Test 3

how to take thyroid hormone replacement

in the morning on an empty stomach; don't eat anything for 30-60 mins (needs to be absorbed)

diabetes insipidus

increased HCT (r/t dehydration) tachycardia, low urine SG, increased BUN

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

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage." Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

"You must avoid coughing, sneezing, and blowing your nose." After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

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

"You must avoid hyperextending your neck after surgery."

4. A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient's family is with the patient and reports that before the patient became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the patient has not been taking any medications. The patient was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient's blood pressure is 70/45. What disorder is this patient most likely experiencing? A. Addisonian Crisis B. Cushing Syndrome C. Thyroid crisis D. Hashimoto thyroiditis

A

5. In the scenario above, what medication do you expect the patient to be started on? A. IV Solu-Cortef B. PO Prednisone C. PO Declomycin D. IV Insulin

A The answer is A. The patient needs cortisol immediately because they are experiencing Addisonian Crisis. IV Solu-Cortef is the best option because it is intravenous and a glucocorticoid. The patient is unconscious and can not take oral medications, therefore Prednisone is not the best option and all the other options are incorrect.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

Acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. (remember: growth hormone increases blood sugar: hint in question)

ACTH stimulation test is for

Addison's disease measures cortisol's response to ACTH response is absent or very low in clients with primary adrenal insufficiency (trying to wake up adrenal cortex)

A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome.

what is the main influence of aldosterone secretion?

Angiotensin II in the bloodstream (as opposed to ACTH).

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

adrenal adenoma An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism.

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?

adrenal cortex (aldosterone= BP: retains salt and fluid, excretes potassium)

what happens if you discontinue steroids abruptly?

adrenal insufficiency results because of the atrophied adrenal cortex

Pheochromocytoma

avoid palpating abdomen- can cause release of catecholamines. greatest risk for injury is from hypertensive crisis.

VMA test for pheochromocytoma

avoid stimulants (coffee, chocolate, etc.) 2-3 days prior

1. Which of the following patients are at risk for developing Cushing's Syndrome? A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted. B. A patient taking glucocorticoids for several weeks. C. A patient with a tuberculosis infection. D. A patient who is post-opt from an adrenalectomy.

B. A patient taking glucocorticoids for several weeks. The answer is option B. A patient taking glucocorticoids for several weeks. Remember that CUSHING'S DISEASE is caused by the pituitary gland producing too much ACTH which in turn increases cortisol. Cushing's SYNDROME is caused by medication therapy of glucocorticoids (think: syndrome= synthetic [drugs])

Cretinism

Cretinism is a form of hypothyroidism that occurs in infants (thyroid hormone is vital for CNS development under the age of 2).

2. Addison's Disease is: A. Increased secretion of cortisol B. Increased secretion of aldosterone and cortisol C. Decreased secretion of cortisol D. Decreased secretion of aldosterone and cortisol

D

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

Deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen (striae). Muscle wasting causes muscle atrophy and thin extremities.

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

Fluid intake is less than 2,500 ml/day. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria.

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, nurse Richard would suspect which of the following disorders?

Hyperparathyroidism Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria.

Which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

Increased urine osmolarity

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

JVD SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. It may cause weight gain and fluid retention (secondary to oliguria).

An incoherent female 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 pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of:

Myxedema coma Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid

Nurse Troy is aware that the most appropriate for a client with Addison's disease?

RISK FOR INFECTION Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Also: deficient fluid volume (polyuria due to low aldosterone)

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?

Related to bone demineralization resulting in pathologic fractures Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury

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

Restricting fluids 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.

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug

Tachycardia Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. Thyroid hormones will cause side effects of hyperthyroidism.

Nurse Ruth 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?

Tetany

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

The client should be encouraged to force fluids to prevent renal calculi formation.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

Thyroid crisis Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness.

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:

Trousseau's sign This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure).

glucocorticoid hormone

cortisol

what do you need to give in acute adrenal insufficiency

cortisol

Addison's disease symptoms

dark pigmentation, hypotension (low aldosterone), low blood sugar (lack of cortisol), low serum sodium (lack of aldosterone), high serum potassium (lack of aldosterone), dehydration

side effects of corticosteroids

diabetes, osteoporosis, peptic ulcer, poor wound healing, body fat deposits (moon face, buffalo hump)

adrenal insufficiency

high serum calcium, low serum sodium

Report to MD 24 hours after thyroidectomy

laryngeal stridor

excess androgen secretion

masculinization in women; feminization in men; premature sexual development in children (adrenogenital syndrome)

adverse effects of long-term steroid therapy

moon face weight gain increased risk for infection

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following?

muscle weakness Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia

beta blocker iV bolus during thyroid storm

reduce effects of thyroid hormone on heart

ACTH

secreted by the anterior pituitary, necessary for growth and development

purpose of aldosterone

the main hormone for sodium balance. Released in response to low blood pressure and hyperkalemia; retains salt, flushes out potassium.

cushing's

thinning of the skin and hirsutism

indication of hypocalcemia post-thyroidectomy

tingling and numbness of hands and feet, weak pulse, increased gastric motility, neuromuscular excitability

why do we need a functioning adrenal cortex

to adapt to stress of all kinds dysfunction= peripheral circulatory failure, circulatory shock, weakness

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:

vasopressin (Pitressin) Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy.

PTU therapy has been effective when you observe

weight gain (it is a medication for hyperthyroidism- it slows down your metabolism by blocking thyroid hormone synthesis)

what can cause the adrenal cortex to atrophy?

when large doses of steroids (meds) are given, the release of ACTH and endogenous steroids are inhibited- this causes the adrenal cortex to atrophy