Thyroid Dysfunction
A nurse is caring for a client with hyperkalemia who has been prescribed intravenous regular insulin and dextrose. The nurse understands that insulin helps lower serum potassium by:
A. Increasing renal excretion of potassium through the kidneys
B. Binding to potassium in the bloodstream for excretion
C. Driving potassium from the bloodstream into the Cells
D. Promoting potassium loss through the GI tract
What is C
Insulin facilitates the intracellular shift of potassium by activating the sodium-potassium ATPase pump, moving potassium INTO THE CELLS and temporarily lowering potassium levels. This is an expected finding so when treating clients with DKA with an insulin drip, potassium will be monitored or supplemented
The parathyroid helps regulate this important electrolyte in the body
What is calcium?
This condition results when the adrenal glands produce too much cortisol
What is Cushing's Disease?
A patient is admitted to the medical unit with possible Graves disease ( hyperthyroidism). Which assessment finding by the nurse supports the diagnosis?
1. Periorbital edema
2. Bradycardia
3. Exophthalmos
4. Hoarse voice
3. Exophthalmos (abnormal protrusion of eyes)
The other symptoms are hypothyroidism
Prioritization question
A client is admitted to the unit with SIADH. for which electrolyte abnormality would the nurse be sure to monitor?
1. Hypokalemia
2. Hyperkalemia
3. Hyponatremia
4. Hypernatremia
What is 3. Hyponatremia
SIADH results in a relative sodium deficit caused by excessive retention of water.
Symptoms also decreased ability to think, nausea , vomiting, headache, muscle cramps ,weakness and fatigue
The symptoms of this condition include weight loss, short attention span, tachycardia, and tremors
What is hyperthyroidism?
A patient's lab results show a calcium level of 11 (hypercalcemia). The nurse suspects this condition
What is hyperparathyroidism?
The nurse is caring for a patient with with bronzed skin, weight loss, GI upset, hypotension, bradycardia, and fatigue. The nurse suspects this adrenal disorder
What is Addison's disease?
Which is the range for Specific Gravity Urine
a. 1.003- 1.030
b. 2-10 mcIU/ml
c. 5-12 mcg/dL
d. 0.8-2.8 ng/dL
What is a- 1.003- 1.030?
b- TSH
c- T4 total
d- T4 free
A 68 year old patient with type 2 diabetes is admitted to the ED with confusion, dry mucous membranes, and a blood glucose level of 850mg/dL. Laboratory results reveal osmolality of 330 mOsm/kg and no significant ketones in blood or urine. Which nursing intervention is most critical in the initial management of this patient?
A. Administer intravenous regular insulin bolus followed by continuous infusion
B. Begin fluid resuscitation with isotonic normal saline
C. Initiate Seizure precautions due to high serum osmolality
D. Prepare the patient for emergent hemodialysis
What is B. Fluid resuscitation with isotonic normal saline
Hyperosmolar Hyperglycemic Non Ketonic (HHNK) also called Hyperosmolar Hyperglycemic State ( HHS) is marked by profound dehydration, hyperglycemia and hyperosmolarity without significant ketones. First aggressive fluid replacement to correct and restore perfusion ( prevents shock and organ damage)
Client Needs Category- Physiologic Integrity - Reduction of risk potential
The most serious complication of myxedema coma
What is respiratory depression?
Trousseau's sign and Chvostek's sign ("the beak and the cheek") are commonly associated with this parathyroid condition
What is hypoparathyroidism?
Cushing's disease can often result in this disorder of glucose regulation
What is hyperglycemia?
The nurse is caring for a patient with SIADH. Which patient care actions should the nurse delegate to the experienced unlicensed assistive personnel?
1. Monitor and record strict I and O
2. Provide the patient with ice chips when requested
3. Remind the patient about his or her fluid restriction
4. Weigh the patient every morning using the same scale
5. Report a weight gain of 2.2 lb ( 1kg ) to the nurse
6. Provide mouth care allowing the patient to swallow the rinses
What are 1, 3, 4, 5
Fluid restriction is essential because fluid intake further dilutes plasma sodium levels. In some cases, fluid intake may be kept to as low as 500-1000ml, over 24 hours. All oral fluids count including ice chips and mouth rinses and are not unrestricted
Focus: Delegation;Supervision
A nurse is educating four clients who are being started on different types of insulin. The nurse must ensure each client understands when they are most at risk for hypoglycemia based on the insulin's onset and peak action. Match each type of insulin to the time when the nurse should most closely monitor for hypoglycemia
A. Glargine ( Lantus)
B. NPH Insulin
C. Regular Insulin ( Humulin R)
D. Lispro( Humalog)
Concerning Timing for Hypoglycemia
1. onset 15 minutes and 1-3 hours after administration for peak effect)
2. 4-12 hours after administration ( Intermediate peak)
3. 2-4 hours after administration ( short acting peak)
4. Minimal peak: monitor consistently but less risk of sharp hypoglycemia
What is
A - 4
B - 2
C - 3
D - 1
What are hyperthyroidism and hypothyroidism
When parathyroid hormone (PTH) increases, calcium levels in the blood do this
The patient with Cushing's disease requires support and reassurance about body image changes like these
What are buffalo hump, moon face, truncal obesity, hirsutism, and muscle wasting?
Which prescribed order for a patient with diabetes insipidus ( DI) would the nurse be sure to question?
1. Monitor and record accurate intake and output
2. Check urine specific gravity
3. Restrict fluids for 6 hours
4. Weigh the patient every morning
What is 3. Restrict fluids for 6 hours
Ensure no patient dx with DI is deprived of fluids more than 4 hours because reduced urine output and severe dehydration can result.
Interventions for DI include accurately measure fluid I &O, checking urine for SG and recording daily weight
Focus: Prioritization
Match the following endocrine drugs with concerning side effects
a. Methimazole
b. Prednisone
c. Levothyroxine
d. desmopressin
Concerning side effects
1. Water intoxication and hyponatremia
2. Signs of infection ( e.g. fever, sore throat, malaise)
3. Chest pain or palpitations
4. Hyperglycemia and mood swings
What is
A. Methimazole 2 Signs of infection
B. Prednisone 4. Hyperglycemia and mood swings
C. Levothyroxine - 3. Chest pain or palpitations
D. Desmopressin 1. Water intoxication and hyponatremia
Your patient has increased levels of TSH and low levels of T3 and T4, so you suspect this
Hypothyroidism
The nurse takes extra safety measures when ambulating for her patient with hyperparathyroidism because she knows he is at increased risk for this
What is fracture?
This life-threatening complication of Addison's disease can cause extreme hypotension and rapid, thready pulse
What is Addisonian crisis?
The nurse is caring for a 81 yo adult with Type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the risk for development of hyperglycemic-hyperosmolar syndrome: Select all that apply.
1. Hydrochlorothiazide (HCTZ) prescribed to control BP
2. Weight gain of 6 lb over the past month
3. Avoids consuming liquids in the evening
4. Blood pressure of 168/94 mmHg
5. Urine output of 50-75 ml/hr
6. Glucose greater than 600 mg/dL
What is 1,3, and 6.
HHS often occurs in older adults with type 2 Diabetes. Risk factors include taking diuretics and inadequate fluid intake and Serum glucose over 600mg/dL
Weight loss (not gain) would be a symptom. Although the patient's blood pressure is high, this is not a risk factor. A urine output of 50-75mL/hr is adequate.
Focus Prioritization
A 56-year-old client with type 2 diabetes is brought to the clinic by a family member who reports the client has been "acting strange". The client appears confused and irritable. Upon assessment, the nurse notes:
Pale, diaphoretic skin
Pulse 110 bpm
Blood glucose 48 mg/dL
Reports skipping lunch due to nausea
Which of the following Clinical signs and symptoms are consistent with the nurse's suspicion of hypoglycemia
A. Pale, sweaty skin
B. Kussmaul respirations
C. Confusion and irritability
D. Fruity-smelling breath
E. Tachycardia
F. Tremors or shakiness
What is A, C, E, F
B and D or hyperglycemia and DKA