specific receptors on specific target cells - some hormones bind to receptors located on the cell surface while others bind to receptors inside the cell
Thymus Gland
- plays an important role in the development of a normal, healthy immune system - The function of the thymus gland is to generate mature T lymphocytes (white blood cels that help the immune system fight off illness)
Pineal Gland
- produces and regulates melatonin - regulates sleep cycles
Adrenal Gland
- produces hormones such as cortisol (which helps regulate metabolism and helps your body respond to stress) and aldosterone (which helps control blood pressure)
Thyroid Gland
- produces hormones that regulate the body's metabolic rate as well as heart and digestive function, muscle control, brain development, mood and bone maintenance - Its correct functioning depends on having a good supply of iodine from the diet - Also regulates calcitonin - controls oxygen consumption, carbohydrate, fat, and protein metabolism, electrolyte mobilization, and vitamin A synthesis
Anterior Pituitary Gland
- produces the following hormones and releases them into the bloodstream: adrenocorticotropic hormone, which stimulates the adrenal glands to secrete steroid hormones, principally cortisol, growth hormone, which regulates growth, metabolism and body composition
Type 2 Diabetes
- progressive disorder in which body cells become less responsive to insulin and cause high glucose levels - insulin resistance - Risk factors: obesity, age, previous identified impaired fasting glucose or impaired glucose tolerance, hypertension ≥140/90 mm Hg, HDL ≤35 mg/dL or triglycerides ≥250 mg/dL, history of gestational diabetes or babies over 9 pounds
Exopthalmus
- protrusion of the eyes out of the eye socket - occurs with hyperthyroidism
Thyroid Storm Treatment
- reduce heart rate and temperature with a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol) - propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland. - beta blockers to reduce patient's heart rate - interventions to reduce body heat
Glucocorticoids
- regulate metabolism - critical in stress response - Cortisol: responsible for control and metabolism of carbs
Islets of Langerhans
- several different types of cell clusters in the pancreas - example: alpha cells make the hormone glucagon, which raises the glucose level in the blood - Beta cells make the hormone insulin, which lowers the glucose level.
Parathyroid Glands
- small pea-like organs that regulate calcium and phosphate balance in blood, bones, and other tissues - imbedded in the thyroid - usually 4 glands but can vary 2-10 - normal ranges for calcium: 8.5-10.5
Hyperparathyroidism Treatment
- surgical removal of abnormal parathyroid tissue - hydration therapy - Primary: CURED with surgery - Secondary: treated with Vitamin D
SIADH
- syndrome of inappropriate antidiuretic hormone - a condition in which the body makes too much antidiuretic hormone (ADH): this hormone helps the kidneys control the amount of water your body loses through the urine - SIADH causes the body to retain TOO MUCH water - need to restrict fluids!
Endocrine System Hormones
- the endocrine system secretes hormones that affect almost all cells, organs, and functions of the body - They have a close interaction of the nervous system and the immune system with the endocrine system - Most hormones are controlled by negative feedback, in which the hormone feeds back to decrease its own production; this type of feedback brings things back to normal whenever they start to become too extreme - Hormones: amines and amino acids, preptide (protein) acts on cell surfaces, steroids act inside the cell, fatty acid derivative
TSH
- thyroid stimulating hormone - Stimulates the thyroid gland to secrete its own hormone, which is called thyroxine - also known as thyrotrophin
Thyroidectomy
- treatment of choice for thyroid cancer - modified or radical neck dissection, possible radioactive iodine to minimize metastasis - preoperative goal: reduce stress and anxiety to avoid precipitation of thyroid storm - Preop education: dietary guidance to meet patient's metabolic needs, avoid caffeine, explain procedure, support head and neck after surgery!
Signs and Symptoms of Hypoparathyroidism
-Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospasm, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes - can cause seizures
What are the 3 P's of diabetes?
1. polyuria (excessive pee) 2. polydipsia (excessive thirst) 3. polyphagia (excessive hunger)
A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client's care plan? Select all that apply: A. Monitor gait, balance, and fatigue level with ambulation B. Encourage intake of dairy products, seafood, nuts, broccoli, and spinach C. Monitor for fluid overload D. Monitor for signs and symptoms of diarrhea.
A, C Rationale: Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet.
True or False? Oversecretion of adrenocorticotropic hormone (ACTH) or the growth hormone results in Graves' disease.
False Oversecretion of ACTH or growth hormone results in Cushing disease. Graves' disease results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins
The nurse is assessing a patient who voices concerns about having thyroid disease. Which question by the nurse is most appropriate? a. "have you experienced muscle spasms or cramping?" b. "Have you experienced tingling, numbness, or changed in sensation?" c. "Have you experienced weight gain or loss during the past 3 months?" d. "Have you experienced episodes of shakiness, sweating, or extreme hunger?"
C. "Have you experienced weight gain or loss during the past 3 months?" Rationale: Thyroid disorders have symptoms of weight loss (hyperthyroidism) or weight gain (hypothyroidism). Asking a patient about recent weight changes will help the nurse determine if there is a thyroid disorder concern. Symptoms of hyperthyroidism include tachycardia, heat intolerance, amenorrhea, weight loss, anxiety, tremor, hypertension, irregular heart rate, palpitations, sweating, fatigue, diarrhea, protruded eyes (exophthalmos), and insomnia. Hypothyroidism symptoms include bradycardia, sexual dysfunction, irregular uterine bleeding, cold sensitivity, weight gain, lethargy, dry skin, constipation, hair loss, and sluggishness. Questions regarding these symptoms would help direct more tests to determine thyroid dysfunction.
True or False? A patient in acute hypercalcemic crisis requires close monitoring for life-threatening complications and prompt treatment to reduce serum calcium levels.
True
Which of the following are clinical manifestations of Cushing Syndrome? Select all that apply: a. weight gain b. moon face c. purple/red striae d. Hyperkalemia e. Hypokalemia f. Hyponatremia
a, b, c, e Rationale: Clinical manifestations of Cushing's include: weight gain, moon face w/plethora, purple/red striae, buffalo hump, supraclavicular fat pad, thin hair, acne, hyperglycemia, HTN, muscle wasting, loss bone matrix, delay wound healing, hypokalemia & hypernatremia
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? Select all that apply: a. "Internal secretion of hormones is the function of the endocrine pancreas." b. "Internal secretion of hormones is the function of the exocrine pancreas." c. "The endocrine pancreas secretes hormones through a ductless gland." d. "The exocrine pancreas secretes hormones from excretory ducts." e. "The exocrine pancreas secretes pancreatic enzymes into the GI tract."
a, c, d, e Rationale: The pancreas has both endocrine and exocrine functions. The endocrine pancreas secretes hormones internally through a ductless gland. The exocrine pancreas secretes external hormones from excretory ducts. Also, the exocrine pancreas secretes pancreatic enzymes into the GI tract.
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? a. "You should take your insulin after you eat breakfast and dinner." b. "Your insulin will begin to act in 15 minutes." c. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." d. "Your insulin will last 8 hours, and you will need to take it three times a day."
a. "You should take your insulin after you eat breakfast and dinner." Rationale: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours
You can elicit Trousseau's sign in a patient with hypocalcemia by: a. Applying a BP cuff to her upper arm, inflating it, and observing for carpopedal spasm b. Tapping a finger on the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the side opposite the stimulation c. Tapping a finger on the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as the stimulation d. Having the patient hyperventilate (breath more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory acidosis
a. Applying a BP cuff to her upper arm, inflating it, and observing for carpopedal spasm Rationale: Trousseau's sign is elicited by applying a blood pressure cuff to the patient's arm, inflating it to the patient's systolic pressure, and observing for carpopedal spasm. Another method for producing this phenomenon is hyperventilation, in which the alkalotic state decreases serum calcium levels.
What category of insulin is rapid acting? a. Humalog b. Humalog R c. Humulin N d. Glargine (Lantus)
a. Humalog Rationale: Aspart is a rapid-acting insulin, Humalog R is a short-acting insulin, Humulin N is an intermediate-acting insulin, and Glargine (Lantus) is a very long-acting insulin
The nurse is caring for a patient who underwent removal of the thyroid gland (thyroidectomy) three days ago. The patient's serum chemistries reveal calcium of 3.2 mg/dL, potassium of 3.9 mEq/L, and phosphorus of 4.0 mg/dL. What condition do these findings indicate? a. Hypocalcemia b. Hypercalcemia c. Hyperkalemia d. Hypophosphatemia
a. Hypocalcemia Rationale: Hypocalcemia is a low serum calcium level. Surgical removal of the thyroid gland may also include removal of the parathyroid gland. This results in a deficiency of parathyroid hormone, which controls serum calcium by regulating absorption of calcium from the GI tract, mobilizing calcium in bones, and excreting calcium in breast milk, feces, sweat, and urine. The normal serum calcium level ranges from 9.0 to 11.5 mg/dL. Potassium is within normal limits (3.5 to 5 mEq/L), and phosphorus is also within normal limits (2.8 to 4.5 mg/dL).
Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply: a. Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain b. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones c. The pituitary gland is called the master gland because it regulates the function of the hypothalamus and other endocrine glands d. The hypothalamus is called the master gland because it regulates the function of the pituitary gland.
a. Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain b. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones Rationale: Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands. Hypothalamus and pituitary integrate communication between nervous and endocrine system.
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: a. rapid-acting insulin only b. short- and intermediate-acting insulins c. intermediate- and long-acting insulins d. short- and long-acting insulins.
a. rapid-acting insulin only Rationale: A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.
A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply: a. Leukocytosis b. Glycosuria c. Dehydration d. Hypernatremia e. Hyperglycemia
b, c, d, e Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.
A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patients immediate care? Select all that apply: a. Administering diuretics to prevent fluid overload b. Administering beta blockers to reduce heart rate c. Administering insulin to reduce blood glucose levels d. Applying interventions to reduce the patients temperature e. Administering corticosteroids
b, d Rationale: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? a. A serum glucose level b. Glucose tolerance test in combination with a GH measurement c. Growth hormone levels d. Bone radiographs
b. Glucose tolerance test in combination with a GH measurement Rationale: •A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
Which medication blocks synthesis of thyroid hormone? a. Dexamethasone b. Methimazole c. Potassium iodide d. Sodium iodide
b. Methimazole Rationale: Dexamethasone, potassium iodide, SSKI, and sodium iodide suppress release of thyroid hormone.
The nurse is teaching the patient, newly diagnosed with Graves's disease, about the normal functioning of the thyroid gland. What hormone will the nurse tell the patient controls production and release of thyroid hormones? a. Thyrotropin-releasing hormone (TRH) b. Thyroid-stimulating hormone (TSH) c. Tetraiodothyronine d. Triiodothyronine
b. Thyroid-stimulating hormone (TSH) Rationale: Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroid-stimulating hormone (TSH).
A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which assessment finding supports this diagnosis? a. Periorbital edema b. Bradycardia c. Exophthalmos d. Hoarse voice
c. Exophthalmos Rationale: Exophthalmos (abnormal protrusion of the eyes) is characteristic of patients with hyperthyroidism due to Graves disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a. Thyroid storm b. Cretinism c. Myxedema coma d. Hashimoto's thyroiditis.
c. Myxedema coma Rationale: 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
A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c. Purplish streaks on the abdomen d. Decreased axillary & public hair
c. Purplish streaks on the abdomen Rationale: Purplish streaks on the abdomen are a common manifestation of Cushing syndrome. Manifestations of Addison's disease include: hypotension & bronzed appearing skin. Manifestations of androgen deficiency include: decreased axillary & public hair
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? 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
c. Restricting fluids Rationale: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
An RN is caring for a client who had a thyroidectomy 2 days ago. Based on the findings of the client's serum lab report, which medication should the nurse plan to administer first?
calcium gluconate 4.5 mEq IV Rationale: hypocalcemia can occur if parathyroid is removed
The nurse analyzes the laboratory results for thyroid function and notices elevation of thyroid stimulating hormone (TSH) and decreased free thyroxine index and T4. The nurse will expect medication which will treat which thyroid condition? a. Hyperthyroidism b. Hypophysectomy c. Graves' Disease d. Hypothyroidism
d. Hypothyroidism Rationale: This answer is correct because laboratory results of elevated TSH with decreased free thyroxine and T4 indicates hypothyroidism. The elevation of TSH shows a need for thyroid hormone so the pituitary is producing more TSH to stimulate the thyroid to produce more hormone that it is lacking, namely free thyroxine and T4. Unfortunately, the thyroid is not working properly due to hypothyroidism and cannot produce these hormones despite being stimulated to produce.
