Everyone needs a little therapy (IV that is)
Water works
It is a "Grave" mistake to overestimate Hoshimotos
"Para"noid about hormones
SWEET
Nclex style
meds
100

What are the 3 types of crystalloid IV solutions, and why are they called crystalloid?

Isotonic, hypotonic, hypertonic

"an aqueous solution of mineral salts and other small, water-soluble molecules"- National Institute of Health; Solutions with small molecules that flow easily from blood into cells and tissues

100

How can you see SIADH in a blood test?

hyponatremia, increased ADH, fluid overload

100

What hormones are secreted by the thyroid and which ones are measured to determine hyper-hypo-thyroidism?

T3, T4- measured

Calcitonin

100

What is the parathyroid?

4 glands under thyroid and produces parathyroid hormone (PTH) and maintains calcium levels
100

What is the difference between type 1 and type 2 diabetes mellitus?

Type 1 is an absolute lack of insulin (non-reversible)

Type 2 is insulin resistant (reversible)

100
  • A Type 2 diabetic may have all the following signs or symptoms EXCEPT:*
    •  A. Blurry vision
    •  B. Ketones present in the urine
    •  C. Glycosuria
    •  D. Poor wound healing

B. ketones present in urine

100

What medications are used for hyperthyroidism and why are those used? (what does it do to the thyroid?)

propylthiouracil (PTU)

methimazole- safe for pregnancy, most common

radioctive iodine- permanent cure

These medications are essentially "killing" the thyroid to reduce T3 and T4 production

200

What is the goal of fluid resuscitation and when do you use it?

goal- patient and organ rescue


-pressure bag for shock, hypovolemia, and dehydration

200
What is the diagnosis of DI determined by? (how is it different from sugar diabetes)

water diabetes- kidneys cant conserve water

200

What is an important patient teaching if they get a thyroidectomy?

They will be on life long medication to compensate for no thyroid

200

What foods contain phosphurous?

dairy, red meat, poultry, seafood, legumes, and nuts

200

If a patient's glucose is 60, and they are awake, what would be the first intervention to get their sugar up?

4 oz OJ- 15 g glucose

3-4 glucose tabs

glucose gell

regular soda- 6 oz

honey- 1 tbs

sugar- 1 tbs

200

A client with the recent diagnosis of MI and impaired renal function is recuperating on the step-down cardiac unit. The client's blood pressure has been borderline low and IV fluids have been infusing at 100 mL /hr via a central line catheter in the right internal jugular for approx 24 hours to increase renal output and maintain the blood pressure. Upon entering the client's room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is most likely experiencing which complication of IV therapy.
1. Hematoma
2. Air embolism
3. Systemic infection
4. Circulatory overload

Circulatory overload

200

What two meds are used for hypothyroidism and what does it replace?

levothyroxine- T4

liothyronine- T3

300

What are the differences between osmalality and osmolarity and what is the normal serum range?

Osmolality- is weight based

osmolarity- is volume based

275-295 mOsm/kg or liter

300

What are some S/S of an Addisonian crisis?

weakness, N/V, abdominal pain, severe hypotension, severe hypoglycemia, hyperkalemia

300

What can hypothyroidism be caused by and what is happening with the thyroid hormones?

  Hashimoto’s disease, Pituitary gland tumor, Hypothalamus dysfunction, Hyperthyroid treatment, Inadequate iodine intake, Thyroidectomy

low T3 T4 and free T4

300

What causes hyperparathyroidism?

low calcium absorption, decreased Ca, vitamin D intake, low absorption in bowels, parathyroid adenoma, renal failure

300

When is a lower blood sugar reading concerning?

If Glucose is LESS than 70, the workload may get HEAVY!!!

300

The nurse is making initial rounds on the nursing unit to assess the condition of assigned clients. The nurse notes that a client's IV site is cool, pale, and swollen, and the solution is not infusing. The nurse concludes that which of the following complications has occurred.
1. Infection
2. Phlebitis
3. Infiltration
4. Thrombosis

infiltration

300

what medications can treat DI?

ADH administration, Vasopressin (but not preferred because of vasoconstriction), desmopressin, thiazide diuretics, chlorpropamide, carbamazepine

400

What are the 3 main types of solutions that are considered isotonic?

5% dextrose (D5W)

0.9% normal saline

Lactated Ringers- contains lactate, so be careful with liver disease patients

400

With Cushing's there could be cardiovascular symptoms such as S/S HF and hypertension, why?

Preload is increased which puts stress on the heart and too much aldosterone and increased fluid retention due to hypernatremia

400

What electrolyte do you need to monitor after a thyroidectomy, and what needs to be in place?

hypocalcemia- seizure precautions

400

What foods are high in calcium?

seeds, dairy, leafy greens, sardines, whey protein

400

What is considered a positive test for A1C and how is it calculated?

Anything greater than 6.5%

it is calculated by the average glucose levels over time

400

Following surgery, the nurse has administered albumin to a client. The nurse would evaluate this intervention to be effective if which of the following assessments was obtained?

A. Heart rate 96
B. Temperature 98.8
C. Respirations 24
D. Blood pressure 140/80

blood pressure 140/80

400

Hyperparathyroid meds

Sensipar (kidney disease)- tricks parathyroid to think there is enough Ca or PTH

calcitonin- lowers Ca by suppressing osteoclasts

loop diuretic- inhibits Ca absorption

alendronate- slow osteoclast activity


500

When would you give a hypertonic solution?

cerebral edema and severe hyponatremia

500

What is the difference between Cushing syndrome and crushing disease?

Syndrome- excess cortisol

Disease- ACTH producing tumor- pituitary adenoma

500

What disease causes hyperthyroidism, and what happens with hormone production and what does that look like?

Graves Disease

T3, T4 are being overproduced, TSH is low 

overheated- weight loss, tachycardia, hypertension, exopthalmos (bulging eyes), palpitations

500

What are S/S of hypocalcemia

Hypo- numbness, tingling, muscle twitching, trousseaus sign, chvosteks sign, seizures, tetany


500

Why don't you hold long-acting insulin even if a patient has lower blood sugar?

it does not have a peak and will not drastically change sugars


500

A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly “water” weight. In addition, they report the patient hasn’t been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient’s HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with?

SIADH

500

What medications can treat Addison's and what class are they?

prednisone, hydrocortisone- glucocorticoids and mineralocorticoids (steroids)

600

When would you give fluids through a central line?

If the serum osmolality is over 900 mOsm/kg because it increases vein irritation and chance of phlebitis/ thrombophlebitis

600

What is Nephrogenic DI?

kidneys are not responding to ADH that may be caused by renal disease/tumor, nephrotoxic drugs, or infections

600

What kind of diet does somebody need to utilize for hypothyroidism?

low calorie- high fiber (constipation)

600

what are S/S of hyperparathyroidism?

groans, stones, bones, psychiatric moans

600

For T1 and T2, what are treatments that are the same for both?

nutrition management, patient and family education, detection and prevention of complications, insulin

600

With a patient diagnosed with SIADH what drug do you anticipate the patient will be started on per doctor’s order?

Declomycin

600

What medications are used for Cushing's disease?

ketoconazole, osilodrostat- decrease cortisol levels

mifepristone- block effects of cortisol on tissues

Pasireotide- decrease amount of ACTH

700

What is a colloid and when would you give them?

contain large insoluble molecules such as protein

to increase blood volume and is usually given in adjunct for hypovolemic fluids

700

What are the differences between SIADH and DI

SIADH- high ADH, fluid overload, seizure risk, hyponatremia

DI- too little or insensitivity to ADH, water diabetes not sugar diabetes, hypernatremia

700

What are some signs and symptoms of a Thyroid storm and what is the treatment?

S/S: anxiety, heat intolerance, mood swings, diaphoresis, tachycardia, palpitations, dyspnea, delirium, coma, HF

Treatment- beta blockers, antithyroid meds, antipyretics

700

how is hypoparathyroid diagnosed?

low Ca and PTH, high phosphorous

albumin may be low 

vitamin D low

700

What are the differences between diabetic ketoacidosis(DKA) and Hyperosmolar hyperglycemic state (HHS)?

DKA is a complication of Type 1,  sugars between 200-300, ketones in blood, affects younger more than older, life threatening, hydration is key, frequent blood sugars, patient may have kussmal respirations.

HHS is a complication of Type 2, sugars over 600, no ketones, depressed immune system, neuropathy, vascular issues

700

A patient is admitted with thyroid storm. Which sign and symptoms are NOT present with this condition-SELECT ALL THAT APPLY?*

  •  A. Temperature of 104.9'F
  •  B. Heart rate of 125 bpm
  •  C. Respirations of 42
  •  D. Heart rate of 20 bpm
  •  E. Intolerance to cold
  •  F. Restless

D- HR of 20 bpm

E- intolerance to cold

700

What kind of medications are used to treat SIADH

loop diuretics- furosemide

hypertonic IV- to increase sodium

salt supplements

ADH antagonist- Declomycin, lithium

800

What is a hypotonic solution used for? (<250 mOsm/kg) and when would you not give it?

DKA

hyperosmolar hyperglycemia

provides free water for kidneys

do not give for ICP, burns, Trauma

800

What are the differences between Addison's and Cushings?

Addisons- too little cortisol, aldosterone and androgens, ACTH is not being adequately produced, hypoglycemia, bronze skin, weakness, weight loss


Cushings- too much cortisol, aldosterone, androgens, caused by adrenal/pituitary tumors, weight gain but thin arms and legs, delay in wound healing, moon face, buffalo hump

800

Why can't you stop hypothyroid meds abruptly and when should you take them?

it can cause a life-threatening myxedema coma

Take in the morning before breakfast

800

How is hyperparathyroidism diagnosed?

increased PTH and Ca for primary

Increased PTH and phosphorus, decreased Ca for secondary (check albumin to ensure it is normal)

800

What are the 4 types of insulin and how are they administered/ what is their peak?

Rapid- subcu, onset: 10-30 min, 30-90 min peak, deadliest

short acting- subcu, onset: 30min-hr, peak 2-5 hr

regular- only one that can be given IV, or subcu, onset: 1.5-4hr, 4-12 hr peak

long acting- subcu, onset: .8-4hr, no pronounced peak


800

A patient with Addison’s Disease should consume which of the following diets?

  • A. High fat and fiber
  • B. Low potassium and high protein
  • C. High protein, carbs, and adequate sodium
  • D. Low carbs, high protein, and increased sodium 

C. high protein, carbs, and adequate sodium

800

What are some other medications you can use for diabetes and their MOA?

Insulin secretagogues Action: increase pancreatic insulin secretion (First generation examples: sulfonylureas, tolazamide, tolbutamide; Second generation examples: glyburide, glipizide, glimepiride; Quicker acting: repaglinide, nateglinide)

Biguanides Action: prevents inappropriate hepatic gluconeogenesis (Glucophage (metformin) Note: often a first try medication)

•Alpha-glucosidase inhibitors Action: delay intestinal absorption of carbs (acarbose, miglitol)

•Thiazolidinedione insulin sensitizers Enhance sensitivity of peripheral cells to insulin (pioglitazone (subclasses- empagliflozin, sitagliptin))

Glucagon-like peptide-1 (GLP-1agonists) Action: slows absorption in the gut and increases secretion of insulin from pancreas in response to hyperglycemia, reduces glucagon levels and reduces appetite (exenatide, liraglutide (Victoza), dulaglutide (Trulicity))

900

What is a febrile nonhemolytic reaction and what does it look like?

happens shortly after blood transfusion

temp increases by 1 degree celsius or more, chills or mild dyspnea, is usually benign

900

Central Neurogenic DI is caused by what?

not enough production of ADH

900

What is the difference in hormones between hypothyroidism caused by an autoimmune disease and a tumor?

autoimmune- increased TSH,  and decreased T4, free T4, and T3

Tumor- everything is decreased

900

What can you administer for a patient experiences hyperparathyroidism to prevent kidney stones?

IV fluids

decrease calcium antacids and vitamin D

900

How does Continuous glucose monitoring work?

Tests interstitial fluid instead of blood which helps monitor non-critical patients (do not use for DKA or HHS)

900

What statement or statements are INCORRECT regarding Diabetic Ketoacidosis?*

  •  A. DKA occurs mainly in Type 1 diabetics.
  •  B. Ketones are present in the urine in DKA.
  •  C. Cheyne-stokes breathing will always present in DKA.
  •  D. Severe hypoglycemia is a hallmark sign in DKA.
  •  E. Options C & D

E. Cheyne stokes breathing will always be present in DKA and severe hypoglycemia is a hallmark sign in DKA

900

how does declomycin work for SIADH?

it is an antibiotic that will decrease the effectiveness of collecting tubule cells in the kidney to decrease responsiveness to ADH.

1000

What is acute hemolytic reaction and what does it look like?

wrong blood was given

medical emergency- DIC, shock, acute renal failure, dyspnea, fever, chills, hypotension, nausea, tachycardia, red urine


Treatment- fluid resuscitation to offset renal failure

1000

What can cause SIADH? (name 3)

medications (chlorpropamide, carbamazepine), cancer, trauma to hypothalmus or pituitary, infection

1000

What is a myxedema Coma and what are the S/S and treatment?

causes- untreated hypothyroidism, meds abruptly stopped, infection, illness

S/S- bradycardia, decreased cardiac output, decreased level of consciousness, hypothermic, hypotensice

Tx- warm, maintain BP, IV levothyroxine

1000

What are some precautions you need to take as the nurse for hyperparathyroidism?

monitor calcium and phosphate levels, airway (have trach kit, O2, and suction at bedside); seizure precautions, cardiac monitoring, neuro checks

1000

What is the rule of 15?

Need to raise glucose level as quickly as possible

If conscious and able to swallow and glucose < 70 mg/dL 15 g carbohydrate à recheck glucose à repeat if needed If unable to swallow and IV access 25 g D50W à recheck glucose à repeat if needed If unable to swallow and no IV access get access I g IM or IV glucagon à recheck and repeat if needed If glucose still < 70 after one repeat of treatment follow policy

1000

Which of the following foods below should a patient experiencing a thyroid storm avoid? Select all that apply:

  • A. Shrimp 
  • B. Milk 
  • C. Hard boiled eggs 
  • D. Seaweed (Kelp) 
  • E. Broccoli
  • F. Peas

A. shrimp

b. milk

c. hardboiled eggs

D. seaweed (kelp)

Reasoning: limit foods with iodine

1000

Hypoparathyroidism Meds

calcium and vitamin D supplements

phosphate binders- aluminum hydroxide, sucroferic oxyhydroxide, calcium carbonate - decreases phosphorous by increasing excretion

Calcium gluconate/ calcium chloride- increases calcium levels

Natara- parathyroid hormone replacement (injection)

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