Labs
A female client has a serum calcium level of 7.2 mg/dl. During the physical exam, the nurse expects to assess:
Trousseau’s sign – serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau’s sign (carpopedal spasm induced by inflating the BP cuff above systolic pressure). Homan’s sign (test for DVT) Hegar’s sign (softening of the uterine isthmus) and Goodell’s sign (cervical softening) are probable signs of pregnancy
Toxic nodular goiter confirmation requires which diagnostic test?
Nuclear med thyroid scan
-A thyroid scan is a nuclear medicine examination that uses the emissions of gamma rays from radioactive iodine to determine whether a patient has thyroid problems, including, goiter, hyperthyroidism, cancer, or other growths.
The nurse is assessing a post craniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour. The nurse should suspect:
a. Cushing’s syndrome
b. Diabetes mellitus
c. Adrenal crisis
d. Diabetes insipidus
D. Diabetes insipidus.
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is under secretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.
The nurse is developing a teaching plan for a male client diagnosed with DI. The nurse should include information about which hormone lacking in clients with DI?
a. antidiuretic hormone (ADH).
b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).
antidiuretic hormone (ADH).
ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and LH levels won’t be affected.
A patient admitted to the ICU with a diagnosis of thyroid storm. The nurse anticipates administering high doses of potassium iodine or strong iodine solution to:
Suppress thyroid hormone release
In reviewing the lab reports of a patient with untreated hypothyroidism, the nurse would expect to see which result?
Low serum T4 and elevated TSH
What is an important assessment that will assist in the early identification of diabetes insipidus?
Urine specific gravity
A new patient with hyperthyroidism has exophthalmos. The nurse is aware that the most likely diagnosis is:
Graves’ disease
A nurse counsels a patient started on Synthroid a thyroid replacement therapy for hypothyroidism. Which information should be included in patient education?
a. Therapy should continue until all symptoms have resolved
b. Medication should be taken as directed for 3-6 months
c. Most patients require therapy for at least 1 year
d. Treatment is likely to be lifelong
Treatment is likely to be lifelong
Which statement indicates that a patient understands RAI therapy?
a. “I will have to isolate myself from my family for 1 week, so I don’t expose them to radiation.”
b. “This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism.”
c. “This drug will help decrease my cold intolerance and weight gain.”
d. “I will need to take this drug on a daily basis for at least 1 year.”
b. This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism
A patient with possible SIADH is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial lab results to include a
a. Serum sodium (Na++) of 125 mEq/L (125 mmol/L)
b. Hematocrit (HCT) of 52%
c. Blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L)
d. Serum chloride (Cl-) of 110 mEq/L (110 mmol/L)
Serum Na++ of 125 mEq/L (125 mmol/L)
When water is retained, the serum Na++ will drop below normal causing the clinical manifestations reported by the patient. The Hct. will decrease because of dilution caused by water retention. The BUN is not helpful in diagnosis of SIADH and this BUN value is increased. The serum CL- level will usually decrease and this level is elevated.
After the administration of ACTH for diagnostic testing, unchanged plasma levels of cortisol would indicate:
Primary adrenal insufficiency
Which disorder may result from the use of adrenal corticosteroids at high doses?
Cushing’s disease
A nurse reviews lab data for an adult patient. The serum TSH is below normal limits. When the patient inquiries about the significance of this finding, what is the nurse’s best response?
a. “Hypothyroidism causes the TSH to decrease”
b. “The test is probably erroneous, as the patient does not exhibit a goiter.”
c. “TSH is not a good screening test for thyroid disease.”
d. “The low TSH is consistent with hyperthyroidism.”
c. “The low TSH is consistent with hyperthyroidism.”
A patient is treated with fludrocortisone for primary adrenal insufficiency. If the dosage is too high, the nurse would expect to see:
Retention of water and salt
A patient with severe head trauma sustained in a car accident is admitted to the ICU. 36 hours later, the client’s urine output suddenly is > 200 ml/h., leading the nurse to suspect DI. Which lab findings support the nurse’s DI suspicion?
a. Above-normal urine and serum osmolality levels
b. Below-normal urine and serum osmolality levels
c. Above-normal urine osmolality level, below-normal serum osmolality level
d. Below-normal urine osmolality level, above-normal serum osmolality level
Below-normal urine osmolality level, above-normal serum osmolality level.
In DI, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, DI doesn’t cause above-normal urine osmolality or below-normal serum osmolality levels.
The nurse will plan patient care that will decrease the patient’s physical and emotional stress when the patient is undergoing
A 24-hour urine test for free cortisol
Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes?
a. Diabetes mellitus.
b. Diabetes insipidus.
c. Diabetic ketoacidosis.
d. Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
B. Diabetes insipidus.
Maintaining adequate fluid and replacing vasopressin are the main objectives in treating diabetes insipidus. An excess of antidiuretic hormone leads to SIADH, causing the patient to retain fluid. Diabetic ketoacidosis is a result of severe insulin insufficiency.
Which statement about glucocorticoids is the most accurate?
a. They influence carbohydrate, lipid, and protein metabolism
b. They are produced in decreased amounts during times of stress
c. They decrease serum sodium and glucose levels
d. They stimulate defense mechanisms to produce immunity
a. They influence carbohydrate, lipid, and protein metabolism
The drug of choice for central DI is desmopressin (DDAVP). What is this drug’s mechanism of action?
a. Mimics vasopressin and increases kidney water reabsorption
b. Blocks vasopressin and increases kidney water reabsorption
c. Mimics vasopressin and increases kidney salt excretion
d. Blocks vasopressin and increases kidney salt excretion
A. Mimics vasopressin and increases kidney water reabsorption
A patient with acute adrenal insufficiency. The nurse determines the patient is responding favorably to treatment upon finding
Decreasing serum potassium –
Addison’s disease includes hyperkalemia and decrease in potassium levels indicates improvement. Decreasing serum sodium and decreasing glucose indicate treatment has not been effective. Changes in urine output are not an effective way of monitoring treatment of Addison’s disease
To confirm central DI, post-injection (desmopressin) urine osmolarity should be what percentage of pre-injection osmolarity?
a. < 50%
b. < 75%
c. 100% (equal)
d. > 125%
e. > 150%
e. > 150%
A patient with lung cancer is treated with demeclocycline (Declomycin) to control the symptoms of SIADH. The nurse determines that the treatment is effective upon finding that the
Patient’s urinary output is increased
Demeclocycline blocks the action of ADH on the renal tubules and increased urine output. A stable body weight and an increase in urine specific gravity indicate SIADH is not corrected. Peripheral edema does not occur with SIADH; a sudden weight gain without edema is a common clinical manifestation of this disorder
When a patient eats a bag of potato chips, the nurse recognizes that hypernatremia is likely to occur if the patient is experiencing a decreased production of
Antidiuretic hormone (ADH)
A male client with primary DI is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?
a. “Administer desmopressin while the suspension is cold.”
b. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
c. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
d. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”
C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.” Desmopressin may not be absorbed if the intranasal route is compromised. Although DI is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.