NRS 222: Endocrine Emergencies
A client is experiencing an adrenal crisis due to Addison's Disease. Which of the following would NOT be a priority nursing intervention for this client? A) Monitor for hyponatremia B) Monitor for hypocalcemia C) Monitor for fluid volume deficit D) Monitor for hypoglycemia
Monitor for hypocalcemia Clients in adrenal crisis (severe adrenal insufficiency) are more likely to experience hypercalcemia, NOT hypocalcemia, due to less excretion by the kidneys and calcium being pushed out of the cells.
A nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which pH level would be consistent with this diagnosis? A) 7.31 B) 7.35 C) 7.41 D) 7.52
7.31 Normal pH range is 7.35 to 7.45. Acidosis exists with pH levels under 7.35.
The nurse working in the emergency department is receiving report. Out of the following group of clients, which would the nurse be concerned about developing hypovolemic shock? A) A 19-year-old with trichotillomania B) A 20-year-old with fibromyalgia C) A 15-year-old with a urinary tract infection D) A 16-year-old in diabetic ketoacidosis
A 16-year-old in diabetic ketoacidosis Diabetic ketoacidosis (DKA) causes polyuria which can lead to severe dehydration and hypovolemic shock. The main concern of the nurse will be to treat the underlying cause, and keep the client hydrated. Causes of hypovolemic shock include body fluid depletion, hemorrhage due to trauma, surgery, GI ulcer, and increased clotting, dehydration due to nausea, vomiting and diarrhea, hyperglycemia, and diuretic therapy.
A provider has prescribed hormone replacement therapy for a client who has Addison's disease. The nurse who is caring for this client understands the difference between Addison's disease and Cushing's syndrome as which of the following? A) Addison's occurs as the result of decreased secretions of hormones while Cushing's occurs as a result of increased secretion B) Addison's causes signs of masculinity in women while Cushing's causes atrophy of skin, tissues, and hair C) Addison's requires treatment with lifetime hormone replacement therapy while Cushing's does not D) Addison's is caused by hyperplasia of the adrenal gland while Cushing's is caused by pituitary enlargement
Addison's occurs as the result of decreased secretions of hormones while Cushing's occurs as a result of increased secretion Addison's disease and Cushing's syndrome are two conditions that develop as a result of abnormal secretion of hormones. In the case of Addison's disease, the client does not secrete enough adrenocortical hormones, and the treatment is to ADD glucocorticoid or mineralocorticoi medications as prescribed. In Cushing's syndrome, the client secretes too much cortisol due to a variety of potential factors, including ACTH secreting tumors or a metabolic disorder.
A nurse in the Intensive Care Unit (ICU) is caring for a client with diabetic ketoacidosis (DKA). Which of the following is NOT a priority nursing intervention for this patient? A) Administer hypertonic saline for fluid resuscitation B) Monitor serum potassium levels and replace as needed C) Monitor blood glucose at least hourly D) Administer IV regular insulin
Administer hypertonic saline for fluid resuscitation While fluid resuscitation is a cornerstone of DKA treatment, they are treated with isotonic fluid replacement rather than hypertonic. The primary fluid choice would be normal saline or D5 1/2NS once the sugar comes down a bit
When administering insulin to someone in severe hyperglycemia, why do we need to ensure the insulin is brought on slowly and the glucose is reduced slowly? What are we trying to prevent happening?
Cerebral Edema. Hypoglycemia.
The nurse is caring for a client with diabetic ketoacidosis (DKA). The client suddenly becomes confused. Which of the following actions should the nurse perform first? A) Check the client's vital signs B) Check the client's glucose level C) Check the client's pupillary reaction D) Call the provider
Check the client's glucose level If a client with DKA becomes confused, they may be hypoglycemic OR hyperglycemic. The nurse should check the glucose level, then obtain a set of vitals, then call the provider.
The nurse is caring for a client in diabetic ketoacidosis (DKA). What is the treatment priority for this client? A) Monitor cardiac rhythm B) Fluid replacement C) Decrease the blood glucose D) Correct acidosis
Correct acidosis Since the body has no insulin in type 1 diabetes, the client can have an acute episode of DKA. Glucose cannot get into the cells, so the body breaks down fatty acids for energy. This leaves ketones as a waste product, which makes the blood acidic. The goal of treatment in diabetic ketoacidosis is to correct underlying acidosis caused by the breakdown of fatty acids. Insulin therapy is used.
The nurse is caring for a client with Cushing syndrome. The nurse knows to perform which daily activity? A) Make sure the scale is near the client's room B) Linens need to be constantly changed, so make sure they are stocked C) Medications need to be exactly on time D) Make sure the client is near the nurse's station
Make sure the scale is near the client's room Clients with Cushing syndrome are at risk for excessive fluid retention which can cause cardiac stress and hypokalemia. The nurse should anticipate daily weights as one way to monitor the client's fluid retention status.
A 79-year-old client with Cushing's disease has developed some cognitive effects that are impacting his ability to care for himself. Which cognitive effects are most likely to develop in a client with Cushing's disease? A) Memory loss B) Seizures C) Aggression D) Coma
"Memory loss" is correct. Cushing's disease occurs when the pituitary gland produces excess amounts of adrenocorticotropic hormone. The client can experience changes in body structure, as well as changes in skin, muscles, and cognition. One of the most common cognitive effects associated with Cushing's disease over time is memory loss.
The nurse is admitting a client with diabetic ketoacidosis (DKA). The client has a history of type 1 diabetes and informs the nurse that she been taking really good care of herself and her blood glucose has been "really really good." Which of the following assessment data leads the nurse to question this statement? A) Hemoglobin A1C 13% B) Fingerstick blood sugar of 492 mg/dL C) Fruity breath D) Total cholesterol 321 mg/dL
Hemoglobin A1C 13% A hemoglobin A1C of 13% indicates that over the last 3 months the client has been averaging a blood sugar of 326 mg/dL, indicating very poorly controlled blood sugars.
A 45-year-old diabetic client has been brought in for care of diabetic ketoacidosis. The client's blood glucose level is 367 mg/dL and blood pH is 7.28. Which of the following respiratory rates would the nurse most likely expect to see in this situation? A) 8/min B) 16/min C) 24/min D) 36/min
36/min The client with diabetic ketoacidosis (DKA) would most likely have Kussmaul respirations, which are rapid and deep. A respiratory rate of 36/minute is abnormally high and would most likely be associated with the rapid breathing pattern of DKA. This is a metabolic acidosis that will continue until the condition is corrected. The rapid breathing rate is the body's way to compensate for the acidosis, but is unlikely to fully correct the client's pH level.
A nurse is working with a client who is brought in the emergency department with abdominal pain and dehydration. His glucose level is 388 mg/dL and he has positive serum ketones. Based on theses symptoms and lab values, which action would the nurse expect to perform first? A) Establish central line access B) Administer IV regular insulin at 0.1 unit/kg bolus C) Administer 0.25% NaCl at a rate of 200 mL/hr D) Provide breathing support with bag-mask ventilation
Administer IV regular insulin at 0.1 unit/kg bolus This client is experiencing diabetic ketoacidosis (DKA), which is a life-threatening complication of diabetes that can cause severe hyperglycemia. The client may have blood glucose levels above 300 mg/dL and a rapid breakdown of fat for energy. In this situation, the nurse should administer isotonic fluids to maintain hydration and give a bolus of insulin to bring down the blood glucose levels. X -Administer 0.25% NaCl at a rate of 200 mL/hr This is a hypotonic solution. Administering hypotonic solutions at a rapid rate in DKA can lead to cerebral edema. X -Establish central line access The initial interventions for the client in DKA can be done with a 20 gauge peripheral IV. X -Provide breathing support with bag-mask ventilation The client in this example is not experiencing respiratory distress. The first action the nurse would perform out of the choices is to give IV insulin as ordered.
What are the S/Sx of HHNS?
Blood Glucose of > No ketosis Polyuria Polydipsia ^BUN ^creatinine PROFOUND dehydration -dry mucous membranes -temp -altered LOC -poor turgor
A client with Addison's disease is deficient in aldosterone. Which of the following are symptoms of this condition? Select all that apply. - Dehydration - Hypotension - Hyponatremia - Bradypnea - Hyperkalemia
Dehydration Aldosterone stimulates the reabsorption of sodium and potassium. Without it, these electrolytes are excreted from the body along with water which leads to dehydration. Hypotension A deficiency in aldosterone leads to diuresis, which decreases blood volume and blood pressure. Hyponatremia Aldosterone causes sodium to be reabsorbed in the kidneys, so a lack of this hormone leads to hyponatremia. Hyperkalemia Aldosterone causes potassium to be reabsorbed in the kidneys, which leads to hyperkalemia.
A nurse receives a client that came by ambulance. The nurse suspects that this client is in diabetic ketoacidosis (DKA). Which of the following signs would suggest DKA? A) Anuria B) Strawberry red tongue C) Halitosis D) Fruity breath
Fruity breath Clients in DKA often have fruity odor on their breath, which is caused by excess ketones in the body.
Which of these has a slower onset of S/Sx? DKA HHNS
HHNS. Since the body does have a little insulin, the glucose can keep rising without causing ketones to build up and acidosis to occur making them (with DKA) feel like shit quickly, causing them to come in. HHNS is a slower progression.
A client with altered mental status and fruity breath has been brought into the emergency department. Which of the following is the priority for the nurse to monitor? A) Hypovolemia B) Hypoglycemia C) Hyperglycemia D) Hypervolemia
Hypovolemia This client is in diabetic ketoacidosis (DKA). The main concern once the client is in DKA is the rapid rate at which they losing fluid. They will develop electrolyte imbalances and acute kidney injury.
A client is suffering from excess cortisol excretion as a result of an adenoma on the pituitary gland. Which of the following skin changes is an expected finding in a client with this condition? Select all that apply. - Increase in the number of stretch marks - Swelling in the neck and throat - Fatty tissue deposits in the face and upper back - Skin that bruises easily - Lesions on the peripheral extremities
Increase in the number of stretch marks Skin changes that may be seen with excess cortisol include purple stretch marks (striae), easy bruising, weight gain, fatty tissue deposits in the midsection, upper back and face, excess body hair in women, and decreased fertility in men. Skin that bruises easily Excess cortisol leads to easily bruised skin. This is a common symptom of Cushing's syndrome. Fatty tissue deposits in the face and upper back Cortisol is a stress hormone secreted from the adrenal glands near the kidneys. Excess cortisol production can cause a number of changes associated with different body systems., including obesity and fatty tissue deposits on the face and upper back.
A nurse is caring for a client who has developed diabetic ketoacidosis. The client has a breathing pattern in which he takes rapid and very deep breaths with large tidal volumes. Which of the following best describes this type of breathing? A) Biot's respiration B) Paroxysmal nocturnal dyspnea C) Kussmaul's respirations D) Cheyne-Stokes respirations
Kussmaul's respirations Kussmaul's respirations involve an abnormal pattern of breathing that is often associated with a condition of metabolic acidosis, such as with diabetic ketoacidosis. Kussmaul's respirations are characterized by a rapid breathing rate in which the client takes very deep breaths. The client may breathe in this manner when the body is trying to compensate in metabolic acidosis.
A nurse is working with a client brought to the emergency department in a comatose state after developing hyperosmolar hyperglycemic syndrome (HHS). The nurse ensures the client's airway is patent and vital signs are stable. What is the nurse's next priority in this situation? A) Providing isotonic fluid replacement B) Maintaining the client's cervical spine C) Administering insulin IM D) Monitoring serum chloride levels
Providing isotonic fluid replacement In this situation, the treatment goals are to vigorously rehydrate, correct the hyperglycemia, treat the underlying cause and monitor cardiac, renal, CNS and pulmonary status. The nurse should first provide a fluid replacement by administering isotonic IV fluids such as normal saline or lactated Ringer's solution. This increases intravascular volume and dilutes the blood when glucose levels are high. Most clients respond to IV fluid replacement only, but the nurse may also administer insulin as ordered. Insulin would be given IV, not IM. Other measures include monitoring oxygen saturations and checking glucose and electrolyte levels such as potassium and sodium.
The nurse working in the emergency department receives a client with altered mental status and fruity breath. The provider diagnosis the client with diabetic ketoacidosis (DKA). Which intervention will be included in the treatment of this client? Select all that apply - Administering IV insulin - Starting an IV - Giving IV fluids - Getting a POC glucose - Getting an EKG
Starting an IV The client in DKA will be dehydrated, so starting an IV may be difficult. For medicine and hydration getting IV access is a priority. Giving IV fluids This client will need volume restored in the form of IV fluids. This is a priority for the nurse. Administering IV insulin The client in DKA will need an insulin infusion in order to bring down the glucose level, so this is a priority. Getting an EKG Electrolyte imbalances are common in DKA, due to the rapid fluid loss, and the IV insulin, which pulls glucose and potassium across the cell membrane, further altering electrolyte levels. Since potassium imbalances can lead to arrhythmias, the client will need an EKG. Getting a POC glucose The nurse must monitor the glucose level, so this is a priority nursing intervention.
A nurse is caring for a client who has been diagnosed with Addison's disease. The nurse is teaching about symptoms of Addisonian crisis in order to best manage and prevent it before it occurs. What symptoms should the client look for that the nurse should include as part of teaching? Select all that apply. - Generalized weakness - High blood pressure - Severe headache - Dehydration - Sudden pain in the lower back or abdomen
Sudden pain in the lower back or abdomen Addison's disease is a type of primary renal insufficiency in which the adrenal glands do not produce enough hormones. The client often has fatigue, muscle weakness, and weight loss. Addisonian crisis is another complication of the condition. It is characterized by sudden pain in the lower back, severe headache, generalized weakness, shock, and dehydration. Severe headache Addison's disease is a type of primary renal insufficiency in which the adrenal glands do not produce enough hormones. The client often has fatigue, muscle weakness, and weight loss. Addisonian crisis is another complication of the condition. It is characterized by sudden pain in the lower back, severe headache, generalized weakness, shock, and dehydration. Generalized weakness Addison's disease is a type of primary renal insufficiency in which the adrenal glands do not produce enough hormones. The client often has fatigue, muscle weakness, and weight loss. Addisonian crisis is another complication of the condition. It is characterized by sudden pain in the lower back, severe headache, generalized weakness, shock, and dehydration. Dehydration Addison's disease is a type of primary renal insufficiency in which the adrenal glands do not produce enough hormones. The client often has fatigue, muscle weakness, and weight loss. Addisonian crisis is another complication of the condition. It is characterized by sudden pain in the lower back, severe headache, generalized weakness, shock, and dehydration.