Endocrine

A nurse is reinforcing education with a client who has been diagnosed with hyperthyroidism. Which of the following statements should the nurse include?

TSH signals the thyroid gland to produce T3 and T4

A nurse in clinic is caring for client who has type 1 diabetes mellitus (DMT1). The client's partner reports that the client's moods and behaviors have been frequently changing. Which of the following questions should the nurse ask the partner?

"Have you observed irritability and confusion?"

A nurse is reinforcing teaching with a client who was diagnosed with metabolic syndrome. Which of the following statements should the nurse make?

"Your cardiovascular system is most at risk for damage from metabolic syndrome."

Treatment of Hypoglycemia: Examples of Fast-Acting Carbohydrates

3 to 4 glucose tablets 6 to 8 hard candies or gummies ½ cup sweetened fruit juice or regular soda 1 tablespoon sugar or honey 2 tablespoons of raisins 4 to 5 crackers

A nurse is reviewing the medical records of clients at a clinic. Which of the following clients has the highest risk for developing hypothyroidism?

A 19-year-old female with a family history of Hashimoto's disease

hemoglobin A1C (HbA1c)

A blood test that measures an individual's average blood glucose level over three months.

A nurse is caring for clients at an urgent care clinic. Which of the following is most at risk for a thyroid storm?

A client who has uncontrolled hyperthyroidism

ketoacidosis

A complication of diabetes mellitus when the body does not have enough insulin to allow for glucose to be used as energy.

neuroglycopenia

A condition of hypoglycemia in the brain, resulting in neuron dysfunction manifestations including dizziness, confusion, blurred vision, and coma.

Kussmaul respirations

A deep, rapid breathing pattern that is an attempt to expel carbon dioxide, an acidic compound of the blood, when the body is too acidic.

pernicious anemia

A deficiency in vitamin B12, which the body uses to make red blood cells.

exocrine gland

A gland that makes substances, such as digestive enzymes, that are released through a duct or other opening in the body.

glucagon

A hormone made in the pancreas that helps breakdown glycogen into glucose.

plasma osmolarity

A measure of hydration status. Determined by sodium, chloride, glucose, urea, bicarbonate, and a measure of different solutes in plasma.

hyperglycemic hyperosmolar state (HHS)

A metabolic complication of hyperglycemia or type 2 diabetes mellitus with severe hyperglycemia, extreme dehydration, hyperosmolar plasma, altered consciousness, and no ketones.

lipolysis

A metabolic process involving the breakdown of stored fatty acids by the liver. They are broken down by hydrolysis into glycerol and free fatty acids.

myxedema coma

A rare and fatal complication of severe and untreated hypothyroidism.

vitiligo

A skin condition that results in depigmentation from the loss of cutaneous melanocytes in the skin.

levothyroxine

A synthetic version of thyroxine (T4) that mimics the body's endogenous production of T4 by the thyroid gland. It can be dangerous for older adults.

Effects of Hyperthyroidism on Body Systems

Circulatory: Increased heart rate, arrhythmia, hypertension Digestive: Weight loss, diarrhea Endocrine: Enlarged thyroid Integumentary: Warm, moist skin, hair loss Muscular: Muscle pain Nervous: Nervousness, depression, insomnia, irritability

Effects of Hypoglycemia on Body Systems

Circulatory: Rapid heartbeat and heart palpitations Endocrine: Epinephrine may not be released for early warning signs of hypoglycemia Digestive: Lack of hunger or interest in eating Nervous: Weakness, lack of coordination, chills, sweating, dizziness, confusion, light-headedness, headaches, nervousness, anxiety, sleep disturbances, irritability, tingling, and blurred vision

Effects of Hypothyroidism on Body Systems

Circulatory: Slowed heart rate, arrhythmia, hypotension, facial swelling Digestive: Weight gain, constipation Endocrine: Enlarged thyroid gland Integumentary: Dry skin, hair loss Nervous: Fatigue, depression, memory problems Reproduction: Low fertility, heavy menses Respiratory: Deep voice

A clinic nurse is meeting with a client who has type 2 diabetes mellitus (DMT2). When reviewing the clients medical record, the nurse notes that the client's HbA1c level is 10%. Which of the following should the nurse address with the client?

Ability to purchase medications

postprandial

After a meal.

A nurse is caring for a client who is postoperative following a thyroidectomy. Within the first 24 hours of surgery, the nurse needs to monitor the client for which of the following complications?

Airway obstruction

central obesity

An accumulation of abdominal adipose tissue that results in an abdominal waist circumference of 35 in or greater in females and 40 in or greater in males.

propylthiouracil (PTU)

An antithyroid agent that blocks the conversion of T4 to T3.

methimazole

An antithyroid agent that works by directly interfering with the first step of thyroid biosynthesis in the thyroid gland, inhibiting the incorporation of iodine into thyroglobulin.

metformin

An oral antidiabetic used to treat type 2 diabetes mellitus by decreasing hepatic production and intestinal absorption of glucose and increasing peripheral glucose uptake and utilization.

Hyperthyroidism Can Mimic Psychiatric Disorders

Anxiety, panic attacks, mood swings, agitation, irritability, and insomnia caused by hyperthyroidism can be misdiagnosed as psychiatric disorders. Ensure thyroid function tests are done in clients who have these conditions to rule out hyperthyroidism.

A nurse is reviewing the medical record for an older adult client who has hyperglycemia. Which previous medical condition should the nurse expect to find?

Atherosclerosis

A nurse is reinforcing teaching with a client about risk factors for hyperglycemia. Which of the following should the nurse explain increases the client's risk for hyperglycemia?

BP 152/78 mm Hg

Long-acting insulin

Begins working after several hours and last about 24 hr Detemir (Levemir) Glargine (Lantus) Ultra-long-acting: Begins working after 6 hr and last at least 36 hr Glargine U-300 (Toujeo)

Rapid acting insulin

Begins working within 15 min and lasts about 2 to 4 hr Insulin aspart (NovoLog) Insulin glulisine (Apidra) Insulin lispro (Humalog)

Regular or short-acting insulin

Begins working within 30 min and lasts about 3 to 6 hr Human regular (Humulin R, Novolin R) Intermediate-acting: Begins working within 2 to 4 hr and lasts about 12 to 18 hr NPH (Humulin N, Novolin N)

proteolysis

Breakdown of protein into amino acids by enzymes.

Risk Factors for Hypoglycemia

Changes in work schedule Travel to different time zones Exercising more than usual Food insecurity Unpredictable access to nourishing foods

A clinic nurse receives a phone call from a client who has type 1 diabetes mellitus. the client reports a fever and cough for the past day and a current blood glucose of 400 mg/dL. Which of the following instructions should the nurse make?

Check your urine for ketones

Effects of Hyperglycemia on Body Systems

Circulatory: Blood vessel damage, cardiovascular disease, poor wound healing Respiratory: Kussmaul respirations Digestive: Nausea, vomiting, pain Nervous: Vision problems, neuropathy, depression, insomnia, stress

Effects of Metabolic Syndrome on Body Systems

Circulatory: Hypertension, heart disease Digestive: Non-alcoholic fatty liver disease Endocrine: Insulin resistance, DMT2, lipid dysfunction Nervous: Dementia Reproduction: Polycystic ovary syndrome (PCOS)

ketosis

Elevated levels of ketone organic compounds in the blood and urine that occurs when the body does not have enough glucose for energy and ketogenesis occurs, creating a by-product of ketone acids.

polyphagia

Excess hunger leading to overeating.

polydipsia

Excessive thirst leading to excess consumption of water or other beverages.

polyuria

Excessive urination leading to dehydration.

A nurse is generating solutions for a client admitted for diabetic ketoacidosis. Which of the following should the nurse anticipate initiating when planning care?

Fluid administration

Pathophysiology of DMT1

Glucose is extracted from food in the digestive system (stomach). The pancreas produces too little or no insulin in beta cells (pancreas). There is an increase in blood glucose levels (blood vessels). Muscles and organs cannot use glucose without insulin (muscle and organ).

Comparing HbA1c With Estimated Average Blood Glucose Level

HbA1c Estimated Average Glucose Level (mg/dL) 6% 126 7% 154 8% 183 9% 212 10% 240

adipokines

Hormones produced by adipose tissue.

A nurse is caring for a client who reports recent unintended weight loss, feeling lethargic, and increased thirst. The client has frequent urination, which interferes with their daily activities. Which of the following alterations in endocrine function should the nurse suspect?

Hyperglycemia

atherosclerosis

Inflammatory damage of the endothelial cells of the vascular walls, which causes atherosclerotic plaque formation, leading to coronary artery heart disease.

goiters

Irregular growths of the thyroid gland due to enlargement of the thyroid gland or an irregular formation of thyroid nodules. They may be associated with hypothyroidism, hyperthyroidism, or no change in thyroid at all.

A clinic nurse is reinforcing teaching with a client who has diabetes mellitus type 2 and has been prescribed metformin. Which of the following effects should the nurse reinforce with the client to expect with this medication?

Lactic acid

A nurse is collecting data on a client suspected of having hypothyroidism. Which of the following laboratory findings should the nurse anticipate?

Low T4 level

A nurse is reviewing the medical record for a client who has elevated fasting blood glucose, elevated blood pressure, elevated triglycerides, and low HDL cholesterol. Which of the following alterations should the nurse suspect?

Metabolic syndrome

A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about self-management strategies and glucose monitoring. Which of the following statements should the nurse include in the teaching?

Monitoring your glucose and keeping it within acceptable ranges can help slow the progress of diabetes and reduce the risk of complications.

sulfonylureas

Oral antidiabetic agents beneficial to clients who have type 2 diabetes mellitus with residual pancreatic beta cell function because they work to lower blood glucose levels by stimulating secretion of insulin.

thiazolidinediones

Oral antidiabetic agents that increase insulin action and enhance insulin sensitivity in the body.

A client who has type 2 diabetes mellitus (DMT2) reports occasional numbness, burning, and tingling in the toes. Which of the following complications of DMT2 should the nurse investigate?

Peripheral neuropathy

Types of Insulins

Rapid-Acting Regular or short-acting Long-acting

A nurse is reinforcing teaching to client who has type 2 diabetes mellitus and was prescribed canagliflozin. Which of the following body systems should the nurse remind the client to monitor?

Renal function

A nurse is reviewing a client's health history. Which of the following is a risk factor for type 2 diabetes mellitus?

The client has a sedentary lifestyle.

A nurse in a long-term care facility is caring for a client who has hypothyroidism. Which of the following situations should the nurse expect to negatively impact the client's health?

The client may tire easier after physical exertion.

gluconeogenesis

The production of glucose from amino acids and the break-down of adipose.

glycogenolysis

The production of glucose from the breakdown of glycogen in the liver.

How Nurses Cope With Their Fears and Concerns When Caring for Clients Who Have Unstable Diabetes

They acknowledge and validate their feelings. They discuss challenges and clinical concerns with an educator or trusted teammate. They participate in routine debriefing exercises. They recognize that they are not alone by collaborating with the interprofessional team when clients who have low or high glucose are not responding well to current medications and diet. They recognize that they do not have to know everything. They reach out to pharmacists, diabetes educators, and nutritionists for support with clinical questions.

a nurse is collecting data on client suspected of having type 1 diabetes mellitus (DMT1). Which of the following findings in the client's lab work supports this diagnosis?

Three pancreatic autoantibodies

A nurse is collecting data on a client who has had a rapid increase of T3 and T4 levels and an elevated temperature. Which of the following health disorders should the nurse suspect?

Thyroid storm

A nurse is reinforcing education to a client who was diagnosed with metabolic syndrome. Which of the following disorders is this client most at risk for developing if left untreated?

Type 2 diabetes mellitus

A nurse is caring for a postoperative patient who is recovering from a thyroidectomy. Which of the following symptoms indicates a change in the client's status that requires immediate attention by the nurse?

Wheezing

A nurse is caring for a client who reports blurry vision and sensitivity to light. the nurse observes that the client's eyes appear swollen and protruding. which of the following statements by the nurse is an appropriate explanation of a likely diagnosis to give the client?

Your symptoms can indicate an overactive thyroid gland.

A nurse is caring for a client who reports a history of pregnancy complications and recent menstrual changes. Which of the following diagnoses should the nurse recognize as the cause of these manifestations?

hypothyroidism

the client is at high risk for developing.... as evidence by the client's .......

hypothyroidism, weight gain

A nurse is assisting in the care of a client who has metabolic syndrome. Which of the following should the nurse expect to see in this client?

insulin resistance