Endocrine Content Post Test (8/10 Correct)

Radioactive Iodine Therapy for Hyperthyroidism

1 dose given PO or tablet *RULE OUT PREGNANCY* Destroys thyroid cells = hypothyroid (normal and expected) Follow radioactive precautions Watch for thyroid storm, which is hyperthyroidism x 100, which can be a rebound effect post-RAI

**Which selection by the client indicates to the nurse that the client understands food allowed during a vanillylmandelic acid (VMA) test? Select All That Apply 1. Milk 2. Caffeine 3. Citrus fruit 4. Chicken 5. Vanilla ice cream

1., & 4. Correct: Milk intake will not alter the production of epinephrine or norepinephrine. The client can drink milk prior to a VMA test. The period prior to a VMA test which measures the amount of production of epinephrine and norepinephrine would not require the client to eliminate chicken. Eating chicken would not alter the production of epinephrine or norepinephrine. 2. Incorrect: The client should not eat/consume caffeine as it will alter the test. 3. Incorrect: Citrus fruit and fruit juices will alter the accuracy of the VMA test which measures the amount of production of epinephrine and norepinephrine. 5. Incorrect: Vanilla ice cream contains vanilla, which can alter the vanillylmandelic acid (VMA) test.

Which clinical manifestation does the nurse expect to see in a client diagnosed with Addison's disease? Select All That Apply 1. Confusion 2. Hypertension 3. Vitiligo 4. Hyperkalemia 5. Hypernatremia 6. Weight gain

1., 3., & 4. Correct: Clients with Addison's disease may present with nonspecific symptoms of confusion. As the continual reduced functioning of the adrenal medulla and adrenal cortex occurs, the client will present with cognitive impairment, delusions, and hallucinations. The reduced blood cortisol increases the adrenocorticotropic hormones (ACTH) and the melanocyte-stimulating activity. The feedback mechanism results in the hyperpigmentation of skin. A deficiency of mineralocorticoids will result in the decreased excretion of potassium which results in hyperkalemia. 2. Incorrect: The client diagnosed with Addison's disease will present with hypotension. The decrease in the production of the adrenal cortex steroids results in the increased excretion of sodium. The sodium loss can cause severe dehydration, decreased circulation, and hypotension. 5. Incorrect: The increased excretion of sodium is the feedback action of the decreased level of adrenal cortex steroid. This action will result in hyponatremia. 6. Incorrect: The reduced glucocorticoid will result in weight loss not gain. This reduction is due to changes in the carbohydrate, fat, and protein metabolism.

The nurse is reviewing the primary healthcare provider's (PHP) initial prescriptions for a client diagnosed with diabetic ketoacidosis (DKA)? Which prescription from the PHP would the nurse question? Select All That Apply 1. Arterial blood gases 2. 500 ml D5W at 100 mL per hour 3. Serum glucose levels every hour 4. Hourly adjustment of Regular insulin IV according to serum glucose level protocol 5. 100 mL O.45% sodium chloride (NaCL) with potassium chloride KCL 10mEq IV

2. & 5. Correct: The clinical manifestation of DKA is a serum glucose level of greater than 300mg/dL. The goal of the treatment for DKA is to reduce the serum glucose level. Prescribing D5W will increase the client's serum glucose level which is already elevated. The prescription should begin with 0.9% NaCL. to compensate for the effects of polyuria, IV normal saline, an isotonic solution. An isotonic solution is composed of equal concentrations of solutes and water which will increase vascular volume. Initially the potassium is normal or high and can decrease when treatment begins. This prescription should be questioned. 1. Incorrect: The prescription for arterial blood gases is appropriate. The arterial blood gases will identify if the client is in metabolic acidosis. 3. Incorrect: The goal of the treatment for DKA is to reduce the elevated glucose level. The glucose levels of the client are evaluated hourly to monitor the efficiency of the treatment and assess for hypoglycemia. As the serum glucose level reduces to 250 -300 mg/dL the IV prescription will change from normal saline to D5W. 4. Incorrect: The glucose levels of the client are evaluated hourly to monitor the desired outcome of control of the serum glucose level. The Regular insulin prescription is adjusted according to the serum glucose levels. The objective of the Regular insulin prescription is to reduce the hyperglycemic episode without a hypoglycemic episode.

The nurse is providing dietary instructions to a client newly diagnosed with type 2 diabetes. Which food examples should make up the highest percentage of this client's recommended diet? Choose One 1. Pecans, eggs, pork chop 2. Wheat bread, dried beans, brown rice 3. Lean hamburger, fish, skinless chicken 4. Whole milk, cheese, dark chocolate

2. Correct: A calorie is the unit of energy needed to raise the temperature of 1 kilogram of water 1 degree of Celsius. Wheat bread, dried beans, and brown rice are complex carbohydrates. The breakdown of complex carbohydrates occurs at a slower rate which decreases the possibility of increases and decreases in the serum glucose level. The recommended percentage of calories from carbohydrates is 45% of the daily diet. 1. Incorrect: The listed foods are high in protein. The intake of proteins will reduce appetite because protein takes longer to digest in the stomach. This results in a person feeling fuller for a extended period. The recommended percentage of daily calories from proteins is 15 -20% for both a regular diet and a diabetic diet. Proteins are beneficial to build, repair, and maintain the body's tissues. Protein with high levels of fat can cause both a weight gain and an increase in the serum glucose levels. Also a high intake of protein has not proven to influence the level of serum glucose levels. 3. Incorrect: The foods that are listed are high in protein which should consist of 15 - 20% of the diabetic diet. The intake of various amounts of high protein foods will not affect the client's glucose level. 4.Incorrect: The monounsaturated and polyunsaturated fats such as milk, cheese and chocolate in the diet functions such as components of cell membranes, energy storage, energy storage, and fat-soluble vitamin A, D, E and K. The intake of fat does not cause an increase or decrease in serum glucose levels.

A nurse is caring for a client with a possible diagnosis hyperparathyroidism. Which serum laboratory value would validate this diagnosis? Select All That Apply 1. BUN 12 mg/dL (4.28 mmol/L) 2. Calcium 12 mg/dL (3 mmol/L) 3. Sodium 140 mg/dL (140 mmol/L) 4. Phosphate 2.8 mg/dL (0.9 mmol/L) 5. Potassium 3.5 mEq/L (3.5 mmol/L)

2., & 4 Correct: Normal calcium range is 9.0 -10.5 mg/dl (2.25-2.62 mmol/L). The client's calcium level is 12 mg/dL (3 mmol/L) which is above normal range. Parathyroids secrete parathormone (PTH) for remodeling of the bones. PTH stimulates transfer calcium from the bone to the blood. Parathyroidism, an excess of PTH production by the parathyroids, will result in an increase in calcium movement from the bone to the blood. The normal range for phosphate is 3.0 - 4.5 mg/dL (0.97-1.45 mmol/L). The client's phosphate level is 2.8 mg/dL (0.9 mmol/L) which is below normal range. Parathyroidism, an excess of PTH production by the parathyroids, reduces the reabsorption of phosphorus in the kidneys. The result is that there is an increase in the excretion of phosphorus in the urine resulting in a decreased serum phosphorus level. 1. Incorrect: The normal range for BUN is 10-20 mg/dl (3.6-7.1 mmol/L). The client's BUN level is 12 mg/dL (4.28 mmol/L). 3. Incorrect: The normal range for sodium is 135 - 145 mEq/L (135-145 mmol/L). The client's sodium level is 140 mEq/dL (140 mmol/L). 5. Incorrect: The normal range for potassium is 3.5 -5.0 mEq/L (3.5-5.0 mmol/L). The client's potassium level is 3.5 mEq/dL (3.5 mmol/L).

The nurse is initiating a client assessment. What signs and symptoms would validate the client's diagnosis of Cushing's disease? Select All That Apply 1. Hypoglycemia 2. Mood alterations 3. Lipolysis 4. Truncal obesity 5. Hirsutism 6. Hyperkalemia

2., 3., 4., & 5. Correct: The client will experience mood swings. Several of the clinical manifestations of Cushing's are related to significant physical changes which can result in periods of depression for the client. Another clinical manifestation is lipolysis which is the breakdown of adipose tissue and the thinning of the extremities. Truncal obesity (apple-shaped obesity) is the distribution of adipose tissue located in the abdominal area. Hirsutism is when a female develops male characteristics such as increased hair on the face. When the adrenal cortex is stimulated there is an increase production of adrenal androgen. This results in the increased production of testosterone, a sex hormone. 1. Incorrect: The clinical manifestation of Cushing's is hyperglycemia not hypoglycemia. The increase adrenocortical activity in the adrenal cortex will result in hyperglycemia. 6. Incorrect: Client's diagnosed with Cushing's disease will present with hypokalemia not hyperkalemia. This is the result from increased adrenocortical activity which results in a decrease in potassium levels, hypokalemia

A nurse on a surgical unit is assigned a client who had a total thyroidectomy 3 days ago. As the nurse enters the room which nursing assessment is the priority for this client? Choose One 1. Eating a soft diet. 2. Positioned at 15 degrees in bed. 3. States hands are tingling. 4. Expresses frontal neck pain level of 5 out of 10.

3. Correct: Hypocalcemia is a severe complication of a thyroidectomy due to damage to the parathyroid. The negative feedback of a low parathyroid hormone (PTH) results in a decrease in serum calcium. PTH regulates the amount of calcium levels in the blood. Symptoms of hypocalcemia include numbness, and tingling on the extremities and face. As the calcium levels decrease the client may present with tetany and spasm of the larynx. 1. Incorrect: The postoperative diet for a client post thyroidectomy begins with ice chips and progresses to a liquid diet for approximately 2 days, and then a soft diet. The last dietary step is diet as tolerated. As the diets progress, the nurse should assess the ability of the client to swallow and changes in the voice such as hoarseness may indicate swelling. 2. Incorrect: On the 3rd postoperative day the client's bed can be positioned at 15 degrees. The nurse should monitor the client's airway for any problems with breathing. If the client experiences any airway difficulty, the nurse should change the bed to a semifowlers or high fowlers position. 4. Incorrect: Whenever a client problem such as pain is identified, a nursing intervention must address the problem. The priority intervention is to address the assessment of the client stating that their hands are tingling. Symptoms of hypocalcemia include numbness and tingling of the extremities and face.

**Which laboratory test should be assessed by the nurse prior to administering radioactive iodine (RAI) to a female client? Choose One 1. Thyroid Scan 2. Serum calcium 3. Pregnancy test 4. Metanephrine test

3. Correct: RAI crosses the placenta and will affect the development of the fetus. If RAI is administered to a client who is pregnant, the fetus can experience mental retardation, hypothyroidism, and develop increased cancer risk. It is imperative that a pregnancy test should be prescribed prior to administering RAI. RAI should not be administered to a client who has a positive pregnancy test. 1. Incorrect: A thyroid scan is prescribed to evaluate the function and size and shape of the thyroid gland. This scan can identify the amount of thyroid hormone the thyroid is producing (hyperthyroidism) Also the thyroid scan will evaluated for the presence of thyroid nodules. Prior to the administration of RAI, the female client should have a pregnancy test prescribed. This test will not identify if the client is pregnant. 2. Incorrect: A calcium test is prescribed to analyze the calcium level in conditions affecting nerves, parathyroid, kidney, and thyroid. Since this test does not identify whether a client is pregnant, a calcium test result is not related to whether the nurse administers the RAI. 4. Incorrect: The metanephrine test measures the amount of metanephrine in urine. The breakdown of catecholamines results in metanephrine. The catecholamines are epinephrine, norepinephrine and dopamine. The female client should be evaluated for pregnancy prior to administrating RAI.

During a clinic visit 3 months following a client's diagnosis of type 2 diabetes, the client reports following a 1200 calorie diet and did not bring their glucose-monitoring record. The nurse will anticipate the prescription of which laboratory test? Choose One 1. Fasting blood glucose test 2. Urine glucose test 3. Glucose tolerance test (GTT) 4. Glycosylated hemoglobin level (HbA1C)

4. Correct: The glycosylated hemoglobin (Hb A1C) test identifies the average serum glucose attached to hemoglobin over 90 days. The 90 days is correlated with 90 day life of hemoglobin. This test is reflective of how well the client's diabetes is controlled. The client has no restrictions prior to the test. 1. Incorrect: A fasting blood level indicates only the glucose level for at least 8 hours. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. 2. Incorrect: Urine glucose testing is not an accurate reflection of blood glucose level and does not identify the average glucose level over a prolonged time. The test will identify whether there is an elevated amount of glucose in the urine. 3. Incorrect: Glucose tolerance requires the client fast for the first serum sample and then drink a glucose drink with serum samples taken at specified times. This client has not fasted prior to the office visit. This test is not appropriate at this time.

Addison's Disease

Adrenocortical insufficiency Not enough steroids Do not have enouch glucocorticoids, mineralocorticoids (aldosterone), or sex hormones Not enough aldosterone = lost Na and water with increased K FVD risk

Mineralocorticoids

Aldosterone- retain H20 and Na, excrete K

The client has been prescribed 0.6 units of insulin/kg /day. The client weighs 214 pounds (97 kg). What is the amount of insulin the client can receive in a day? (Round to the nearest whole number)

Answer: 58 units per day 97 kg x 0.6 units = 58.2 units = 58 units The average adult dose of insulin is 0.4-1.0 units/kg/day. Rounding Rules for Whole Units: 0.1 -0.4 = round down to whole unit 0.5-0.9 = round up to whole unit

Foods that Alter VMA and MN test

Anything with vanilla in it; caffeine, vitamin B, fruit juices, bananas

Phemochromocytoma Alert

Avoid palpating the abdomen of a client with a suspected pheochromocytoma as it may cause sudden release of catecholamines and severe HTN

Pheochromocytoma Diagnosis

Catecholamine levels- VMA test or MN test 24 hour urine specimen to screen for increased levels of epi and norepi (catecholamines) Avoid activities that can increase episodes and norepi prior to tests

Glucocorticoid Actions

Change your mood Alter defense mechanisms = infection risk Breakdown fats and proteins Inhibit insulin = hyperglycemia risk

Thyroid Scan Alert for Hyperthyroidism

Client must discontinue any iodine containing medication 1 week prior to thyroid scan and must wait 6 weeks to restart medications (i.e. Amiodarone/Cordarone- antiarrhytmic drug with high levels of iodine that can affect thyroid function)

Adrenal Medulla

Epinephrine and norepinephrine

Adrenal Cortex

Glucocorticoids, mineralocorticoids, and sex hormones

Adrenal Glands

Handle stress Includes adrenal medulla and adrenal cortex

Hyperparathyroidism Treatment

IV Calcium Phosphorous Binding Drugs

Hypothyroid Treatment

Levothyroxine (Synthroid), Liothyronin (Cytomel) Take on empty stomach 30 min before meals Tend to also have CAD, so we worry about an MI when these meds are started Lifelong therapy Effectiveness of Tx- increased energy

ACTH

Made in pituitary and stimulates cortisol to be made Cortisol is hormone of adrenal cortex Increased ACTH = increased cortisol

Anti-Thyroid Meds for Hyperthyroidism

Methimazole (Tapazole) and PTU Used preoperatively to stun thyroid

Hyperthyroidism S/S

Nervous, irritable, decreased attention span, increased appetite, decreased weigh, sweaty/hot, exophthalmos, fast GI, increased BP and HR, arrhythmias/palpitations, hypertrophied thyroid size TSH decreased, T4 increased

Hypothyroid S/S

No energy, fatigue, no expression, slow/slurred speech, weight gain, cold, amennorhea T4 decreased, TSH increased

Adrenal Medulla Problem

Pheochromocytoma- benign tumors that secrete epi and norepi in boluses; familial S/S- increased BP, HR, palpitations, flushing, diaphoresis, HA Tx- surgical removal of tumors

Iodine Compounds for Hyperthyroidism

Potassium Iodine (SSKI and Lugol's Solution) Decrease size and vascularity of gland All endocrine glands are VERY VASCULAR Give in milk or juice with straw b/c it stains teeth

Thyroidectomy

Priority = Hemorrhage S/S- Pressure in neck Assess for recurrent laryngeal nerve damage (hoarseness) b/c it can result in vocal cord paralysis = airway obstruction with immediate trach Assess for hypocalcemia (partial removal of parathyroid) Keep personal items close to reduce suture tension HOB elevated to reduce edema More calories needed

Beta Blockers for Hyperthyroidism

Propranolol (Inderal) Decreases myocardial contractility Decreases CO Decreases HR and BP Decreases anxiety *Do NOT give to asthmatics or diabetics

Thyroid Gland Produces These 3 Hormones

T3, T4, and Calcitonin

Sex Hormones

Testosterone, estrogen, progesterone

Addison's Disease Treatment

combat shock (losing Na and water) (losing volume) increase Na in diet- processed fruit/juice broth lots of Na I and O and daily weight because FV issue- losing weight check Vs - BP down FV deficit Meds

Addison's Disease S/S

extreme fatigue nausea, vomiting, and diarrhea anorexia/weight loss hypotension confusion decreased sodium, increased potassium and hypoglycemia hyperpigmentation bronzing color of the skin and mucous membranes white patchy area of depigmented skin (vitiligo)

Adrenal Cortex Problems

not enough steroids shock hyperkalemia hypoglycemia