Endocrine System

Question 1

What are they levels of t3, t4 and tsh in hyperthyroidism?

Answer 1

High t3 and t4

Low TSH

Question 2

What is thyroid storm?

Answer 2

Thyroid storm is a life threatening emergency that occurs with uncontrolled hyperthyroidism due to graves disease. Symptoms include fever, tachycardia, agitation, anxiety, and HTN.

Question 3

What drugs are used to treat thyroid storm?

Answer 3

Propylthiouracil and methimazole. These block the synthesis of T3 and T4
-Propranolol may be given to decrease excessive sympathetic stimulation

Question 4

What is the diet for hyperthyroidism?

Answer 4

High calorie
High protein
Low caffeine
Low fiber

Question 5

What should you have bedside postoperatively for a thyroidectomy?

Answer 5

Be prepared for laryngeal edema by having a tracheostomy set at the bedside, along with O2, and a suction machine.
Calcium gluconate should be easily accessible

Question 6

What is the normal serum calcium level?

Answer 6

9.0 - 10.5 mEq/L

Question 7

What is the best indicator of parathyroid problems?

Answer 7

A decreased in the clients calcium compared to the preoperative value

Question 8

How do watch for tetany?

Answer 8

-Monitor serum calcium
-Check for tingling of toes and fingers and around the mouth
-Check Chvostek sign
-Check Trousseau sign
too low calcium

Question 9

Hyperthyroidism is also called

Answer 9

Graves Disease and Goiter

Question 10

Hypothyroidism is also referred to as

Answer 10

Hashimoto’s Disease and Myxedema

Question 11

What precipitates a myxedema coma?

Answer 11

acute illness
withdrawl of thyroid medication
anesthesia
use of sedatives
hypoventilation

Question 12

What is Addisions Disease?

Answer 12

Primary adrenocortical deficiency/ hypo function of the adrenal cortex

Question 13

What is the diet requirements for a patient with Addison’s disease?

Answer 13

High Sodium
Low Potassium
High Carbohydrate
3L of fluid per day

Question 14

What happens in an Addison’s Crisis?

Answer 14

Vascular collapse: hypotension and tachycardia (Nursing care is to administer IV fluids at a rapid rate)
Hypoglycemia: Administer IV glucose
Administer parenteral hydrocortisone
Aldosterone replacement with simultaneous administration of salt

Question 15

What is Cushing’s Syndrome?

Answer 15

Excess adrenocorticoid activity

Question 16

Physical assessment of cushing’s syndrome

Answer 16

Mood face
truncal obesity
buffalo hump
abdominal striae
hirsutism

Question 17

What are the electrolyte balances in Cushing’s Syndrome?

Answer 17

Hyperglycemia
Hypernatremia
Hypokalemia

Question 18

Teach clients to take steroids with meals

Answer 18

to prevent gastric irritation, they should never skip a dose.

Question 19

What are the characterisitics of HHNKS (Hyperosmolar hyperglycemia nonketotic syndrome)

Answer 19

Hyperglycemia >600
Plasma hyperosmolality
Dehydration
Change in mental status
Absent ketone bodies

Question 20

What is glycosylated HGB (HbA1c)

Answer 20

Indicates glucose control over previous 90-120 days. It is a valuable measurement of diabetes control and informs the diagnosis of diabetes and prediabetes

Question 21

The body’s response to illness and stress is to produce

Answer 21

glucose. Therefore, any illness result in hyperglycemia

Question 22

What is basal insulin?

Answer 22

Long acting and intermediate acting insulin that suppresses glucose production between means and overnight

Question 23

What is bolus insulin

Answer 23

limits hyperglycemia after meals. Rapid or short acting. Clear

Question 24

Correction factor

Answer 24

The amount of insulin needed to correct hyperglycemia, usually give pre meal

Question 25

What diagnostic test is used to determine thyroid activity

Answer 25

T3 and T4

Question 26

What condition results from all treatments of hyperthyroidism

Answer 26

hypothyroidism, requiring thyroid replacement

Question 27

State three symptoms of hyperthyroidism and three symptoms of hypothyroidism

Answer 27

Hyperthyroidism: weight loss, heat intolerance, diarrhea Hypothyroidism: Fatigue, cold intolerance, weight gain

Question 28

List five important teaching aspects for clients who are beginning corticosteroid therapy

Answer 28

- Continue medication until weaning plain is begun by physician - Monitor serum potassium, glucose, and sodium frequently - weigh daily - and report weight gain of >5lbs/ week - Monitor BP and pulse closely - Teaching symptoms of Cushing's Syndrome

Question 29

Describe the physical appearance of clients who have Cushing syndrome

Answer 29

``` Moon face Obesity in trunk Buffalo hump in back Muscle atrophy Think skin ```

Question 30

Which type of diabetes always requires insulin replacement

Answer 30

Type 1

Question 31

Which type of diabetes sometimes requires no medication

Answer 31

Type 2

Question 32

List five symptom's of hyperglycemia

Answer 32

``` Polydipsia Polyuria Polyphagia Weakness Weight loss ```

Question 33

List five symptoms of hypoglycemia

Answer 33

``` Hunger Lethargy Confusion Tremors or shakes SWeating ```

Question 34

Name the necessary elements to include in teaching client newly diagnosed with diabetes

Answer 34

``` The underlying patho Management and treatment Meal planning exercise program insulin administration sick day management symptoms of both hypo and hyper foot care ```

Question 35

In fewer than 10 steps, describe the method of drawing up a mixed dose of insulin Clear to Cloudy

Answer 35

- Identify the prescribed dose and type of insulin - Store unopened insulin in the refrigerator - Opened insulin may be kept at room temperature - Draw up regular insulin first - Rotate injection sites - May reuse syringe by recapping

Question 36

Identify the peak action time of the following types of insulin: Rapid acting Intermediate acting Long acting

Answer 36

Rapid acting: 2-4 hours Intermediate: 6-12 Long; 14-20

Question 37

When preparing a client with diabetes for discharge, the nurse teaches the client the relationship between stress, exercise, bedtime snacking, and glucose balance. State the relationship of each

Answer 37

- Stress and stress hormones usually increase glucose production and increase insulin need - Exercise may increase the change of hypoglycemia therefore client should always carry a fast acting source of carbohydrates

Question 38

When making night rounds, the nurse notes that a client prescribed insulin is complaining of a headache, slight nausea, and minimal trembling. This clients hand is cool and moist. What is the client most likely experiencing

Answer 38

hypoglycemia

Question 39

Identify five foot care intervention that should be taught to a client with diabetes.

Answer 39

-Check feet daily -report any break or sores -wear well fitting shoes -never go barefoot -never personally remove corns or calluses -wash feet daily with mild soap -