Test Bank of ATI Targeted Medical; Surgical Practice Assessment and Study Guide - Endocrine

ATI-ENDOCRINE TEST BANK ELABORATED QUESTIONS UPDATED

2023

ATI Targeted Medical-Surgical Practice Assessment: Endocrine 1. A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot

care. Which of the following statements by the client indicates an understanding of the teaching?

I will apply lotion to the dry areas of my feet, avoiding application between my toes.

2. A nurse is assessing a client who has diabetes mellitus and reports feeling anxious.

Which of the following findings should the nurse expect if the client is hypoglycemic?

Cool, clammy skin 3. A nurse is caring for a client who has Type 2 Diabetes Mellitus and is admitted with

hyperglycemic-hyperosmolar (HHS). Which of the following laboratory findings should the nurse expect?

Blood glucose of 846 mg/dL and serum pH of 7.40 4. A nurse is preparing insulin for a client who has diabetes mellitus. The client is to receive

evening doses of insulin glargine and regular insulin. Which of the following actions should the nurse take to administer these two medications safely?

Draw up the glargine and the regular into separate syringes. (Because insulin glargine is not compatible with other insulins.)

5. A nurse is monitoring a client's status 24 hr after a total thyroidectomy. Which of the

following findings should the nurse report to the provider?

Laryngeal stridor 6. A nurse is caring for a client who has diabetes mellitus and developed peripheral

neuropathy. Which of the following measures should the nurse recommend to prevent injuries to his feet?

Monitor the temperature of the water with a thermometer.

7. A nurse is planning preoperative care for a client who has pheochromocytoma. Which

of the following interventions should the nurse anticipate as being priority?

Avoid palpating the abdomen and elevate the head of the client’s bed to reduce blood and abdominal pressure.

8. A nurse is caring for a client following thyroidectomy. The nurse should assess for which of

the following findings as an indication of hypocalcemia?

Tingling and numbness of the hands and feet. (Hypocalcemia causes paresthesia, which usually starts in the hands and feet.)

9. A nurse is preparing to administer propranolol by IV bolus to a client experiencing thyroid

storm. Which of the following findings indicates the client is having a therapeutic response?

Reductions of the effects of the thyroid hormone on the heart.

10. A nurse is providing teaching for a client who has diabetes mellitus. Which of the following

findings associated with DKA should the nurse include?

Blood glucose levels greater than 300 mg/dL 11. A nurse is assisting a client who has adrenal insufficiency. Which of the following

findings should the nurse expect?

Serum Calcium 12.8 mg/dL 12. A nurse is managing care of a client who is postoperative and experiencing acute adrenal insufficiency. Which of the following actions should the nurse take?

Administer hydrocortisone sodium succinate. (Hydrocortisone sodium is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency.)

13. A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the

following findings should the nurse expect?

Hirsutism (Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production.)

14. A nurse is admitting a client who has hyperthyroidism. When assessing the client, the

nurse should expect which of the following findings?

Tremors 15. A nurse is providing teaching for a client who has type 1 diabetes mellitus about how to

prevent complications during illness. Which of the following statements indicates that the client understands the teaching?

I will call my doctor if my blood sugar is more than 250 mg/dL 16. A home health nurse is assessing a client who is on lifelong hormone replacement therapy for

treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect?

Hypotension (Hypotension is an expected finding with hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin.)

17. A nurse is caring for a client undergoing screening for primary Cushing's disease. The nurse

should expect that which of the following laboratory findings to be elevated?

Blood Glucose 18. A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a

thyroid hormone replacement. Which of the following instructions should the nurse plan to include?

Take this medication on an empty stomach.

19. A nurse is providing discharge teaching for a client who has diabetes insipidus and has a

new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?

Blow nose gently prior to using nasal spray. (This action prevents dilution of the medication with nasal secretions.)

20. A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the

following statements by the client indicates an understanding of the information about this test?

This test is a good indicator of my average blood glucose levels. (HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs.) 21. A nurse is performing an assessment on a client who has syndrome of inappropriate

antidiuretic hormone (SIADH). Which of the following assessment data should the nurse report?

Serum Sodium 110 mEq/L (A client who has SIADH retains fluids, which causes dilutional hyponatremia.)

22. A nurse is preparing a teaching plan for a client who has diabetes insipidus and is

receiving intranasal desmopressin. Which of the following information should the nurse include in the teaching plan?

Occurrence of nocturia indicates the need for a dosage adjustment. (The client should receive the initial dose of desmopressin in the evening; the provider will increase the dosage until the client no longer has nocturia.)

23. A nurse is preparing to give a client information about adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders?

Addison's disease (It measures the cortisol response to ACTH. The response is absent or very decreased in clients who have primary adrenal insufficiency.)

24. A nurse is planning dietary teaching for a client who has type 1 diabetes mellitus.

Which of the following information should the nurse include regarding alcohol consumption?

Ingest alcohol with meals to reduce alcohol induced hypoglycemia 25. A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking

insulin. Which of the following results indicates a therapeutic outcome of insulin therapy?

Fasting blood glucose 96 mg/dL 26. A nurse is teaching a client who has autoimmune disease about the adverse affects of long-

term corticosteroid therapy. Which of the following effects should the nurse include? (select all that apply) Osteoperosis Moon shaped face Increased risk of infection (Osteoporosis is an adverse effect of long-term corticosteroid therapy due to the suppression of bone formation and the acceleration of bone resorption that corticosteroid therapy can cause. Long-term corticosteroid therapy causes characteristics of iatrogenic Cushing's syndrome, including a moon-shaped face, a potbelly, and a buffalo hump. Increased risk of infection is an adverse effect of long-term corticosteroid therapy due to suppression of the immune system. It reduces the phagocytic actions of macrophages and neutrophils, thus increasing the risk of infection.

27. A nurse is caring for a client who is taking propylthiouracil (PTU). The nurse should

recognize that the client has met the treatment goals when she reports an increase in which of the following effects?

Weight 28. To screen a client for pheochromocytoma, a nurse schedules a vanillylmandelic acid test.

When teaching the client about this test, which of the following instructions should the nurse include?

Restrict coffee intake 2 to 3 days prior to the test. (The client should avoid coffee and tea (even if they are decaffeinated), bananas, chocolate, and vanilla for 2 to 3 days prior to the test.)

29. A nurse is assessing a client for diabetes insipidus. The nurse should expect which of the

following findings? Increased hematocrit (An increased hematocrit is an expected

finding resulting from dehydration.)

30. A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA).

Which of the following findings should the nurse expect? pH 7.32, PaCO2 36 mm Hg, HCO3 14 mEq/L (Metabolic acidosis is a common manifestation of DKA, with pH characteristically low, carbon dioxide within the expected reference range, and bicarbonate low.)

31. A nurse is caring for a patient that had DM type 2 and HHS. Which of the following lab

values should the nurse expect to find?

Serum Ph of 7.45 (A client who has HHS produces enough insulin to prevent ketosis, but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range. Glucose levels will be above 600 mg/dL.) 32. A nurse is teaching a patient about diabetes type 1. Which of the following should the nurse include?

Ingest alcohol with food to avoid alcohol induced hypoglycemia. (Alcohol inhibits the liver from producing glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia.)

Detailed Answer Key ATI Complex Endocrine Practice

1. A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client

reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings shouldthe nurse assess the client?

A. Chvostek's sign

Rationale: The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia.

B. Babinski's sign

Rationale: Babinski's sign is a diagnostic test for brain damage or upper motor neuron damage. It ispositive if the toes flare up when the nurse strokes the plantar aspect of the foot.

C. Brudzinski's sign

Rationale: Brudzinski's sign is an indication of meningeal irritation, such as in clients who have meningitis. With the client supine, the nurse should place one hand behind his head and places her other hand on his chest. The nurse then raises the client's head with her hand behind his head, while the hand on his chest restrains him and prevents him from rising.

Flexion of the client's lower extremities constitutes a positive sign.

D. Kernig's sign

Rationale: Kernig's sign is an indication of meningeal irritation, such as in clients who have meningitis. The nurse performs the maneuver with the client supine with his hips and knees in flexion. The inability to extend the client's knees fully without causing pain constitutes a positive test.

2. A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being

admitted to the emergency department confused, flushed, and with an acetone odor on the breath.

Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

A. NPH insulin

Rationale: Isophane NPH insulin is intermediate-acting. It has an onset of action of 1 to 3 hr and is not appropriate for emergency treatment of ketoacidosis.

B. Insulin glargine

Rationale: Insulin glargine is a long-acting insulin, with an onset of 2 to 4 hr. It is not appropriate for emergency treatment of ketoacidosis.

C. Insulin detemir

Rationale: Insulin detemir is an intermediate-acting insulin. It has an onset of action of 1 hr and is not appropriate for emergency treatment of ketoacidosis.

D. Regular insulin

Rationale: Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

3. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?

A. Dehydration

Rationale: Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.

B. Polyphagia

Rationale: Polyphagia is a finding of diabetes mellitus, not insipidus.

C. Hyperglycemia

Rationale: Hyperglycemia is a finding of diabetes mellitus, not diabetes insipidus.

D. Bradycardia

Rationale: Tachycardia, not bradycardia, is a manifestation of diabetes insipidus.

4. A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse

should identifywhich of the following findings as an indication that the medication is effective?

A. A decrease in blood sugar

Rationale: Blood sugar level is not affected in diabetes insipidus.

B. A decrease in blood pressure

Rationale: Diabetes insipidus causes the loss of large amounts of urine, which can lead to hypotension.

An increase (or at least no further decrease) in blood pressure would be the desired response to vasopressin.

C. A decrease in urine output

Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst.

Vasopressin is used to control frequent urination, increased thirst, and loss of water associatedwith diabetes insipidus. A decreased urine output is the desired response.

D. A decrease in specific gravity

Rationale: An increase in specific gravity (indicating a more concentrated urine) would be the desiredresponse of vasopressin.

5. A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has

metabolic acidosis. Which of the following results should the nurse expect to see?

A. pH below 7.35 Rationale: With acidosis, the pH is below 7.35. However, the pH alone does not indicate whether theproblem is metabolic or respiratory. A pH above 7.45 indicates alkalosis.

B. HCO3 above 26 mEq/L

Rationale: With metabolic acidosis, the HCO3 is below 21 mEq/L. C. PaO2 below 70 mm Hg

Rationale: With metabolic acidosis, the PaO2 is likely to be within the expected reference range of 80 to 100 mm Hg, unless the client has other complications that are causing hypoxia.

D. PaCO2 above 45 mm Hg

Rationale: With metabolic acidosis, the PaCO2 is within the expected reference range of 35 to 45 mm Hg or below 35 mm Hg with respiratory compensation. An elevated PaCO2 indicates respiratory acidosis.

6. A nurse is caring for a client who is 8 hr postoperative following a subtotal thyroidectomy. In which of

the followingpositions should the nurse keep the client?

A. High Fowler's with neck extended

Rationale: Neck extension could place excessive tension on the operative area and the sutures.

B. High Fowler's with neck in a neutral position.

Rationale: High Fowler's does not support the head and neck area well enough and could place excess pressure on the operative area.

C. Semi-Fowler's with neck extended

Rationale: Neck extension could place excessive tension on the operative area and the sutures.

D. Semi-Fowler's with neck in a neutral position

Rationale: Semi-Fowler's is the most comfortable position for a client who has had thyroid surgery. Neck flexion could compromise the airway, and neck extension could place excessive tension on the operative area and the sutures. A neutral position is essential.

7. A nurse is reviewing a client’s laboratory report of blood gas findings: HCO3- 18 mEq/L and PaCO2

28 mm Hg.Which of the following pH values and conditions should the nurse expect when interpreting these findings?

A. Decreased pH and metabolic acidosis

Rationale: This client would have a decreased pH and be in metabolic acidosis. Other findings

would include diarrhea, circulatory shock, decreased level of consciousness, abdominal pain, cardiac dysrhythmia, and increased depth and rate of respirations.

B. Decreased pH and respiratory acidosis

Rationale: The client would have a decreased pH, but would not be in respiratory acidosis.

C. Elevated pH and metabolic alkalosis

Rationale: The client would not have an increased pH, but would be in metabolic alkalosis.

D. Elevated pH and respiratory alkalosis

Rationale: The client would not have an increased pH, and would not be in respiratory alkalosis.

8. A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following

data should thenurse identify as the priority to monitor?

A. Airway patency

Rationale: When using the airway, breathing, circulation approach to client care, the nurse should determine it is the priority to monitor the client's airway. Nerve damage, hypocalcemia inducedtetany, and edema can all impair the airway following thyroidectomy.

B. Temperature

Rationale: The nurse should monitor the client's temperature to detect infection of the incision site.

However, there is another factor that is the priority for the nurse to monitor.

C. Urination

Rationale: The nurse should monitor the client's urinary output to determine hydration status.

However, there is another factor that is the priority for the nurse to monitor.

D. Pain control

Rationale: The nurse should monitor the client's pain to promote comfort and compliance with breathing and mobility prescriptions. However, there is another factor that is the priority for the nurse tomonitor.

9. A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical

manifestations shouldthe nurse monitor? (Select all that apply.)

A. Bicarbonate excess B. Kussmaul's respirations C. Flushing D. Circumoral paresthesia E. Lethargy

Rationale: Bicarbonate excess is correct. Bicarbonate excess is a clinical manifestation for a client experiencing metabolic alkalosis.Kussmaul's respirations is incorrect. Kussmaul's respirations are a clinical

manifestation for a client experiencing metabolic acidosis.Flushing is incorrect. Flushing is a clinical manifestation for a client experiencing respiratory acidosis.Circumoral paresthesia is correct. Circumoral paresthesia is a clinical manifestation for a client experiencing metabolic alkalosis.Lethargy is incorrect.

Lethargy is a clinical manifestation for a client experiencing metabolic acidosis.

10.AA nurse is admitting a client who has influenza and is reporting numbness and tingling of the toes and

fingers. The nurse should recognize the client is experiencing which of the following acid-base imbalances?

A. Metabolic acidosis Rationale: A client who has metabolic acidosis has a low pH level and a low bicarbonate level with manifestations such as Kussmaul’s respirations, lethargy and confusion.

B. Metabolic alkalosis Rationale: A client who has influenza has experienced excessive vomiting leading to metabolic alkalosis. Manifestations include dizziness, Circumoral paresthesias, and numbness and tingling of the extremities.

C. Respiratory acidosis Rationale: A client who has respiratory acidosis has a low pH and a high bicarbonate level with manifestations such as warm, flushed skin, headache and tachycardia.

D. Respiratory alkalosis Rationale: A client who has respiratory alkalosis has high pH and a low bicarbonate level with manifestations such as tremulousness, blurred vision and difficulty concentrating.

11. A nurse is caring for a client who has the following arterial blood gas results: HCO3 18 mEq, PaCO2 28 mm Hg and pH 7.30. The nurse recognizes the client is experiencing which of the following acid base imbalances?

A. Metabolic acidosis Rationale: A client experiencing metabolic acidosis would have a decreased pH, a decreased HCO3 and a decreased PaCO2.

B. Respiratory acidosis

Rationale: A client experiencing respiratory acidosis would have a decreased pH, a normal (or slightlyelevated if acute) HCO3 and an increased PaCO2.

C. Metabolic alkalosis

Rationale: A client experiencing metabolic alkalosis would an increased pH, and increased HCO3 and an increased PaCO2.

D. Respiratory alkalosis

Rationale:A client experiencing respiratory alkalosis would an increased pH, a normal (or slightly decreased if compensated) HCO3 and a decreased PaCO2.

12.AA nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations

should the nurse expect?

A. Malignant hypertension Rationale: Diabetic ketoacidosis is a complication caused by the absence, or significant deficiency, of insulin. The clinical features include hyperglycemia, acidosis, and dehydration which manifests as hypotension.

B. Acetone odor to breath Rationale: Because of the lack of insulin, the body is unable to use glucose and instead breaks down fatsresulting in excessive ketones. The large amount of ketones causes the body to become acidotic and causes a fruity, or acetone odor to the breath C. Cheyne-Stokes breathing Rationale: In an attempt to regain homeostasis, the body increases the rate and depth of respirations (Kussmaul respirations).

D. Blood glucose level below 40 mg/dL Rationale: Significant hyperglycemia is seen in the client who has diabetic ketoacidosis, with blood glucose levels between 300 and 800 mg/dL.

13. A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect?

A. Hypoglycemia Rationale: Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger,and anxiety.

B. Nephropathy

Rationale: Manifestations of nephropathy include hypertension, microalbuminuria, and elevated uric acid levels.

C. Hyperglycemia

Rationale: Manifestations of hyperglycemia include warm skin, rapid respirations, and changes in mental status.

D. Ketoacidosis

Rationale: Manifestations of ketoacidosis include tachycardia, Kussmaul respirations, nausea, andlethargy.

14. A nurse is assessing a client who has Graves' disease. The nurse should expect which of the following laboratoryresults?

A. Decreased thyroid-stimulating hormone (TSH) level Rationale: The nurse should expect a TSH level below the expected reference range in a client who hasGraves' disease.

B. Decreased triiodothyronine (T3) level

Rationale: The nurse should expect a T3 level above the expected reference range in a client

who hasGraves' disease.

C. Decreased thyroxine (T4) level

Rationale: The nurse should expect a T4 level above the expected reference range in a client who hasGraves' disease.

D. Decreased thyroid-stimulating immunoglobulins (TSI) percentage

Rationale: The nurse should expect TSI above the expected reference range in a client who has Graves'disease.

15.AA nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a

blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider?

A. Glucocorticoid medications

Rationale: Glucocorticoid medications are prescribed for their anti-inflammatory effects.

B. Dextrose 5% in 0.45% sodium chloride

Rationale: Administration of dextrose 5% in 0.45% sodium chloride is prescribed when the blood glucoselevel reaches 250 mg/dL to prevent hypoglycemia and cerebral edema.

C. Oral hypoglycemic medications

Rationale: Oral hypoglycemic medications are prescribed for clients who have type 2 diabetes mellitus.

D. 0.9% sodium chloride IV bolus Rationale: The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion tothe vital organs.

16.AA nurse is collecting the medical history from a client who has manifestations of syndrome of

inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH? 16.B

Rationale: Systemic lupus erythematosus can cause SIADH, but not osteoarthritis.

B. Lung cancer Rationale: The nurse should ask the client if he has a history of lung cancer because some of the treatment options for small cell lung cancer can cause secretion of antidiuretic hormone. This results in the body retaining water and can cause the syndrome of inappropriate antidiuretic hormone (SIADH).

C. Liver cirrhosis Rationale: Certain medications, such as fluoroquinolone antibiotics, can cause SIADH. However, livercirrhosis does not cause SIADH. D. Dyspepsia Rationale: Bacterial pneumonia can cause SIADH. However, dyspepsia does not cause SIADH.

17.AA nurse is caring for a client who is 1 day postoperative following a thyroidectomy and reports

severe muscle spasms of the lower extremities. Which of the following actions should the nurse take?

A. Check the pedal pulses.

Rationale: There is no indication of a problem with this client's circulation, so it is not necessary to checkthe pedal pulses at this time.

B. Verify the most recent calcium level.

Rationale: A client who has had a thyroidectomy is at risk of hypocalcemia due to the possible disruption of the parathyroid gland during surgery. The parathyroid glands are four small glands located inside the thyroid gland that are responsible for calcium regulation. If they are damaged during a thyroidectomy, there is a risk of hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive reflexes. If a client develops any of these manifestations following a thyroidectomy, the nurse should check the client's latest calcium level. The expected reference range for calcium is 8.5 to 10.5 mg/dL. If the calcium level is low, the provider should be notified, and oral or intravenous calcium replacement should be administered.

C. Request prescription for a relaxant.

Rationale: A client who has had a thyroidectomy is at risk of hypocalcemia due to possible disruption of the parathyroid gland during surgery which causes muscle spasms, and numbness and tingling. If the client has a low calcium level, replacement with oral or intravenous calcium is required. Treating the manifestation without correcting the underlying cause places the client at risk for further complications of hypocalcemia, such as laryngospasm and airway obstruction.

D. Administer an oral potassium supplement.

Rationale: Clients who have low potassium levels often have leg cramps, rather than spasms.

There is nota risk of low potassium associated with a thyroidectomy, and therefore this should not be a suspected cause of muscle cramps in this client. Additionally, the nurse should only administer a potassium supplement to a client who has confirmed hypokalemia.

18.AA nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the

following interventions should the nurse include in the plan of care?

A. Measure blood glucose levels every 4 hr.

Rationale: The nurse should measure the blood glucose of a client who has diabetes mellitus.

B. Administer a diuretic.

Rationale: The nurse should plan to administer a diuretic for a client who has a syndrome of inappropriateantidiuretic hormone to promote diuresis.

C. Initiate fluid restrictions.

Rationale: The nurse should increase fluids to prevent dehydration in a client who has diabetes insipidus.

D. Check urine specific gravity.

Rationale: The nurse should check the client’s urine specific gravity to monitor urine concentration in a client who has diabetes insipidus. A client who has diabetes insipidus has a urine specific gravity of less than 1.005.

19.A

A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take?

A. Turn the client ever 4 hr.

Rationale: The nurse should turn the client every 2 hr to reduce the risk for impaired skin integrity andatelectasis.

B. Check the client’s blood pressure every 2 hr.

Rationale: The nurse should check the client’s blood pressure every hour to assess for hypotension.

C. Initiate measures to cool the client.

Rationale: The nurse should initiate warming measures for the client, such as warm blankets, to reducethe risk for hypothermia.

D. Place the client on aspiration precautions.

Rationale: The nurse should place the client on aspiration precautions because the client can have decreased mental status and is at risk for laryngeal edema and tongue thickening.

20.AA nurse is planning care for a client who is postoperative following a thyroidectomy. Which of

the following interventions should the nurse include in the plan?

A. Instruct the client to deep breathe every 4 hr.

Rationale: The nurse should instruct the client to deep breath every 30 min to 1 hr to reduce the risk for atelectasis.

B. Check the client’s voice every 2 hr.

Rationale: The nurse should assess the client’s voice every 2 hr to monitor for hoarseness, which is a manifestation of laryngeal nerve damage.

C. Place the head of the client’s bed in the flat position.

Rationale: The nurse should elevate the client’s head of bed to reduce the risk for respiratory distress.

D. Hyperextend the client’s neck.

Rationale: The nurse should support the client’s neck with pillows and avoid neck hyperextension to reduce the risk for bleeding and discomfort.

21. A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?

A. Tingling of the extremities Rationale: A serum calcium level of 7.6 mg/dL is below the expected reference range, indicating hypocalcemia. A client who undergoes a total thyroidectomy is at risk for parathyroid injury which can lead to hypocalcemia. The nurse should monitor the client for reports of tingling and numbness of the extremities and around the mouth, muscle tremors, cramps and cardiac dysrhythmias.

B. Hypoactive deep tendon reflexes.

Rationale: A client who undergoes a total thyroidectomy is more likely to have hyperactive deep tendonreflexes as a result of hypocalcemia.

C. Shortened QT intervals.

Rationale: Calcium plays a role in the electrical conduction of the heart by controlling depolarization andaction potentials within cells. A client who undergoes a total thyroidectomy is more likely to have lengthened QT intervals and prolonged ST segments, and weak and thread pulses as aresult of hypocalcemia.

D. Constipation

Rationale: A client who undergoes a total thyroidectomy is more likely to have increased peristaltic activity leading to abdominal cramps and diarrhea.

22.AA nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following

findings should the nurse expect?

A. Hypertension

Rationale: Hypotension is an expected finding for a client who has uncontrolled diabetes.> B. Hematuria

Rationale: Hematuria is not an expected finding for a client who has uncontrolled diabetes.

C. Weight loss Rationale: Weight loss is an expected finding for a client who has uncontrolled diabetes.

D. Bradycardia Rationale: Tachycardia is an expected finding for a client who has uncontrolled diabetes.

23.AA nurse is reviewing the laboratory results for four clients. The nurse should recognize which of

the following clients has a manifestation of hypoparathyroidism?

A. A client who has a vitamin D of 25 ng/mL

Rationale: This level is within the expected reference range of 25 to 80ng/mL. Vitamin D levels aredecreased in a client who has hypoparathyroidism.

B. A client who has a magnesium of 1.8 mEq/L

Rationale: This level is within the expected reference range of 1.3 to 2.1 mEq/L. Magnesium levels are decreased in a client who has hypoparathyroidism.

C. A client who has a calcium of 9.8 mg/dL

Rationale: This level is within the expected reference range of 9.0 to 10.5 mg/dL. Calcium levels are decreased in a client who has hypoparathyroidism.

D. A client who has a phosphate of 5.7 mg/dL Rationale: This level is above the expected reference range of 3.0 to 4.5 mg/dL. Phosphorus levels are increased in a client who has hypoparathyroidism.

24.AA nurse is assessing four clients on a medical unit. The nurse should identify which of the

following clients as exhibiting positive manifestations of hypercortisolism?

A. A client who has a butterfly rash on his face.

Rationale: A butterfly rash on the face is a manifestation of lupus erythematosus.

B. Moon face Rationale: A client who has a moon face and fat pads on his neck, back and shoulders is exhibiting manifestations of hypercortisolism or Cushing’s syndrome.

C. A client who has a positive Chvostek’s sign.

Rationale:A positive Chvostek’s sign is a manifestation of hypocalcemia.

D. A client who has muscle hypertrophy.

Rationale: Muscle atrophy is a manifestation hypercortisolism.

ATI ENDOCRINE 1. A common clinical term used to refer to women with an excess growth of terminal hair in a male pattern is: a. Hirsutism 2. Hyperplasia of the thyroid gland is caused by a deficiency of: a. Iodine, resulting in a goiter 3. Which of the following is NOT a complaint of patients with type 1 diabetes? a. Polycythemia 4. Based on the 2-hour glucose tolerance test (GTT), a positive result for gestational diabetes is: a. 200 mg/dL 5. A sweat test is used to help diagnose: a. Cystic fibrosis 6. The presence of pubic hair in girls between the age of 5 and 8 years is termed: a. Adrenarche 7. The most common cause of death in children diagnosed with cystic fibrosis is: a. Respiratory failure 8. Hypofunctioning of the thyroid gland would lead to all the following disorders except: a. Grave’s disease 9. A finding NOT identified in boys diagnosed with Klinefelter syndrome is: a. A high sperm count, Klinefelter syndrome is a condition that affects male physical and cognitive development. SxS are: low testosterone level, micro-orchidism,

gynecomastia, facial hair, baldness, and low sperm count 10. During assessment of the thyroid, a fixed, firm, nontender large mass is noted. These findings describe: a. A nodule 11. A common symptom noted in patients who have a thyroid goiter is: a. A frequent cough 12. A life-threatening symptom of parathyroid hormone (PTH) deficiency, hypoparathyroidism, is: a. Tetany, which can develop of hypocalcemia is severe, causing laryngospasms and bronchospasms, which can be life threatening 13. When auscultating the enlarged thyroid with a stethoscope, a bruit is suggestive of: a. Hyperthyroidism 14. Thyrotoxicosis is most commonly associated with: a. Hyperthyroidism 15. A butterfly-shaped gland located in the middle of the neck below the larynx and above the clavicle is the: a. Thyroid gland 16. A general term for an enlarged thyroid is: a. A goiter 17. A hormonal disorder in adults resulting from the overproduction of growth hormones is known as:

Drone IT a. Acromegaly 18. Hyperpigmentation of the skin and mucous membranes can be seen in patients who: a. Addison’s disease 19. The appearance of breast development in girls before the age of 8 years is termed: a. Precocious puberty 20. A 29-year-old woman with systemic lupus erythematosus (SLE) complains of facial swelling. She has been on a prolonged course of corticosteroids. On assessment, moon face appearance is noted. She has most likely developed: a. Cushing Syndrome 21. When a patient presents with myxedema coma, which one of the following groups of symptoms may be present? a. Hypothermia, thickening of the tongue, and disorientation 22. Which hemoglobin A1C level is typically used to diagnose type 2 diabetes? a. 6.50% 23. Which electrolyte is regulated by the parathyroid gland? a. Calcium 24. Symptoms of Graves’ disease include: a. Proptosis 25. When assessing the thyroid gland, the nurse practitioner for abnormalities while asking the patient to: a. Swallow water 26. A common arrhythmia associated with hyperthyroidism is: a. Atrial Fibrillation 27. Which of the following is NOT considered a benign tumor of the pituitary gland? a. Craniopharyngioma 28. Which of the following is NOT a symptom of polycystic ovarian syndrome (PCOS)? a. Insomnia 29. Fruity breath odor correlates with assessment for: a. Diabetic Ketoacidosis 30. A patient has an enlarged thyroid gland with an audible bruit. The examiner should suspect: a. Hyperthyroidism 31. Examination of the hair reveals a sparse amount with a coarse appearance. These findings may be seen in patients who have: a. Hypothyroidism 32. A 30-year-old woman is taking phenytoin (Dilantin) for seizures. She has recent hair loss and anorexia but is craving salty foods. Her lab results show abnormally high cortisol levels. These symptoms suggest: a. Addison’s disease, which will present with above normal cortisol levels 33. Women with hyperthyroidism often experience: a. Oligomenorrhea, infrequent menstrual periods 34. Which of the following is NOT associated with Hashimoto’s thyroiditis? a. Weight loss (Hashimoto’s presents with Cold intolerance, hair loss, and decreased perspiration)

Drone IT 35. Symptoms of underdeveloped ovaries, web-like neck, and shirt stature are associated with: a. Turner Syndrome, SxS include short stature, delayed growth, low-set ears, weblike neck, and in girls, underdeveloped ovaries 36. Myxedema is a symptom commonly found in patients diagnosed with: a. Hypothyroidism 37. Hyperfunctioning of the thyroid gland could lead to all of the following disorders except: a. Myxedema 38. Bilateral exophthalmos suggests: a. Grave’s disease 39. A 20-year-old with acanthosis nigricans should be evaluated for: a. Diabetes mellitus 40. Which one of the following groups of symptoms would be more consistent in a child with type 2 diabetes mellitus? a. Blood glucose levels on two separate occasions greater than 126 mg/dL, enuresis, and complaints of being tired.

41. Which one of the following groups of symptoms would be more consistent in a child with type 2 diabetes mellitus? a. Blood glucose levels on two separate occasions greater than 126mg/dL, enuresis, and complaints of being tired 42. A 9-year-old girl had a history of tuberculosis when she was 6 years old. She presents with recent weight loss and anorexia. Along with her presenting symptoms, which one of the following assessment findings would be the most indicative of Addison’s disease? a. Hyperpigmentation and low blood pressure 43. What is the earliest recognizable clinical manifestation(s) of cystic fibrosis in a child? a. Clubbing, frequent respiratory infections, and rectal prolapse 44. Breastfeeding is contraindicated for an infant diagnosed with which one of the following conditions? a. Galactosemia, lack of enzyme which breaks down galactose into glucose in the liver 45. The earliest recognizable clinical manifestation(s) of cystic fibrosis in an infant is: a. Salty taste on the skin 46. A six-year-old has a history of diabetes mellitus type 1 and is now experiencing cellulitis of the right lower leg. The child presents with deep, rapid, and unlabored respirations, fruity odor, and dry skin. These are symptoms of: a. Ketoacidosis 47. A 13-year-old girl presents with complaints of insomnia and hyperactivity along with gradual weight loss despite a good appetite. She has warm, flushed, and moist skin and unusually fine hair. These manifestations are indicative of which of the following conditions? a. Hyperthyroidism 48. Children with type 1 diabetes mellitus usually present with which one of the following symptoms? a. Polyuria

1. A nurse is planning care for a client who has Cushing’s syndrome due to chronic corticosteroid use. Which of the following actions should the nurse involve in the plan of care? a. Check the client’s urine specific gravity. i. Rationale: to assess for fluid volume overload. ii.

2. A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? a. Turkey and cheese sandwich i. Rationale: high in protein, carbohydrates, and sodium. A client who has Addison’s requires a diet low in potassium, and high in protein, carbs, and sodium.

3. A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. The nurse should understand that which of the following laboratory values is consistent with diabetic ketoacidosis? a. Bicarbonate level 12 mEq/L i. Rationale: DKA patients have bicarbonate levels less than 15 ii.

4. A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings should indicate to the nurse that the client has hyperglycemia? a. Increased urination i. Rationale: increased urination/polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.

5. A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find? a. Bronze pigmentation of skin i. Rationale: hormone deficiency caused by damage to the outer layer of the adrenal gland.

6. A nurse is caring for a client who has diabetes insidious. For which of the following findings should the nurse monitor? a. Polyuria i. Rationale: DI is characterized by increased thirst and increased urination.

7. A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. the nurse should report which of the following findings to the provider? a. Hypertension i. Rationale: Thyroid storm patients will have an exaggerated condition of hyperthyroidism, associated with the development of a fever, hypertension, abdominal pain, and tachycardia 8. A nurse is preparing a 24-hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hour urine specimen should the nurse use to determine the client's condition? a. Vanillylmandelic acid (VMA) 9. A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. the nurse should expect to administer glucocorticoids following the procedure to enhance

which of the following therapeutic effects? a. Compensate for decrease in cortisol levels i. Rationale: glucocorticoids are used to prevent an adrenal crisis caused by a sudden drop in cortisol levels.

10. A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? a. Difficulty sleeping i. Rationale: a client who has graves’ disease has difficulty sleeping and anxiety due to the overproduction of thyroid hormone.

11. A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? a. Shakiness i. Rationale: an early manifestation of hypoglycemia is shakiness.

12. A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? a. Increased head size i. Rationale: enlarged head size due to excessive production of growth hormones after the closing of the epiphyses.

13. A nurse is providing teaching to a client who has type 2 diabetes mellitus about pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? a. "My cells are resistant to effects of insulin." i. Rationale: the client who has type 2 diabetes mellitus will have a resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells.

14. A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening? a. Men and women who are obese i. Rationale: There is a high correlation between obesity and type 2 DM. 15. A nurse is monitoring a client who has syndrome of inappropriate antidiuretic secretion (SIADH). Which of the following findings should the nurse expect? a. Hyponatremia i. Rationale: the client who has SIADH will have hyponatremia caused by the excessive release of ADH. As a result of the excessive secretion the client retains water.

16. A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise.

Which of the following statements should the nurse include in the teaching? a. "Wear a medical alert identification tag when you exercise." i. Rationale: a client should wear a medical alert ID tag in the event of hypoglycemic response, because exercise can potentiate the effects of insulin and cause the blood glucose levels to decrease.

17. A nurse caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure?

a. Calcium i. Rationale: parathyroid hormone regulates calcium, phosphorous, magnesium balance in the blood and bone.

18. A nurse is checking laboratory values to determine if a client who has diabetes is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? a. Glycosylated hemoglobin levels (HbA1c) 19. A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? a. Monitor the client's nighttime blood glucose levels i. Rationale: the Somogyi effect is a swing of high blood glucose levels in the morning after an extremely low blood glucose level during the night.

The swing is caused by a release of stress hormones to counter low glucose levels.

20. A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (select all that apply) a. Tachycardia and hypertension b. Laryngeal stridor and hoarseness c. A positive Trousseau's sign d.

21. A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following adverse effects? a. Peritonitis i. Rationale: Peritonitis is an adverse effect of peritoneal dialysis.

Prevention requires sterile technique.

22. A nurse is reinforcing teaching with a client who has chronic kidney disease (CKD).

Which of the following instructions should the nurse include? a. Limit fluid intake i. Rationale: a client who has CKD should limit fluid intake to prevent hypervolemia, or excessive fluid overload.

23. A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that dialysate output is less than input, and the client's abdomen is distended. Which of the following actions should the nurse take? a. Change the client's position i. Rationale: the client is retaining the dialysate solution after the dwell time. The nurse should ensure the clamp is open and the tubing is not kinked and reposition the client to facilitate the drainage of the solution from the peritoneal cavity. ii.

24. A nurse is reinforcing teaching about urinary tract infections (UTIs) with a client. Which of the following manifestations should the nurse include? a. Back pain i. Rationale: back pain and flank pain are manifestations of a UTI. Other manifestations include frequency, urgency, and cloudy, foul-smelling urine.

25. A nurse is reinforcing teaching with a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? a. "You should complete the entire cycle of antibiotic therapy." i. Rationale: the client should take the full prescription of the antibiotic therapy to decrease the chance of regrowth of the causative organism. The should drink at least 2,000 mL of fluid per day.

26. A nurse is reinforcing teaching with a client who has a history of urinary tract infections (UTIs). Which of the following statements should indicate to the nurse the need for additional instructions? a. "I will vaginal douche daily." i. Rationale: the client should avoid vaginal douches, bubble baths, and any substances that can increase the risk of UTIs. Client should use mild soap and water to wash the peritoneal area.

27. A nurse is reinforcing teaching to a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following statements indicates as an understanding of the information? a. "I will feel the urge to urinate following this procedure." i. Rationale: after a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve his discomfort.

28. A nurse is collecting data from a client who is postoperative following a transurethral resection of the prostate (TURP). After the nurse discontinues the client's urinary catheter, which of the following findings should the nurse report to the provider? a. Decreased urinary output i. Rationale: a decrease in urine output after TURP indicates obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider.

29. A nurse is reinforcing teaching to a client prior to a renal biopsy. Which of the following statements should the nurse make? a. "You will need to be on bedrest following this procedure." i. Rationale: the client should maintain bed rest in a supine position with a back roll for support for 2-24 hours following the procedure to reduce the risk for bleeding.

30. A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make? a. "Avoid taking blood pressures on the client's left arm." i. Rationale: the nurse should avoid taking blood pressure measurements on the client’s left arm, which can decrease blood flow and cause clotting.

31. A nurse is caring for a client who has a diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing intervention? a. Relieve the client's pain i. Rationale: the pain associated with renal calculi is severe and can lead to shock; therefore, this is the priority action.

32. A nurse is reinforcing teaching about collecting a 24-hr urine specimen for creatinine

clearance with a newly licensed nurse. Which of the following instructions should the nurse include? a. Place signs in the bathroom as a reminder about the test in progress i. Rationale: the nurse should place signs in the bathroom and alert family members of the test in progress so that everyone saves the specimens appropriately throughout the test.

33. A nurse is collecting data from a client who is 1 week postoperative following a living donor kidney transplant. Which of the following findings should the nurse indicate the client is experiencing acute kidney rejection? a. BP 160/90 mmHg i. Rationale: due to the kidney’s role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension.

34. A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury.

The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first? a. Check the client's electrolyte values i. Rationale: the nurse should check the client’s most recent potassium value, because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias, therefore, this is a priority action.

35. A nurse is collecting data from a client who has an injury to the lower abdomen following a motor-vehicle crash. The nurse should identify that which of the following findings is a manifestation of bladder trauma? a. Hematuria i. Rationale: manifestations of bladder trauma include hematuria, or blood in the urine; blood at the urinary meatus; pelvic pain; and anuria, or the absence of urine.

36. A nurse is reinforcing dietary teaching with a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet? a. Calcium i. Rationale: a client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium reabsorption. The client should supplement dietary calcium.

37. A nurse is reinforcing teaching about the prostate-specific antigen (PSA) test with a client. Which of the following statements should the nurse make? a. "You should not ejaculate for 24 hours after the PSA test." i. Rationale: PSA is a glycoprotein that it manufactured in the prostate and is used to screen for prostate cancer. Ejaculation within 24 hours prior to the test can cause falsely elevated levels of PSA. 38. A nurse is reinforcing teaching with a client prior to a cystoscopy. Which of the following statements should the nurse make? a. "Expect to have pink-tinged urine after this procedure." i. Rationale: a cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Pink-tinged urine following the procedure is expected.

39. A nurse is collecting data from a client who is postoperative following a extracorporeal shockwave lithotripsy (ESWL). The nurse should identify that which of the following findings is the priority? a. Report of palpitations/dysrhythmias i. Rationale: ABCs 40. A nurse is collecting data from a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? a. Potassium 3.0 mEq/L i. Rationale: a potassium level of 3.0 mEq/L is below the expected reference and can cause dysthymia’s. The dialysis removes fluid, waste products, and electrolytes from the blood and can cause hypokalemia.

41. A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy?

Fasting blood glucose 96 mg/dL Postprandial blood glucose 195 mg/dLCasual blood glucose 210 mg/dL Preprandial blood glucose 60 mg/dL Fasting blood glucose 96 mg/dL This is within the expected reference range for a fasting blood glucose level andindicates that insulin therapy is effective.

42. A nurse is caring for a client following a thyroidectomy. The nurse should assess for which ofthe following findings as an indication of hypocalcemia?

Strong, bounding pulse Decreased bowel sounds Tingling and numbness of the hands and feetDiminished deep-tendon reflexes 43. A nurse is caring for a client who has pheochromocytoma. Which of the following actions should the nurse take?

Elevate the head of the client's bed.

Palpate the client abdomen Monitor the client for hypotension Check the client urine specific gravity 44. A nurse is assessing a client who is taking propylthiouracil. The nurse should identify which of the following findings as an indication that the medication has been effective?

Increased the ability to sweat Increased bowel movements

Increased body Weight Increased libido 45. A nurse is performing an assessment on a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessment data should the nurse report?

Serum sodium 110 mEq/L (A client who has SIADH retains fluids, which causes dilutional hyponatremia.)

2+ deep-tendon reflexes Serum potassium 3.7 mEq/L Urine specific gravity 1.025 46. A nurse is assessing a client who has diabetes insipidus. The nurse should expect which ofthe following findings?

Decreased heart rate Increased hematocrit (An increased hematocrit level is an expected finding related to dehydration.)

High urine specific gravityDecreased BUN 47. A nurse is caring for a client who has diabetes mellitus and developed peripheral neuropathy.Which of the following measures should the nurse recommend to prevent injuries to his feet? Examine the skin and feet weekly for alterations in skin integrity.

Monitor the temperature of bath water with a thermometer. (Peripheral neuropathy makes it difficult to determine if bath water is too hot. Therefore, to prevent injury, the client should usea bath thermometer to ensure the water temperature is less than 43.3° C (110° F).)

Shop for shoes early in the day.

Round the edges of toenails when trimming.

48. A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of thefollowing instructions should the nurse plan to include?

Consume no more than three serving of alcohol per day Ingest alcohol with meals to reduce alcohol-induced hypoglycemia. (Alcohol prevents liver production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia.)

Increase insulin dosage before planned exercise Rest for 3 days between periods of vigorous exercise.

49. A nurse is managing the care of a client who is postoperative and experiencing acute adrenalinsufficiency. Which of the following actions should the nurse take?

Administer IV hydrocortisone sodium succinate. (Hydrocortisone sodium succinate is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency.)

Give oral spironolactone.

Infuse 1 unit of platelets.

Restrict daily fluid intake.

50. A nurse is caring for a client who has type 2 diabetes mellitus and has hyperglycemichyperosmolar state (HHS). Which of the following laboratory findingsshould the nurse expect?

Serum pH 7.32 Blood glucose 250 Blood glucose 425 Serum pH of 7.45 51. A nurse is caring for a client undergoing screening for primary Cushing's disease. The nurse should expect and elevation in which of the following laboratory findings?

Lymphocyte count potassium calcium glucose 52. A nurse is teaching a client who has diabetes mellitus about insulin injections. The client prescription includes evening doses of insulin glargine and regular insulin. Which of the following instruction should the nurse include?

Inject the insulins intramuscularly Shake the insulin vigorously prior to administration Draw up the insulins into separate syringes Expect the insulin to appear cloudy 53. A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching?

"I will let my feet air dry after washing."

"I will wear sandals to allow air to circulate around my feet."

"I will buy over-the-counter medicine to treat the calluses on my feet."

"I will apply lotion to the dry areas of my feet, avoiding application between my toes." (Lotion is appropriate for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth.)

54. A nurse is teaching a client who is scheduled for a vanillylmandelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the teaching?

Start fasting at midnight prior to the day of the test.

Begin the 24-hr urine collection with the first morning urination.Take low-dose aspirin for pain during the testing period.

Restrict coffee intake 2 to 3 days prior to the test. (The client should avoid coffee and tea (evenif they are decaffeinated), bananas, chocolate, and vanilla for 2 to 3 days prior to the test.)

55. A nurse is monitoring a client's status 24 hr after a total thyroidectomy. Which of the following findings should the nurse report to the provider?

Laryngeal stridor (Laryngeal stridor is a harsh, high-pitched sound upon inspiration that indicates respiratory obstruction. The nurse should take immediate action to preserve theclient's airway.)

Productive cough Pain with hyperextension of the neck Hoarse, weak voice

56. A nurse is assessing a client who has adrenal insufficiency. Which of the following findingsshould the nurse expect?

Moon face Weight gain Serum calcium 12.8 mg/dL (A client who has adrenal insufficiency has a serum calcium level above the expected reference range.)

Serum sodium 150 mEq/L 57. A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings?

Cold intolerance Lethargy Tremors (Findings of hyperthyroidism include tremors, diaphoresis, and insomnia.)

Sunken eyes 58. A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect?

Decreased blood pressure Weight loss Hirsutism (Increased hair growth, or hirsutism, is an expected finding of Cushing's disease dueto increased androgen production).

Increased skin thickness 59. A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following statements by the client indicates an understanding of the information about this test?

"I need to fast after midnight the night before the test."

"This test is a good indicator of my average blood glucose levels.” (HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs.) "A level of 8% to 10% suggests adequate blood glucose control."

"I will use my hemoglobin A1c level to adjust my daily insulin doses.

60. A nurse is providing teaching for a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements indicates that the client understands the teaching?

"I should stop taking my insulin if I feel nauseous."

"I will test my urine for protein when I start to feel ill."

"I will call my doctor if my blood sugar is more than 250 mg/dL." (The client should call the provider if blood glucose levels exceed 250 mg/dL during illness.)

"I should check my blood glucose level every 8 hours."

61. A nurse is preparing to administer propranolol by IV bolus to a client experiencing a thyroid storm. Which of the following findings indicates the client is having a therapeutic response?

Reduction of the effects of thyroid hormone on the heart (Propranolol is a beta2-adrenergic blocking agent that decreases the rapid heart rate caused by excessive thyroid stimulation.)

Blockage of the release of thyroid hormone from the thyroid gland Increase of the heart's sensitivity to thyroid hormone Increase of the uptake of thyroid hormone by the thyroid gland 62. A nurse is providing discharge teaching for a client who has diabetes insipidus and has a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?

Depress the pump once before using the nasal spray for the first time Blow your nose gently prior to using the nasal spray. (By blowing the nose gently prior to use of the spray, the client avoids dilution of the medication by nasal secretions or improper absorption of the medication due to nasal blockage.)

Administer the nasal spray while in a side-lying position.

Notify the provider if you develop numbness or tingling around the mouth 63. A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic?

Rapid, deep respirations Cool, clammy skin (Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness,tachycardia, and confusion.)

Abdominal cramping Orthostatic hypotension 64. A nurse is providing a teaching plan for a client who has diabetes insipidus and is requires intranasal desmopressin. Which of the following information should the nurse include?

Drink at least 3 liters of fluid per day weight yourself weekly while wearing similar clothing at the same time of day.

Notify the provider if a weight loss of 1 pound or more per week is noted.

Report nocturia because it requires a dosage adjustment. (The initial dose of desmopressin is administered in the evening; the provider will increase the dosage until the client no longer experiences nocturia.)

65. A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA).Which of the following results should the nurse expect? pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L (With DKA, the pH is low, carbon dioxide is withinthe expected reference range, and bicarbonate is low.) pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L 66. A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following effects should the nurse include?

(Select all that apply.)

Osteoporosis Moon-shaped face Increased risk of infection Hearing loss Weight loss 67. A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroid hormone replacement. Which of the following instructions should the nurse plan to

include?

"Take this medication on an empty stomach." (To promote proper absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30 to 60 min after taking it.)

"Take this medication with an antacid."

"Change position slowly while taking this medication."

"Limit your fluid intake while taking this medication."

68. A nurse is teaching for a client who has diabetes mellitus. Which of the following should the nurse include as an expected findings of diabetic ketoacidosis (DKA)?

Decreased urine output Weight gain of 0.45 kg (1 lb) in 24 hrRapid, shallow respirations Blood glucose levels greater than 300 mg/dL (Blood glucose levels above 300 mg/dL are an expected finding of DKA.) 69. A nurse is preparing to give a client information about an adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders?

Diabetes insipidus Hyperthyroidism Pheochromocytoma Addison's disease (The ACTH stimulation test is the standard test for Addison's disease. It measures the cortisol response to ACTH. The response is absent or very decreased in clientswho have primary adrenal insufficiency.)

70. A home health nurse is assessing a client who is on lifelong hormone replacement therapy for treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect?

Significant weight lossPersistent diarrhea Tachycardia Hypotension (Hypotension is an expected finding of hypothyroidism.)

71. A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency.Which of the following action should the nurse take? o o o o

Adminster IV hydrocortisone sodium Give oral spironolactone Infuse 1 unit of platelets Restrict daily fluid intake 72. A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasaldesmospressin. Which of the following information should the nurse include in the teaching plan?

o Drink at least 3 L of fluid per day o Weigh yourself weekly while wearing similar clothing at the same time of day

o Notify the provide of a weight loss of 0.45 kg (1lb) or more per week o Report nocturia because it requires a dosage adjustment 73. A nurse is teaching a client about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders? o o o o

Diabetes insipidus Hyperthyroidism Pheochromocytoma Addisons disease 74. A nurse is teaching a client who has an autoimmune disease about the adverse effects of long- term corticosteroid therapy. Which of the following effects should the nurse include? (Select allthat apply)

o o o o o

Osteoporosis Moon-shaped face Increased risk of infection Hearing loss Weight loss 75. A nurse is caring for a client undergoing screening for primary Cushings disease. The nurseshould expect an evaluation in which of the following laboratory finding?

o o o o

Lymphocyte count Potassium Calcium Glucose 76. A nurse is assessing a client who has a new diagnosis of Cushing’s disease.

Which of the followingfindings should the nurse expect?

o o o o

Decreased blood pressure Weight loss Hirsutism (increased hair growth; due to androgen production) Increased skin thickness 77. A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of thefollowing findings should the nurse expect if the client is hypoglycemic?

o o o o

Rapid, deep respirations Cool, clammy skin Abdominal cramping Orthostatic hypotension

78. A nurse is teaching a client who has diabetes mellitus about insulin injections.

The clients prescription includes evening doses of insulin glargine and regular insulin. Which of the followinginstructions should the nurse include? o o o o

Inject the insulin intramuscularly Shak the insulins vigorously prior to administration Draw up the insulins into separate syringes Expect the insulins to appear cloudy 79. A nurse is planning teaching for a client who has type 1 diabetes mellitus.

Which of the followinginstructions should the nurse include?

o o o o

Consume no more than 3 servings of alcohol per day Ingest alcohol with food to reduce alcohol-induced hypoglycemia Increase insulin dosage before planned exercise Rest for 3 days between periods of vigorous exercise 80. A nurse in an outpatient clinic is teaching a client who has a diabetic food ulcer about foot care.Which of the following statements should the nurse identify as an indication that the client understands the teaching?

o o o o

“I will let my feet air dry after washing” “I will wear sandals to allow air to circulate around my feet” “I will buy over-the-counter medicine to treat the calluses on my feet” “I will apply lotion to the dry areas of my feet, but not between my toes” 81. A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is takinginsulin. Which of the following results indicates a therapeutic outcome of insulin therapy?

o o o o

Fasting blood glucose 96 mg/dL Postprandial blood glucose 195 mg/dL Casual blood glucose 210 mg/dL Preprandial blood glucose 60 mg/dL 82. A nurse is monitoring a clients status 24 hr after a total thyroidectomy. Which of the followingfindings should the nurse report to the provider?

o Laryngeal stridor (harsh, high-pitched sound with inspiration that indicates respiratory obstruction. The nurse should takeimmediate action to preserve the clients airway) o Productive cough o Pain with hyperextension of the neck o Hoarse, weak voice 83. A nurse is caring for a client who is taking propylthiouracil. The nurse should identify that theclient has met the treatment goals when she reports an increase in which of the following manifestations? o Sweating o Stools o Weight (propylthiouracil suppresses the production of thyroid hormones & allows for weight gain. Excessive weight gain could indicate that the dose is too high) o Appetite

84. A home health nurse is assessing a client who requires lifelong hormone replacement therapy for the treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect? o o o o o

Increased urine output Persistent diarrhea Tachycardia Hypotention 85. A nurse is caring for a client who has type 2 diabetes mellitus an has hyperglycemic-hyperosmolarstate (HHS). Which of the following laboratory findings should the nurse expect?

o o o o

Serum pH of 7.32 Blood glucose of 250 mg/dL Blood glucose of 425 mg/dL Serum pH of 7.45 (a client who has HHS produces enough insulin to prevent ketosis, but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range. Glucose levels will be above 600 mg/dL) 86. A nurse is providing discharge teaching for a client who has diabetes insipidus and has a new prescription for desmopressin nasal spray. Which of the following instructions should the nurseinclude in the teaching?

o “Depress the pump once before using the nasal spray for the first time” o “Blow your nose gently prior to using the nasal spray” (prevents dilution of the medication with nasal secretions) o “Administer the nasal spray while in a side-lying position” o “Instill the medication four times per day” 87. A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing.

Which of the following statements should the nurse identify as an indication that the client understands theinformation about this test? o o o o

“I need to fast after midnight the night before the test” “This test’s result is a good indictor of my average blood glucose levels” “A level of eight to ten percent suggests adequate blood glucose control” “I will use my hemoglobin A1C level to adjust my daily insulin doses” 88. A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complicationsduring illness. Which of the following statements should the nurse identify as an indication that the client understands the teaching?

o “I should stop taking my insulin if I feel nauseous” o “I will test my urine for protein when I start to feel ill” “I will call my doctor if my blood sugar is more than 250 milligrams per deciliter” o “I should check my blood glucose level every 8 hours”

89. A nurse is assessing a client who has adrenal insufficiency. Which of the following findings shouldthe nurse expect? o o o o

Moon face Weight gain Calcium 12.8 mg/dL Sodium 150 mEq/L 90. A nurse is caring for a client who has diabetes mellitus and has developed peripheral neuropathy.Which of the following measures should the nurse recommend to prevent injuries to the clients feet?

o Examine the skin and feet weekly for alterations in skin integrity o Monitor the temperature of bath water with a thermometer (peripheral neuropathy makes it difficult to determine ifbath water is too hot. Therefore to prevent injury the client should use a bath thermometer to ensure a water tem below 43.30C (1100F) o Shop for shoes early in the day o Round the edges of toenails when trimming them 91. To screen a client for pheochromocytoma, a nurse schedules a vanillylmandelic acid test. Whenteaching the client about this test, which of the following instructions should the nurse include? o o o o

“Start fasting at midnight prior to the day of the test” “Begin the 24-hour urine collection with the first morning urination” “Take low-dose aspirin for pain during the testing period” “Restrict coffee intake 2 – 3 days prior to the test” (the client should avoid coffee & tea (even if they aredecaffeinated), bananas chocolate & vanilla for 2-3 days prior to the test) 92. A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurseinclude as an expected finding of diabetic ketoacidosis (DKA)?

o o o o

Decreased urine output Weight gain of 0.45 kg (1lb) in 24 hr Rapid, shallow respirations Blood glucose levels above 300 mg/dL 93. A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurseshould expect which of the following findings?

o o o o

Cold intolerance Lethargy Tremors Sunken eyes 94. A nurse is caring for a client who has a pheochromocytoma. Which of the following actions shouldthen nurse take?

o o o o

Elevate the head of the clients bed (elevate the HOB to reduce BP & abdominal pressure) Palpate the clients abdomen Monitor the client for hypotension Check the clients urine specific gravity

95. A nurse has administered propranolol by IV bolus to a client who is having a thyroid storm. Whichof the following findings indicates that the client is having a therapeutic response? o o o o

Reduction of the effects of thyroid hormone on the heart Blockage of the release of thyroid hormone from the thyroid gland Increase in the hearts sensitivity to thyroid hormone Increase in the uptake of thyroid hormone by the thyroid gland 96. A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroidhormone replacement. Which of the following instructions should the nurse plan to include?

o “Take this medication on an empty stomach” (to promote proper absorption, the client should take the medication onan empty stomach and not eat or drink anything for 30-60 minutes after taking it) o “Take this medication with an antacid” o “Change position slowly while taking this medication” o “Limit your fluid intake while taking this medication” 97. A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of thefollowing findings? o o o o o

o o o o

Decreased heart rate Increases hematocrit (an expected finding resulting from dehydration) High urine specific gravity Low BUN 98. A nurse is caring for a client following a thyroidectomy. The nurse should assess for which of thefollowing findings as an indication of hypocalcemia?

Strong, bounding pulse Decreased bowel sounds Tingling & numbness of the hands and feet Diminished deep tendon reflexes 99. A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which ofthe following results should the nurse expect?

o pH 7.32, PaCO2 36 mm Hg, HCO3 – 14 mEq/L (pH low, carbon dioxide within expected range, bicarbonate low) o pH 7.38, PaCO2 55 mm Hg, HCO3 – 22 mEq/L o pH 7.44, PaCO2 40 mm Hg, HCO3 – 24 mEq/L o pH 7.50, PaCO2 42 mm Hg, HCO3 – 30 mEq/L 100.

A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH).Which of the following should the nurse report to the provider? o o o o

Sodium 110 mEq/L (a client who has SIADH retains fluids, which causes dilutional hyponatremia) 2 + deep tendon reflexes Potassium 3.7 mEq/L Urine specific gravity 1.025

Endocrine Study guide 2 types of glands- exocrine and endocrine (each does what?)

• •

Exocrine glands (e.g., salivary, sweat, digestive) discharge their products through ducts Endocrine glands (ductless) secrete their products, hormones, directly into the blood rather than through a duct

Hypothalamus- what it does and action on hormones, regulates, effects on pituitary •

Action/regulation of hypothalamus o Regulation of certain metabolic processes & other activities of the autonomic NS o Synthesizes & secretes releasing hormones or hypothalamic hormones, and these in turn stimulate or inhibit the secretion of pituitary hormones o Temperature regulation, thirst, hunger, sleep, mood, sex drive o Area of the brain that houses the pituitary gland & other glands o

•

Hormones- TSH, TRF, CRF o TSH: produced by the pituitary gland & responsible for regulating the amount of hormones released by the thyroid o TRF (thyrotropin-releasing factor) produced by the hypothalamus.

Stimulates the release of TSH & prolactin from the anterior pituitary o CRF (corticotropin-releasing factor) peptide hormone involved in the stress response

Direct and indirect control of hormones- define •

•

Direct Control o Involves endocrine cells releasing secretions into blood stream as a result of changes in extracellular fluid composition o Ex. Decrease in calcium levels causes release of parathyroid hormone, causing release of calcium by target cells Indirect Control o Pathway via negative feedback through the hypothalamus o Controls adrenal cells via autonomic pathways o Secretes specialized regulatory hormones which regulate activity of pituitary gland

Pituitary – anterior and posterior control of certain hormones- be able to name and action pertaining to ADH and ACTH, TSH

ADH- other name

Hormone disorders- define primary, secondary, tertiary o o o

Primary – defect originates in gland Secondary – at pituitary gland, defect in level of stimulating hormone or releasing factor Tertiary – dysfunction of hypothalamus, both pituitary & target organ under-

stimulated Negative feedback loop- define and understand examples

Adrenal glands- secrete ?, function of each

Adrenal cortex – secretes glucocorticoids (hydrocortisone, cortisol, corticosterone), mineral corticoids (aldosterone), sex hormones o Glucocorticoids ➢ Stimulates lipid and carbohydrate metabolism. ➢ They break down fat and body proteins to provide a source of energy during periods of fasting (produces glucose by breaking down fat) ➢ Affect defense mechanisms of the body and influences emotional functioning ➢ Suppress inflammation and inhibits scar tissue formation ➢ Antagonizes insulin o

o

Mineralocorticoid ➢ Aldosterone is the primary hormone for the long-term regulation of sodium balance. (It promotes conservation of Na+ and elimination of K+). ➢ ACTH has only a little influence over the secretion of aldosterone. ➢ Release of aldosterone is also increased by hyperkalemia o Sex hormones (androgen) ➢ exerts effects similar to male sex hormones ➢ May also secrete some estrogens and is controlled by ACTH ➢ When secreted in normal amounts, there is little effect. But when secreted in excess, masculinization may result. Adrenogenital syndrome o o o o o o o o o o o o

Adrenal medulla – secretes catecholamines (epi/norepi) Epinephrine AKA adrenaline Antiasthmatic brochodilator and Vasopressor Vasoconstriction Maintenance of HR& BP localization/prolongation of local/spinal anesthetic Norepinephrine AKA levophed or noradrenaline Vasopressor Increase BP & CO Vasoconstriction Myocardial stimulation

Diabetes insipidus- define, causes, signs and symptoms

o

Clinical manifestations: enormous daily output of very dilute urine, extreme thirst, poor skin turgor, weight loss, anorexia o Fluid restrictions won’t help SIADH- define, causes, signs and symptom o

Disorders of the CNS may stimulate the hypothalamus-pituitary system to secrete ADH such as: head injury, brain surgery, tumor, infections o Clinical manifestations: hyponatremia, fluid overload without peripheral edema, lethargy, personality changes, seizures, increase in thirst o Fluid restrictions will help <1,000 cc/day

Difference between DI and SIADH

Thyroid gland- describe function

2 cell types

Parafollicular cells- secrete calcitonin (secreted in response to high plasma calcium level & increases calcium deposit in bone) Follicular cells- secrete thyroid hormone Regulation of thyroid hormone secretion o o o o o

T3 stimulates metabolism T4 is inactive until converted into T3 in the tissues Secretion is regulated by hypothalamus & anterior pituitary gland (negative feedback loop) High levels of iodine – temporary decrease in thyroid hormone activity Exposure to cold – stimulates increased thyroid hormone production

Thyrotropin-releasing hormone and thyroid-stimulating hormone-where originates and what happens o TRF originates from the hypothalamus o TSH originates from the anterior pituitary Hormones produced- define and action of each Thyroxine (T4)o Most abundant, 90% of thyroid secretion o Better indicator of thyroid function Triodthyronine (T3) o Most powerful o 10% secreted by thyroid the rest is converted from T4 by the peripheral tissues o measures serum levels (helpful in diagnosing hyperthyroidism when T4 is normal) o T3 has a greater effect on metabolism Thyroid hormones travel through blood how? o Thyroid hormone travels through bloodstream attached to carrier protein -> thyroxine – binding globulin

Goiter- define

Hypothyroidism- define, risk, causes, signs and symptoms, foods to avoid, medical management, nursing management

o Foods to avoid (goitrogens) ➢ Soy foods ➢ Veggies (cabbage, broccoli, kale) ➢ Sweet potatoes, peaches, strawberries ➢ Nuts & seeds o Medical management

➢ Levothyroxine (Levothroid, Synthroid)

Hashimoto’s– autoimmune disease, a disorder in which the immune system turns against the body’s own tissues.

Hyperthyroidism- define, risk, causes, signs and symptoms , foods to avoid, medical management, nursing management

o Medical management ➢ Radioactive iodide therapy ➢ Medications: Propylthiouracil & methimazole, sodium or potassium iodine solutions, dexamethasone, beta-blockers ➢ Surgery; subtotal thyroidectomy

Graves’ disease- define, risk, causes, signs and symptoms, diagnostics, treatment

o Elevated levels of T3 & T4 o Two major complications associated with Graves disease – ophthalmopathy & toxic storm ➢ Opthalmopathy: stare (exophthalmos), diplopia (double vision), proptosis (bulging of the eyes) ➢

Thyrotoxicosis- define o Excessive output of thyroid hormone (thyroid storm) Thyroid storm- define, risk, causes, signs and symptoms, medical management, nursing management EMERGENCY – life threatening if not treated quickly Brought on by stress, trauma, infection A score of 45 or more is suggestive of thyroid storm S/S ➢ Temperature, extremely high fever (>101.3 F) ➢ GI – N/V, abdominal pain ➢ Resp. rate increased ➢ Neurological signs (restlessness, delirium, agitation, psychosis, coma) ➢ Cardiovascular – tachycardia >130 (a-fib, heart failure, angina); high SBP with wide pulse pressure ➢ Early sign of storm – high fever & diaphoresis out of proportion to infection o Treatment – ICU ➢ Cardiac monitoring ➢ IV fluids – with glucose ➢ Humidified O2 ➢ PropyLthiouracil (PTU) & methimazole (Tapazole) o o o o

Hydrocortisone – treat shock & adrenal insufficiency Beta blockers – propranolol Antibiotics – for infection Antipyretics – only acetaminophen Antiemetic’s – Zofran, Phenergan o Nursing Management ➢ IV fluids ➢ Indwelling cath ➢ NG tube if vomiting/suction ➢ Continuous telemetry monitoring ➢ ➢ ➢ ➢ ➢

➢

Thyroid surgery, post op care, nursing management, potential complication o o o o o o o

Head & neck support after surgery Assess ease of respirations; potential airway impairment Monitor for potential bleeding & hematoma formation; check anterior/posterior dressing Diet – liquid to soft as tolerated Semi – fowler’s position Assess voice for changes (discourage talking) Monitor labs – TSH, T3, & T4; calcium (potential hypocalcemia R/T injury or removal of parathyroid glands o Safety – sterile trach tray at bedside Potential complications o Laryngeal stridor o Hemorrhage o Hypocalcemia – tetany o Trous Hypoparathyroidism- when it occurs, nursing assessment, management, and medical management o Commonly occurs because of damage to or removal of parathyroid glands at the time of parathyroid or thyroid surgery o Medical management ➢ Oral calcium carbonate tablets ➢ High doses of vitamin D (helps body to absorb calcium) ➢ Goal of treatment is to restore the body’s calcium & phosphorous to normal levels

Negative feedback loop

Parathyroid gland- location, describe function o Four tiny glands located in the neck

o Controls the body’s calcium levels Calcitonin released when and function

AdrenalAdrenal glands Cortex- secretes what hormones and major functions of each Medulla- secretes what hormones and major functions of each Adrenal cortex disorderAddison’s disease- define, risk, causes, signs and symptoms, medical management, nursing management o A disorder in which the adrenal glands don’t produce enough hormones o Treatment involves taking hormones to replace those not produced by the adrenal glands Cushing’s syndrome- define, risk, causes, signs and symptoms, medical management, nursing management o A condition that occurs from exposure to high cortisol levels for a long time o The most common cause is the use of steroid drugs, but it can also occur from overproduction of cortisol by the adrenal glands o Treatment options include reducing steroid use, surgery, radiation, and medication

Diabetes – must have an understanding of diabetes patho and management with insulin

Glucagon- stimulates what o It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream o Glucagon’s role in the body is to prevent blood glucose levels from dropping too low 2 hormones responsible for controlling concentration of glucose in the blood are? o Insulin o Glucagon Diabetes mellitus –describe and understand effects on body-kidney, heart, nerves

Type 1- define, causes? Risk, signs and symptoms, medical management, nursing management DKA- define, causes, signs and symptoms, effect on K+ (what can happen) o Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat o Clinical features: hyperglycemia, dehydration, acidosis o Body will choose alternate sources of energy, principally fat

o o o o o o

Ketonuria Acetone breath-fruit smelling breath Ketonemia – strong acids that lower serum Ph in the blood Kussmaul respirations – hyperventilation – body’s respiratory system attempt to eliminate carbon dioxide by increase depth & rate Blood glucose levels > 300 – 1,000 Acidosis causes increase in serum potassium to the intracellular to extracellular shifts ➢ Hyper/hypokalemia – LIFE THREATENING ➢ Cell death – potassium is from ICF to ECF & excreted by kidneys ➢ Once insulin therapy is initiated, K shifts to ICF & the K needs lessens ➢ Complications: coma, cardiac arrest, death

DKA- treatment, medical and nursing management

o

Nursing Implications: ➢ physical every hour & labs ➢ cardiac – dysrhythmias, changes in VS (BP drop in SBP 20 mmHg, tachycardia) ➢ neurological – alert or changes in LOC due to cerebral edema ➢ GI – due to ketoacidosis (N/V, diarrhea, anorexia, pain), fruit breath ➢ Respiratory – due to ketones -> increased resp. rate (deep, rapid resp., non labored) Kussmaul ➢ Hyperventilation is body’s way to rid excess acid ➢ Renal – polyuria (replace fluids with 0.9% NS to decrease glucose) then 0.45% NS to decrease BS to 300 & IV fluid of D5 0.45% NS to prevent continued glucose loss ➢ Increase in BUN, creatinine, and hematocrit seen with dehydration (if levels remain increased after rehydration – indicate renal failure)

Type 2- define, causes, risk, signs and symptoms, medical management, nursing management HHS- define, causes, risk, signs and symptoms o Hyperosmolar Hyperglycemic Syndrome (HHS)

o Caused by insufficient circulating insulin o Seen in the elderly o No ketones present o Blood sugars can be 600-1200 mg o Severe state with dehydration & hypotension (skin flushed, dry, warm) o There is a lack of insulin to transport glucose into cells, so it accumulates in the bloodstream causing hyperglycemia ➢ Hyperglycemia produces serum hyperosmolarity (higher concentrations of ions), drawing fluid from intracellular spaces ➢ This increases renal blood flow which causes fluid/electrolyte imbalances producing osmotic diuresis (polyuria) ➢ This in turn causes extracellular dehydration o Manifestations: hypotension, profound dehydration, tachycardia, variable neurologic signs caused by cerebral dehydration HHS- medical and nursing management o Rehydration o Insulin administration o Monitor fluid volume & electrolyte status o Nursing Implications ➢ Assess skin & mucous membranes – severe dehydration causes dry mucus membranes, poor skin turgor (flushed, warm skin) ➢ Cardiac – tachycardia, hypotension due to severe dehydration ➢ Neurological changes – altered mental status, seizures, hemiparesis (may take 3-5 days for neuro changes to clear after treatment) ➢ Renal – urine output closely monitored because of high risk of renal failure due to severe dehydration ➢ ECG monitoring ➢ Insulin drip – regular insulin drip at slow rate with frequent blood glucose assessments ➢ Fluid status – IV fluids – NS (0.9% or 0.45%) ➢ IV fluid with dextrose after blood sugar drops to 250-300 ➢ KCl added per lab findings & ECG monitoring

Endocrine Study guide(1).

Skin cancer-define, risk factors, signs and symptoms, medical management, nursing management Skin assessment Asymmetrical Border Irregularity Color Changes Diameter < 6mm Evolving Appearance Prevention strategies Avoid environmental hazards (prolonged sun exposure, radiation, irritants or allergens, proper hygiene and nutrition, and self examination.

Basal cell: most common type of skin cancer and least deadly.

Squamous cell: potential for metastasize. Pipe, cigar, and cigarette smoking.

Malignant melanoma – define, risk factors, signs and symptoms, medical management, nursing management Cause unknown: environmental factors, genetic factors.

S/S: ABCDE Rule o

asymmetry

o

border irregularity

o

color change

o

diameter >6mm

o

evolving in appearance

Risk factors: o

red or blond hair

o

light colored eyes

o

fair skin that freckles

o

chronic sun exposure

o

family history

Tumor staging: o

O-IV

o

Tumor size

o

Nodal involvement

o

Metastasis

o

T-N-M

Diagnosis/Collaborative Therapy o

topical therapy

o

phototherapy

o

radiation therapy

o

laser therapy

o

drug therapy

Diagnostic/Surgical Therapy o

skin scraping

o

electrodesiccation

o

electrocoagulation

o

curettage: scraping

o

punch biopsy: extraction of tissue for pathologist to view to diagnose pt

o

cryosurgery: liquid nitrogen used to destroy unwanted tissue

o

excision - Mohs procedure: most effective for BCC and SCC, taken off little by little till normal cells found

Nursing Management o

ambulatory and home care

o

wet dressings

o

baths

o

topical medications

o

control of pruritus

o

lichenification (skin becomes thick and leathery due to constant itching)

o

prevention of spread

o

prevention of secondary infections

o

specific skin care

Mohs procedure: during Mohs surgery, thin layers of cancer containing skin are progressively removed and examined until only cancer free tissue remains. Also known as micrographic surgery.

BurnsTypes- define, describe damage to tissue, assessment, emergent care and management, nursing management Thermal: exposure to flame, hot object/surface, or scalding (stove top, grease, bathtub, hot water) Chemical: exposure to acid, alkali, or organic substance (gasoline, household cleaners, garden products.)

Electrical: electrical energy converted into heat (power cords, power tools, lightening) Burn classification- describe and define 1 degree: (superficial thickness) sunburn, low intensity flash, superficial scald. Least damage; epidermis is only part of the skin damaged. Erythematous, but epidermis is intact; may blister.

Peeling of dead skin may occur in 2 to 3 days after burn.

2 degree: (partial thickness) scalds, flash flame, contact. Involves entire epidermis and dermis in varying depths. Painful and typically associated with blister formations; hair follicles and skin appendages remain intact. Healing time depends on depth of injury and usually ranges from 2-3 weeks.

3 degree: (full thickness) flame, prolonged exposure to hot liquids, electric current, chemical, contact. Destruction of entire epidermis and dermis and sometimes destruction of underlying tissues. Edema; wound color ranges from pale white to red, brown, or charred; burned area lacks sensation because nerve fibers damaged; leathery appearance; hair follicles and sweat glands destroyed. Skin does not regrow.

4

degree: (deep full-thickness) deep burn necrosis. Extends into the fat, fascia, muscle, and/or bone. Prolonged exposure or high voltage electrical injury. Would appears charred; burn shock; myoglobinuria (presence of myoglobin in the urine, usually associated with rhabdo or muscle destruction). Amputations likely; grafting as no benefit.

Rule of nines- the rule of 9s assesses the % of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transferto a burn unit. You can estimate body surface area on an adult that has been burned by using multiples of 9.

Smoke and inhalation injury- signs and symptom, assessments, treatments, complications Caused by components of smoke, heat particules, systemic toxins.

Mechanisms of injury is thermal damage, asphyxiation, and irritation of the pulmonary tissue.

S/S:injury occurring in an enclosed space; burns of the face or neck, singed nasal hair; hoarseness, high-pitched voice change, stridor; soot in sputum; dyspnea or tachypnea and other signs of reduced oxygen levels; erythema and blistering of the oral or pharyngeal mucosa.

Upper and lower airway injuries result in edema.

Pulmonary deterioration by be delayed as long as 24-36 hours Emergent phase- define, time frame, assessments, medical management, nursing management Severity of Injury: o

Determination of depth: how the injury occurred, causative agent, temperature, duration of contact with causative agent, and thickness of the skin.

o

Temperatures ≥ 54°C (130°F) for 30 seconds will results in burn injury

o

Temperatures ≥ 60°C (140°F) tissues destruction occurs in 5 seconds

o

Temperatures ≥ 71°C (160°F) a full thickness burn occurs instantaneously

o

Burns that exceed ⅓ of the TBSA are considered major burn injuries

o

Consider age of the patient

o

Secondary injuries

Burn injuries that should be referred to a burn center include: o

partial thickness burns greater than 10% TBSA

o

burns that involve the face, hands, feet, genitalia, perineum or major joints

o

electrical burns including lightning injury

o

third degree burns of any age group

o

chemical burns

o

inhalation injury

Medical management: o

STABILIZATION

o

airway, breathing, circulation

o

fluid resuscitation

o

assessment of secondary injuries

o

removed all clothing and jewelry

o

contact lenses? removal

o

monitor temp

o

validate history of injury

o

indwelling catheter

o

Burns > 20% TBSA need NGT to LIS

o

Tetanus prophylaxis if not given within last 5 years

Nursing management: o

stabilization of airway, breathing, and circulation

o

cardiac monitoring pulse assessment; BP

o

large-bore IVs (14 to 18 gauge)

o

hourly assessment of intake and output

o

infusion pumps for IVF

o

elevation of burned extremities above the heart

o

indwelling catheter

o

pain management

o

documentation

Fluid therapy- using the Parkland formula – (4 ml formula) Adults with electrical burns o

4mL LR x patients weight in Kg x %TBSA burned = amount of fluid resuscitation used within first 24 hours

Potential complications Fluid and electrolyte shifts Cardiovascular problems Respiratory problems Immune Drugs used- (pain meds) opioids, NSAIDS, anxiolytics and anesthetic agents. Drug of choice: Morphine Nutrition therapy Endocrine Study guide 2 types of glands- exocrine and endocrine (each does what?)

•

Endocrine glands - include the hypothalamus, thyroid, parathyroid, adrenals, pancreas, ovaries, testes, and pineal gland. The glands secrete hormones which play a role in

reproduction, central nervous system development of the fetus, stimulating growth and development during childhood and adolescence, maintaining homeostasis, and responding to emergency demands.

Hypothalamus- the hypothalamus releases substances that either stimulate or inhibit the formation and release of groups of hormones from the pituitary gland.

The hypothalamus, in the base of the brain, produces thyrotropin-releasing hormone (TRH).

TRH stimulates the pituitary gland to produce TSH. Somatostatin is also produced by the hypothalamus, and has an opposite effect on the pituitary production of TSH, decreasing or inhibiting its release.

•

CRF - a major regulator in the hypothalamic-pituitary system that release in response to stress “fight or flight”

•

TRH - the hypothalamus produces thyrotropin-releasing hormone which stimulate the pituitary gland

•

TSH - the pituitary gland produces Thyroid stimulating

hormone Direct control of hormones: •

Example: insulin secretion from endocrine pancreas based on the concentration of glucose

Indirect Control of Hormones: •

The hypothalamic-anterior pituitary axis - our central stress response system. The HPA axis is an eloquent and every-dynamic intertwining of the central nervous system and endocrine system.

Pituitary – anterior and posterior control of certain hormones- be able to name and action pertaining to •

ADH - secreted by the posterior pituitary, made in hypothalamus. Stored in posterior pituitary until the appropriate stimuli triggers its release. The major role ADH is to regulate fluid volume by causing the renal tubules to reabsorb water

•

ACTH - a tropic hormone secreted by anterior pituitary which stimulates the adrenal cortex to produce corticosteroids

•

TSH - a tropic hormone released by the anterior pituitary which stimulated the thyroid to produce thyroid hormones

ADH- other name is arginine vasopressin Hormone disorders- define primary, secondary, tertiary Primary hormone disorder - related with the dysfunction of the glands and the secretory hormones Secondary Hormone Disorder - dysfunction that is related to the increased or decreased trophic factors and originates from the pituitary glands Tertiary Hormone Disorder - malfunction of hypothalamus. The hypothalamus makes thyroid releasing hormone TRH is what tells the pituitary how much TSH to make. Secondary and tertiary hypothyroidism can be caused by tumors in either the pituitary or hypothalamus.

Adrenal glands·

Adrenal Cortex: secrets glucocorticoids (hydrocortisone, cortisol, corticosterone),

mineral corticoids (aldosterone), sex hormones. ·

SSS – SUGAR, SALT, SEX Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø

·

Ø Ø Ø Ø Ø Ø Diabetes insipidus- disorder of the posterior lobe of the pituitary gland. Deficiency of antidiuretic hormone.

When ADH is absent, urine output increases and the body loses water.

Manifestations: Ø Can have a gradual or sudden onset in adults. If hereditary, symptoms begin at birth Ø Enormous daily output of very dilute urine Specific gravity of 1.001 – 1.005 Urine contains no abnormal substances such as glucose or protein Ø Serum osmolality may be high because the blood is more concentrated Ø Extreme thirst – drink 4-40 liters of fluid/day with special craving for cold water Ø Cannot be controlled by limiting the intake of fluids because the loss of high volumes of urine continues whether or not fluids intake occurs Ø Attempts at limiting fluid may result in insatiable craving for fluid and development of hypernatremia and severe dehydration Ø Poor skin turgor, weight loss, anorexia Ø SIADH- Syndrome of inappropriate antidiuretic hormone Ø Ø Ø Ø Ø

Ø Ø Ø Ø Ø Ø Ø Difference between DI and SIADH DI: Thyroid gland- describe function 2 cell types ·

Parafollicular cells- secrete calcitonin

·

Follicular cells- secrete thyroid hormone

Regulation of thyroid hormone secretion Thyrotropin-releasing hormone and thyroid-stimulating hormone-where originates and what happens Hormones produced·

Thyroxine (T4)- most abundant, 90% of thyroid hormone secretion (constant)

·

Triodthyronine (T3) – most powerful – 10% secreted by thyroid, the rest is converted from

T4 by the peripheral tissues Stimulates metabolism Thyroid hormones travel through blood how?

Thyroid hormones travel through the bloodstream attached to carrier protein called thyroxine-binding globulin.

Goiter- an enlarged thyroid gland. Most common cause of a goiter worldwide is a lack of iodine in the diet.

Hyperthyroidism- hyperactivity of the thyroid gland with sustained increase in synthesis and release of thyroid hormones. Grave’s disease (most common cause); thyrotoxicosis: excessive output of thyroid hormone (thyroid storm). Affects women 8 x more than men.

Risks/Cause -toxic nodular goiter, thyroiditis, excess iodine intake, pituitary tumors, and thyroid cancer.

S/S: nervousness, rapid pulse, heat intolerance, tremors, skin flushed, warm soft and moist, exophthalmos, increased appetite, weight loss, elevated BP, cardiac dysrhythmias.

Hashimoto’s– AKA chronic lymphocytic thyroiditis, often leads to an underactive thyroid gland (hypothyroidism). It is the most common cause of hypothyroidism in the US where the immune system attacks the thyroid.

Hypothyroidism- a deficiency of thyroid hormone that causes a general slowing of the metabolic rate.

Risk/Causes- primary hypothyroidism is caused by destruction of thyroid tissue or defective hormone synthesis. Secondary hypothyroidism or hypothalamic dysfunction is caused by pituitary disease with decreased TSH secretion or hypothalamic dysfunction with decreased thyrotropin-releasing hormone (TRH) secretion.

Tx: radioactive therapy, medications, prophylthiouracil and methimazole, surgery (subtotal thyroidectomy).

Graves’ disease- an autoimmune disease of unknown etiology characterized by diffuse thyroid enlargement and excess thyroid hormone secretion.

Thyrotoxicosis- refers to the physiologic effects or clinical syndrome of hyper metabolism resulting from excess circulating levels of T4, T3, or both.

Thyroid storm- EMERGENCY – life threatening if not treated quickly (mortality rate 8090%). Brought on by stress, trauma, infection.

S/S: temp (101.3 or greater), GI (nausea, vomiting, abdominal pain), resp. rate increased, neurological signs, cardiovascular – tachycardia (130 or greater) (a-fib, heart failure, angina); high SBP with wide pulse pressure

Tx: Cardiac monitoring, IV fluids with glucose, humidified O2, PTU and methimazole, hydrocortisone, beta blockers, antibiotics, antipyretics and antiemetics.

Thyroid surgery: Thyroidectomy Post op care: Monitor VS Complete assessment to have baseline Assess ease of resp; potential airway impairment Monitor for potential bleeding and hematoma formation check anterior/posterior dressing, post op care, nursing management, potential complication Assess drain/amount if applicable Assess pain and provide pain relief measures Diet – liquid to soft as tolerated Semi-fowlers position, support head and neck Assess voice for changes (discourage talking) Monitor labs – TSH, T3 and T4; calcium Safety – sterile trach tray at beside Hypoparathyroidism- when it occurs, nursing assessment, management, and medical management •

Inadequate circulating PTH, characterized by hypocalcemia due to lack of PTH to maintain serum calcium levels.

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Occurs most commonly due to iatrogenic. Usually accidental removal of the parathyroid.

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Idiopathic hypoparathyroidism is rare, occurs early in life.

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Nursing assessment: sudden decrease in calcium causing tetany, tingling of lips, and stiffness in extremities. Dysphasia, and laryngospasms, lethargy, anxiety, and personality changes. ↓ Ca, ↑ Phosphate levels.

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Nursing Management: Treat acute symptoms, maintain normal Ca levels, and prevent longterm complications. May give IV Ca, give slowly. Use ECG while administering Ca, high levels of Ca can cause hypotension, dysrhythmias, or cardiac arrest.

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Medical management: Vit D to increase absorption of Ca in GI system. High Ca meal such as dark leafy vegetables, avoid foods containing oxalic acid (spinach).

Negative feedback loop

Parathyroid gland- location, describe function, •

Located in or around the thyroid

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Regulates bodys calcium levels

Calcitonin released when and function •

Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone

Adrenal cortex disorderAddison’s diseaseAKA adrenocortical insufficiency. Insufficient cortical hormones.

90% of the adrenal cortex must be destroyed before the onset of the disease occurs.

Etiology: Ø Autoimmune or idiopathic atrophy of the adrenal glands is responsible for 75% of cases. Ø Surgical removal of both adrenal glands Ø Infections of adrenal glands

Ø Inadequate secretion of ACTG from pituitary Ø Sudden discontinuation of adrenocortical hormonal therapy such as prednisone S/S: Ø Muscle weakness Ø Anorexia Tx:

Ø GI symptoms Ø Fatigue Ø Emaciation Ø Dark pigmentation of the skin, knuckles, knees, elbows & mucus membranes Ø Hypotension Ø Low BS, Low serum Na+, High serum K+ Ø Marked Na+ and water loss leading to severe chronic dehydration in severe cases Ø Lifelong replacement of corticosteroids and mineralocorticoids to prevent recurrence of adrenal insufficiency Ø Supplement dietary intake with added salt during times of GI losses of fluids (vomiting and diarrhea)

Nursing Implications: Ø Assess fluid status, orthostatic pulse and BP Ø Assess skin color and status, history of weight changes (due to hypovolemia) Ø Assess for presence of muscle weakness and level of fatigue Ø Ask family about the onset of illness and whether it was precipitated by a stressful event Cushing’s syndrome- Too much adrenocortical hormone Etiology: Ø Elevated production of cortisol by the adrenal cortex Ø Excessive secretion of ACTH from pituitary

Ø Ectopic production of ACTH by malignancies (such as bronchogenic carcinoma) Ø Prolonged therapy with glucocorticoids Manifestations: Ø Results of over secretion of glucocorticoids and androgens Ø Central obesity, with fat pads over the shoulders and back (buffalo hump) in the neck and supraclavicular areas, a heavy trunk, and thin extremities Ø Skin is thin, fragile and easily traumatized Ø Weakness S/S: Ø Sleep disturbances, muscles wasting and osteoporosis Ø Kyphosis, backache and compression fractions Ø Sodium and water retention, HTN and CHF Ø Moon faced appearance and may have increased oiliness of skin and acne Ø Elevated susceptibility of infection Ø Hyperglycemia or DM Tx: If caused by pituitary, treatment is directed at the pituitary Ø Hypophysectomry – treatment of choice Ø Radiation although takes months to control sx Ø Adrenalectomy treatment of choice for pts with primary adrenal hypertrophy Nursing implications: Ø H&P Ø Assess pts level of activity and ability to carry out ADLs Ø Assess skin and observe for trauma, infection, breakdown, bruising and edema Ø Have there been changes in physical appearance? Ø Assess mental function, including mood, responses to questions, and awareness of environment and level of depression.

Diabetes – a disease in which the body does not produce or properly use insulin Glucagon- role in the body is to prevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

2 hormones responsible for controlling concentration of glucose in the blood are?

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insulin

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glucagon

Diabetes mellitus •

Effect on Kidneys - High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don't work as well.

Many people with diabetes also develop high blood pressure, which can also damage your kidneys.

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Effect on Heart -diabetes can damage your blood vessels and the nerves that control your heart and blood vessels .............. People with diabetes tend to develop heart disease at a younger age

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Effect on Nerves - Prolonged exposure to high blood sugar can damage delicate nerve fibers, causing diabetic neuropathy

Type 1•

Define - Lack of insulin production or production of defective insulin

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Cause - viral infection, toxin, autoimmune (destruction of cells); idiopathic

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S/S - –Abrupt onset-thirst, weight loss, usually non-obese

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Early Symptoms of DKA

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Polyuria

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Polydipsia

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Polyphagia

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Visual blurring

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Fatigue

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Weight loss

Late Signs & Symptoms DKA

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Coma

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Chronic complications

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Management: •Assessments- physical (every hour) and labs •Cardiac- dysrhythmias, BP(drop in SBP 20 mmHg) and tachycardia •Neurological- changes in LOC due to cerebral edema or alert, lethargic, comatose •GI- due to ketoacidosis (N/V, diarrhea, anorexia, pain), fruity breath •Resp.- due to ketones-increased resp. rate, (deep, rapid resp., non labored) Kussmaul (Hyperventilation is body’s way to rid excess acid) Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity. A large part of the shifted extracellular potassium would have been lost in urine because of osmotic diuresis.

Type 2- define, causes, risk, signs and symptoms, medical management, nursing management •

Define - most common type (90%),

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Cause - insulin deficiency and insulin resistance

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Risks - obesity, physical inactivity, first degree relative, African-american, Pacific islander, Hispanic, GDM, hypertension (BP > 140/90), PCOS, CVD history, HDL-C <35 mg/dL ± TG >250 mg/dL, acanthosis nigricans

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S/S - Hyperglycemia not as severe as Type 1, usually mild polyuria, polydipsia, overweight, vision changes, fatigue, paresthesias, skin/vaginal infections, irritability

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Management - a1c twice a year, weight loss, exercise which enhances the effectiveness of insulin. Emphasize skin and foot care, educate on signs and symtoms, If exercise and diet are not enough, then medication…

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Medicine - Oral antidiabetic agents, Insulin therapy

HHS •

Define - uncontrolled diabetes II; fatal

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Cause - insufficient circulating insulin

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Risks - type II, elderly

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S/S - No ketones present, blood sugars can be 600-1000 mg, severe state with dehydration & hypotension (skin flushed, dry, warm), tachycardia, altered mental status, seizures, hemiparesis,

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HHS- medical and nursing management

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Monitor urine output because severe dehydration can lead to kidney failure

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Insulin drip with regular glucose monitoring

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IV fluid (0.9 or 0.45%)

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Iv fluid with dextrose once sugars drop below 250-300

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Kcl added based off lab findings

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Obesit y

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BMI over 30 or two times the normal size for patients’ height.

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Treatment: lifestyle changes, meridia (curbs appetite), gastric band (reduces the size of the stomach, decreasing food intake), bariatric-surgery (long-term weight loss process, malabsorptive procedure, at risk for absorption issues later on)

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nursing management: pre and postoperative evaluations, postoperative meals are small and frequent with a total of 600-800 calories a day, psychosocial interventions for eating behaviors, education of long-term effects (vitamin and nutrient malabsorption are a main concern; can lead to osteoporosis, endocrine issues, liver and kidney stress, etc.)

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Complications of bariatric-surgery: hemorrhage, bile reflux, dysphagia, bowel obstruction, and Dumping syndrome

Gastrectomy • •

pre-op care: Assess patient knowledge, nutritional status, abdomen, and anxiety post op care: Monitor for complications (hemorrhage, steatorrhea, bile reflux, dietary deficits, and Dumping syndrome), help control pain (Fowler’s position, ambulation, analgesics, and NG) o o

Bile Reflux: Use of medication, Cholestyramine, to bind with bile acid o

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Steatorrhea: Fatty streaks in BMs, reduce fat intake and take loperamide

Dietary Deficits: Use of vitamins and other nutritional substitutes to help meet the body’s needs (iron, calcium, B12, etc), parenteral nutrition may be needed Dumping Syndrome: avoid fluids with meals, laying down in a semi-Fowler’s position 20-30 minutes after eating, avoid carbohydrates and sugars, have more dry foods than wet, and antispasmodics

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nursing management: educate patient on complications, proper diet after gastrectomy (small, frequent meals, nutrient dense, decrease carbohydrate intake, few liquids with meals, etc), help control pain, reduce anxieties

Stomach cancer: survival rate is low because it is caught in late stage •

risk factors: men, history of peptic ulcers with H. pylori, diet high in salts, meats, and few fruits and vegetables, family history of stomach cancer, smoking, seen with pernicious anemia

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s/s

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Early: mild abdominal pain, anorexia, indigestion, ulcer-like symptoms

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Late: GI bleed, malnourishment (usually seen as weight loss and/ or anemia)

medical management: total or partial gastrectomy and chemotherapy o

Dumping syndrome is very common with gastrectomy (S/S: nausea, vomiting, pain, diarrhea, borborygmi= loud, high-pitched bowel sounds)

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Lack of absorption of iron because stomach is not there to produce intrinsic factor (B12) leading to anemia

nursing management: educate patient about proper dietary habits to avoid Dumping syndrome (small frequent meals, high fat and protein, eating food and having fluids at different times), and use of medications B12 shots, antacids, and sedatives.

Bowel obstruction (large and small) •

s/s: colicky (crampy wave-like pain), blood or mucus without stool or gas, vomiting, diarrhea, abdominal distention, hypovolemic shock, sepsis

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types o

herniation: protruding out of the abdominal cavity through to various locations (inguinal, hiatus, umbilical, femoral, and epigastric) causing the protruding part to become ischemic

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adhesions: fibrous tissue forms around bowel causing them to stick to each other

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intussusception: bowel gets pushed into itself (like a telescope that can collapse), can cause ischemia of the affected bowel, infection, and perforation.

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volvulus: bowels twist around itself

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risk factors: history of abdominal surgeries: colorectal and gynecological

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diagnostics: with S/S, X-ray, CT scan, and labs (electrolytes and CBC)

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medical management: NPO, NG, pain management, IV fluids, antiemetics, laparoscopy and/ or exploratory laparoscopy

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nursing management: VS, focused assessment of skin, LOC, pain, GI (distention, N/V, firmness), and labs (K+ and CBC) and continue to assess for fluid and electrolyte imbalances.

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NG tubes- purpose and nursing management •

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Purpose: To feed with fluids when oral intake is not possible, dilute and remove consumed position, instill ice cold solution to control gastric bleeding, prevent stress on operated site by decompressing, relieve vomiting and distention, and to collect gastric juice for diagnostic purposes.

Nursing Management: Check tube placement before and after feedings, assess for bowel sounds before feedings, use liquid medications, crush tabs, keep HOB 30-45, check for residual volumes, assess regularly for complications, (i.e., aspiration, diarrhea, ect.)

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Paralytic ileus- causes, s/s, management, nursing care • •

Seen most often post-op- (post op ileus POI) from surgical manipulation of bowel, hypokalemia, wound infection, or use of codeine, morphine, atropine.

Signs and symptoms: Sluggish GI motility Severe abdominal distention, usually with vomiting Severe constipation or passage of liquid stools with flatus

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Various modalities used by surgeon- depends on severity NG tube- Salem sump to low constant wall suction NPO- this means nothing given to patient by mouth or through NG tube I&O Vital signs and pain assessment IV fluids Medications

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After POI

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Assessments: Tolerates oral intake without N/V Return of appetite Absence of distention, feeling bloated, cramps

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Monitor- pain, VS, I&O

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- they arise from the mucosal surface of the colon and project into the lumen. They may be sessile (flat, broad based, and attached directly to the intestinal wall) or pedunculated (attached to the intestinal wall by a thin stalk). Rectal bleeding and occult blood in the stool are the most common signs, but most patients with polyps are asymptomatic.

- second leading cause of cancer related deaths and the third most common cancer in men and women.

- has an insidious onset, and symptoms do not appear until the disease is advanced. Common clinical manifestations include iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits, and intestinal obstruction or perforation.

- Surgical therapy-Goals of surgical therapy include 1)complete resection of the tumor 2) a thorough exploration of the abdomen to determine if the cancer has spread 3)removing all lymph nodes that drain the area where the cancer is located 4)restoring bowel continuity so that normal bowel function will return 5) preventing surgical complications. Chemotherapy and radiation can be used to shrink the tumor before surgery, as an adjuvant therapy after colon resection, and as a palliative treatment for non-resectable cancer. Radiation therapy-some may receive radiation therapy as an adjuvant to surgery and chemotherapy or as a palliative measure for those with metastatic cancer. The objective is to reduce tumor size and provide symptomatic relief. encourage all persons over 50 to get CRC screening, help identify those at high risk who need screening at an earlier age. Patients who have open and packed wounds requires meticulous care. Reinforce dressings and change them frequently during the first several hours postoperatively when drainage is likely to profuse. Assess all drainage for amount, color, and consistency. The drainage is usually serosanguineous. Examine the wound regularly and record bleeding, excessive drainage, and unusual odor. Use aseptic technique with dressing changes.

Assess for inflammation and infection. Discuss the patient’s feelings about his or her prognosis and future screening. Patients need much emotional support because recurrent cancer is painful, debilitating, and demoralizing.

•Family history of colorectal cancer (first-degree relative) • Personal history of inflammatory bowel disease • Personal history of colorectal cancer • Family or personal history of familial adenomatous polyposis (FAP) • Family or personal history of hereditary nonpolyposis colorectal cancer (HNPCC) syndrome • Obesity (body mass index ≥30 kg/m2) • Red meat (≥7 servings/wk) • Cigarette smoking • Alcohol (≥4 drinks/wk) • Personal history of diabetes mellitus • - a surgically created opening on the abdomen that allows the discharge of body waste. typestemporary or permanent. Ex. the person with a draining fistula may need a temporary ostomy to prevent stool from reaching the diseased area. Patients who have trauma to the intestines (e.g. gunshot wound, stabbing) may need a temporary ostomy. Cancer involving the rectum requires a permanent ostomy if all bowel distal to the ostomy is removed. Permanent ostomies may by continent or traditional. Continent ileostomies (e.g. Koch pouch, Barnett Continent Ileal Reservoir) use 40 to 45 cm of the terminal ileum to fashion an internal pouch, nipple valve, and abdominal stoma. They are an option for patients who have had a prior APR with ileostomy for ulcerative colitis or FAP. The include end, double barreled, and loop ostomy.

- is constructed by dividing the bowel and bringing out the proximal end as a single stoma, making a colostomy or ileostomy. When the distal bowel is oversewn and not removed, the procedure is called a . With a Hartmann’s pouch the potential exists for the bowel to be reanastomosed and the stoma closed (referred to as a ).

is constructed by bringing a loop of bowel to the abdominal surface and then opening the anterior wall of the bowel to provide fecal diversion.

- the surgeon divides the bowel and both the proximal and distal ends are brought through the abdominal wall as two seperate stomas. The distal nonfunctioning stoma is referred to as the . The double barrel stoma is usually temporary.

- Two major aspects of nursing care for the patient with an ostomy are 1) emotional support as the patient copes with a radical change in body image and 2) patient and caregiver teaching about ostomy care. Accurate information, emotional support, and mastering basic skills will help patients learn to live a full life with an ostomy and accept the changes in body appearance and function.

Educate patient and family on keeping bag from getting too full (gas or liquid), empty bag just before bed so it will not explode during the night (can roll over onto bag and cause it to leak), change diet (little to no fried foods, minimal fatty foods, small frequent meals, increase carbohydrates, slowly add vegetables and fruits (add fresh vegetables slowly), decrease meats (chicken and fish are ok, add after about 2 months), stay hydrated).

When putting on ostomy bag, create 3-5 layers of paste (using adhesion pads and powder) creates a better seal than the traditional stoma paste without compromising the skin around the stoma.

- results from a localized or generalized inflammatory process of the peritoneum, causesPrimary- blood-borne organisms, genital tract organisms, & cirrhosis with ascites, Secondaryappendicitis with rupture, blunt or penetrating trauma to abdominal organs, diverticulitis with rupture, ischemic bowel disorders, pancreatitis, perforated intestine, perforated peptic ulcer, peritoneal dialysis, postoperative (breakage of anastomosis) - abdominal pain is the most common symptom of peritonitis. A universal sign is tenderness, muscular rigidity, and spasm are other signs of peritoneal irritation. Patients may lie still and take only shallow breaths because movement worsens the pain. Abdominal distention, fever, tachycardia, tachypnea, nausea, vomiting, and altered bowel habits may be present. These manifestations vary depending on severity and acuteness. risk factors, - Treatment consists of antibiotics, NG suction, analgesics, and IV fluid administration.

Surgery is indicated to locate the cause of the inflammation, drain purulent fluid, and repair any damage (perforated organs). establish IV access for fluid replacement and antibiotics, Monitor for pain & response to analgesics, position patient with knees flexed to increase comfort, sedatives may be given to relieve anxiety. Monitor I’s & O’s, frequently monitor vitals, administer antiemetics to decrease nausea and vomiting and prevent further fluid and electrolyte losses. Place the patient on NPO

status, may need NG tube to decrease gastric distention and further leakage of bowel contents into the peritoneum. Administer low-flow oxygen therapy as needed.

Acute cholecystitisdefine: Inflammation of the gallbladder causes: Gallstones, tumor s/s: Pain in the upper right quadrant, bloating management: bowel rest, IV hydration, correction of electrolyte imbalances, analgesia, and antibiotics. nursing care: Treating pain, relieving N/V, provide comfort, accurate assessments, observe for complications.

Liver: •

Main Functions: bile production, excretion of: bile, hormones, and cholesterol, stores: glycogen (helps to maintain sugar levels in the body), vitamins, minerals and blood, synthesizes: albumin and urea, helps with clotting factor, filters blood, detoxes body

Liver cancer •

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risk: Hepatitis B and C (HBV, HCV), cirrhosis, “fatty livers” (an accumulation of fat that isnot being synthesized by the liver), alcohol consumption, other liver diseases (Wilson’s or hemochromatosis), diabetes causes: Most common cause of a primary liver tumor is chronic liver infections (HBV and HCV) resulting in mutations of the liver cells. Other secondary tumors are related to another cancer that has metastasized. s/s: Weight loss, anorexia, constant dull pain in RUQ, jaundice, ascites, bile duct blockage medical management o Nonsurgical: Treatment of the cirrhosis, radiation, chemotherapy, biliary drainage, may just be palliative care if cancer has spread enough o Surgical: Removal of the infected lobe (lobectomy), liver transplant (long list and very restrictive of who can be on this list, chronic drug and alcohol users are usually not allowed a transplant), cryosurgery nursing management: educate on alcohol and drug consumption, pain medication doses may be altered, get detailed assessment about risk factors for this cancer (HBV and HCV history, drinking habits, drug use, family history, personal history), percuss to find edges

of the liver to check for enlargement (should not be able to percuss/ palpate more than 2 cm below lowest rib)

Ascites •

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define: decreased metabolism of aldosterone causes retention of sodium and water, decreasing synthesis of albumin, decreasing osmotic pressure causing fluid and albumin to shift into the third space (peritoneal cavity) s/s: increased abdominal girth, increased rapid weight, SOB, dullness during percussion of abdomen, electrolyte and fluid imbalances management: decrease sodium intake <2 g, bedrest, diuretics, paracentesis: drainage of the fluid if severe enough, colloid IV fluids to help shift fluids back into intravascular cavity

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Pancreatitis • •

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define: inflammation of the pancreas causes: injury or damage to pancreatic cells, enzymes released as a result of damage causing further damage to pancreas and surrounding tissues o damage can be related to alcohol intake s/s: epigastric pain radiating up back, fever, elevated WBC, hypotension, tachycardia, hypovolemia, increased amylase levels, aggravated by eating, starts when laying back, vomiting (no relief after vomiting) acute: inflammation of the pancreas that can vary between mild inflammation to necrosis of pancreatic/ surrounding tissues o “GET SMASH’D” are all the main causes ▪ Gallstones ▪ Ethanol (alcohol) ▪ Trauma ▪ Steroids ▪ Mumps ▪ Autoimmune ▪ Scorpion bites ▪ Hyperlipidemia ▪ Drugs (diuretics)

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Patho: S/S previously listed plus: flushing, cyanosis, dyspnea, jaundice, guarding of abdomen, decreased/ absent bowel sounds, Cullen’s sign (periumbilical ecchymosis caused by necrotizing pancreatitis and hemorrhage), Grey Turner’s sign (ecchymosis on the flank, occurs 3-7 days after onset of pain caused by retroperitoneal hemorrhage) medical: decrease pancreatic secretions (NG, NPO, suppress acid production), pain relief, prevention of shock (plasma expanders), treatment of infection, correction/ removal of initial cause nursing management: monitor vitals, assess respiratory function, monitor IV fluids, pain management, turn cough deep breath, assess for signs of infection, wound care (if they have surgery), monitor glucose levels, check for changes in mental status, educate on drug and alcohol abstinence, educate on low-fat high-carb diet, teach patient and family about signs of infection, diabetes, and to monitor stools (check for steatorrhea)

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Parenteral nutrition reason for use: meet nutritional needs to allow tissue growth, used when GI can’t be used for digestion, absorption, or ingestion • difference between central and peripheral o Central: long-term supply of nutrition, goes directly into superior vena cava, hypertonic solution at a 20-50% glucose content o Peripheral: used for two weeks or less, hypertonic solution at a 10% glucose content • difference in types • Lipids emulsion contains soybean, triglycerides, and egg phospholipids, used as 10-20% of calories in PN patients o do not use in patients with hyperlipidemia, allergy to eggs or soy, or patients that are at risk for fat embolism (ex.fractured femur) o use cautiously in patients with bleeding disorders, liver failure, pancreatitis, and respiratory disease •

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nursing management and assessments o Check EACH bag of PN to make sure it is the correct concentration/ ratio for proper nutrition for the patient. Pick proper filter tubing, must use 1.2 micron filter tubing for 3-in-1 solution that contain amino acids, dextrose concentration greater than 10%, or lipids. Must use 0.22 micron filter tubing for 2-in-1 solution that contain amino acids or dextrose concentration greater than 10%. o If feeding bag is empty and no replacement is available, begin running D5 solution till proper feeding becomes available to avoid hypoglycemia. Assess patient q15 minutes during first feeding for N/V, urticaria (hives), chest/ back pain, fever/ chills (any of these signs is an allergic reaction; stop infusion immediately and call physician). Assess infusion site for infection, inflammation, phlebitis; clean dressing site PRN as per protocol. o Daily weights (checking for fluid retention, electrolyte imbalances, seeing if nutrition is helping), I&O’s (checking kidney function, liver function), blood glucose potential complications o Refeeding: hypophosphatemia (heart dysrhythmias, respiratory arrest, neurological disturbances), fluid retention, electrolyte imbalances, patients that have a history of: chronic alcoholism, excessive vomiting and/ or diarrhea, chemotherapy, major surgery are at risk for this o Metabolic problems: hyper/hypoglycemia, prerenal azotemia, fatty acid deficiency, electrolyte disturbances, hyperlipidemia, mineral deficiencies o Mechanical problems: dislodgement of tube, thrombus formation, phlebitis glucose management: monitor blood sugar every 4-6 hours, do not suddenly stop PN it can cause rebound hypoglycemia

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HepatitisDefinition: Inflammation of the liver Causes for types A, B, C: A: Fecal oral B/C: Bloodborne s/s: mild flulike symptoms, low-grade fever, anorexia, later jaundice and dark urine, indigestion and epigastric distress, enlargement of liver and spleen Prevention: –Good handwashing, safe water, and proper sewage disposal –Vaccine

–Refer to Table 43-1, page 975 –Immunoglobulin for contacts to provide passive immunity Bed rest during acute stage Nutritional support Cirrhosis •The end-stage of liver disease.

•Cirrhosis is characterized by extensive degeneration and destruction of the liver cells.

•This results in the replacement of liver tissue by fibrosis (scar tissue) and regenerative nodules that occur from the liver’s attempt to repair itself.

• Most common causes in United States are chronic hepatitis C and alcohol-induced liver disease S/S: Relatively few symptoms in early stage disease Fatigue and enlarged liver may be early symptoms Blood tests may be normal- compensated cirrhosis Late manifestations –Result from liver failure and portal hypertension •

Jaundice, peripheral edema, ascites

Other Skin lesions, hematologic disorders , endocrine disturbances , and peripheral neuropathies Hematologic disorders –Thrombocytopenia –Leukopenia –Anemia Coagulation disorders Endocrine disorders Secondary to decreased metabolism of hormones –Gynecomastia, loss of axillary and pubic hair, testicular atrophy, impotence and loss of libido (men) –Amenorrhea or vaginal bleeding –Hyperaldosteronism in both sexes

Risk Factors for Cirrhosis: •

alcoholism, malnutrition, viral hepatitis, biliary obstruction, obesity, and right sided heart failure.

Nursing Management: • • • •

Reducing or eliminating these risk factors Conserve patients strength while maintaining muscle Check for jaundice Edema? Ascites?

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Alcoholic: Peripheral neuropathy –Dietary deficiencies of thiamine, folic acid, and cobalamin (vitamin B ) –Sensory and motor symptoms Sensory symptoms may predominate Biliary- primary and secondary- define Primary Biliary Cholangitis: In the small bile ducts of the liver, an autoimmune disease that ultimately blocks the flow of bile. This will lead to liver fibrosis and cirrhosis. Drugs include Ocaliva.