Exam 2 ch44 &45

Question 1

Know in acromegaly, what the purpose of the “glucose-tolerance test” is, what is measures. (pg 1000)

Answer 1

Growth Hormone concentration

-unchanged in acromegaly

Question 2

What is acromegaly?

Answer 2

excessive growth (in width) b/c of excessive GH (hyper-pituitary)

Question 3

Know what the post operative teaching is for a pt., scheduled for transphenoidal hypophysectomy. (pg. 1005)

Answer 3

Avoid strenuous things

-sneezing

Question 4

What is transphenoidal hypophysectomy?

Answer 4

removal of pituitary gland

Question 5

Know excess of what, causes the Large flattened features of the pt. with acromegaly. (pg. 998)

Answer 5

GH- Growth hormone

Question 6

Know the classic s/s of diabetes insipidus (pg. 1008)

Answer 6

Massive diuresis, dehydration, thirst

Question 7

Know why a pt. w/ “Addison Disease” must take hydrocortisone. (pg. 1017)

Answer 7

Regulate K+ and Na+ excretion

Question 8

Know what nephrogenic DI is and how it differs from neurogenic DI (pg. 1007)

Answer 8

Nephro:
-Doesn’t respond to ADH, and is inherited

Neuro:
-defect in neither the production or secretion of ADH exisits

Question 9

Know why a pt. w/ Addison disease would have disturbed body image related to the color of their skin. (pg. 1014 box 44-2)

Answer 9

Hyperpigmentation; Smokey/ bronze color

Question 10

Know what a “cardinal indication: of pheochromocytoma is. (pg. 1023)

Answer 10

Diastolic B/P of 115 or higher

Question 11

What is pheochromocytoma?

Answer 11

Tumor in adrenal glands

• usually benign
• excessive catecholamine’s = fight or flight

Question 12

Know what the s/s of “Adrenal Crisis” are, when caring for a pt. w/ Addison’s disease. (Pg. 1014) ON BOARDS

Answer 12

“Addisonians Crisis” = life-threatening

• decreased available adrenal hormones
• mineralocorticoid & glucocorticoid
• HTN, tachycardia, confusion, hyperkalemia, glycaemia

Question 13

Know what the purpose of the lab test is, to measure the serum level of adrenocorticotropic hormone (ACTH.) is (pg.998)

Answer 13

Good indication that pituitary gland is sending the right signals to adrenal glands to release ACTH

Question 14

Where does ACTH come from?

Answer 14

Adrenal glands

Question 15

Know what would be included in the discharge plan for a pt. W/ Addison’s disease related to “ Risk for injury” (pg. 1019)

Answer 15

Call for help, rise slowly -dizziness

Question 16

Know why a pt. In adrenal crisis, after receiving the initial dose of IV Solu Cortef, would need to continue IV Solu Cortef (pg. 1015)

Answer 16

To maintain level in blood

Question 17

Know what a nurse would include in a teaching plan w/ a pt. Who has Addison’s Disease. (Pg. 1018)

Answer 17

Wear emergency ID

Question 18

Know what medication would cause a long term asthma pt. To develop “Cushing Syndrome” (pg. 1019)

Answer 18

Corticosteroid agents

Question 19

Know what the “hallmark findings” are expected when assessing a pt. W/ Cushing Syndrome (pg. 1020)

Answer 19

Moon face, truncal obesity, protein-wasting, purple striae

Question 20

Know the instructions the nurse would give a pt. W/ Cushing syndrome for self care (pg 1021)

Answer 20

Avoid people W/ infections

-Decreased immune system

Question 21

Know what a nurse would anticipate when assessing a pt. W/ Simmonds Cachexia, related to hypopituitarism (pg 1006)

Answer 21

Muscle & organ wasting

Question 22

In documenting a care plan for a 10 year old boy w/ hyperpituitarism, what would the nurse tell the pt. Related to “disturbed self image”
(-giantinism)

Answer 22

He’s going to grow tall

-ask him what his concerns are

Question 23

Know what the nursing care for a pt. Is, who had a hypophysectomy, in which the whole pituitary was removed. (Post-op) (pg.1004)

Answer 23

• hormone replacement for life
• strict doc of I&Os
• inspect nasal dressing for drainage
• assess for infection
• check for meningitis (bend head and foot toward trunk.

Question 24

Know what causes are for Addisonian crisis (pg 1014)

Answer 24

Stress, adrenal surgery, pituitary destruction, abrupt Interruption of steroid therapy, stressors (emotional, trama, psychiatric disturbances)

Question 25

Know what discharge planning for the pt. Who underwent a hypophysectomy if focused on (pg 1005) (Self care)

Answer 25

Avoid straining (cough, sneeze, vomiting) Heavy lifting, Constipation, Follow up care important

Question 26

Know what nursing responses would be best for the pts family and the pt., if the pt. Has giantism (pg 998)

Answer 26

Ask them about their concerns; try to get them to have acceptance "What is it about his height that bothers you?"

Question 27

For a pt. W/ hypopituitarism who must take medications for the rest of their life, know what the teaching plan would include (pg 1007)

Answer 27

Continue prescribed drug therapy, keep Dr apts, have rest periods for fatigue, wear medical ID, *notify Dr if there's an increase in urine output, thirst, weight, malaise, weakness*

Question 28

Be familiar w/ the drug "Sandostatin" and what it is used for and how it works (pg1000)

Answer 28

Acromegaly | -surpresses GH (won't reverse)

Question 29

If a pt. C/o headache and nuchal rigidity after a hypophysectomy, based on these assessments what should the nurse do? (Pg 1005)

Answer 29

``` Menegial irritation (meningitis) Report to physician or head nurse. ```

Question 30

If a physician orders a T3 and T4, what levels of these tests would indicate hypothyroidism? (Pg 1027)

Answer 30

Hypothyroid= decrease T3 & T4

Question 31

If a pt. Starts taking potassium iodide SSKI, know what the nurse should instruct the pt. To do. (Pg1030)

Answer 31

Drink through a straw to prevent staining teeth

Question 32

If a pt. W/ hyperthyroid, cannot get to sleep, know what the nurse should suggest (pg1031)

Answer 32

Encourage bed time rituals

Question 33

Know what significant instructions to give a pt. Who is post thyroid scan (pg1027,1231)

Answer 33

Wash hands w/ soap and water after voiding for 24hrs post scan BC of radioactive solution.

Question 34

If a pt. Had a lab test that showed a high level of thyroid stimulating hormone (TSH) and low level of T4, know what that would indicate (pg 1025/1035)

Answer 34

Hypothyroidism

Question 35

Know what "exophthaloms" is and when it goes away

Answer 35

Bulging eyes- will go away w/ medication treatment

Question 36

Know the pathophysiology (cause of Dx) of Graves Disease and how to explain that to a pt. (Pg1028)

Answer 36

?what's going on abnormally increased synthesis and secretion of thyroid hormones

Question 37

If a pt. Was 1 day post op after subtotal thyroidectomy and noted the pts color was poor, pulse and respirations were rapid and the pt feels warm to the touch. Know what the nurses initial implementation would be. (Pg1028)

Answer 37

Call Dr or head nurse

Question 38

If a pt had been given the drug "propythiouracil" know what nursing implementations should be included (pg1030)

Answer 38

Monitor for bleeding, weight gain, fatigue, avoid use when pregnant

Question 39

Know what an appropriate nursing diagnosis is for a pt recently diagnosed w/ hyperthyroidism would be (pg1031)

Answer 39

Disturbed sleep pattern, etc

Question 40

If a newly diagnosed pt w/ hypothyroidism begins a drug regimen, know what the nurses instructions should be given relative to hormone replacement

Answer 40

Can flip to hyperthyroidism

Question 41

Know pre surgical teachings includes for a pt. Scheduled for subtotal thyroidectomy (pg1032)

Answer 41

how to avoid straining the neck, support the head/neck during position changes. Encourage cough and deep breathing.

Question 42

After a pt undergoes thyroidectomy know what explanation you would give the pt for the tracheostomy tray on the bed side

Answer 42

Airway can close= larengalspasm

Question 43

Know how a nurse should assess for hemorrhage in post thyroidectomy pt (pg1033)

Answer 43

Check back of neck for seeping (pt usually in high fowlers to prevent swelling)

Question 44

Know how foods such as soybeans, turnips, and rutabagas can have an effect on persons w/ a thyroid disorder (pg1035)

Answer 44

Suppress TH effect

Question 45

Know why an older persons daily dose of thyroid hormone taken for many years might need to be reduced

Answer 45

Metabolism rate slows down

Question 46

A pt who is 2 days pot op total thyroidectomy has a carpopedal spasm of the hand. Know why this would occur and what the spasm is called

Answer 46

Trousseaus sign (b/p cuff) hypocalcemia

Question 47

Know how the nurse would address the nursing diagnosis of "risk for impaired skin integrity, related to dry skin" In a pt w/ hypothyroidism. What intervention would the nurse provide

Answer 47

Lotion/creams, reduce frequency of bath

Question 48

Know how the nurse initiates "chvostek sign" and what it indicates

Answer 48

Tap on facial nerve. Watch for spasm | -hypocalcemia

Question 49

Know what a pt with hyperparathyroidism would exhibit in their history

Answer 49

Renal stones, impaired urinary elimination

Question 50

If a pt who has hyper parathyroid is and is to receive the drug Calcitonin (Calcimar) know what the pt should b tested for before receiving this drug

Answer 50

Sensitivity

Question 51

Know what an appropriate nursing diagnosis for a pt with hyper parathyroid is m would be HINT related to urinary elimination

Answer 51

Impaired urinary elimination related to renal calculi

Question 52

If a pt with hypo parathyroid I am c/o fatigue and lack of energy know what the nurse should be aware of

Answer 52

Hypocalcemia | -cardiac dysrythmia, decrease cardiac output

Question 53

Know nurse should recommend the use of salt that is iodized

Answer 53

To prevent goiter and cretinism ( infants)

Question 54

Know how a pt with hypothyroidism can live a full and normal life, related to the pts medication

Answer 54

Life long hormone replacements (synthroid/ levothyroxine/cytomel)