ATI Endocrine

Question 1

Alcohol with Type 1 DM

Answer 1

ingest alcohol with meals to reduce alcohol induced hypoglycemia. alcohol prevents liver production of glucose, consume carbs during to prevent hypoglycemia.
One alcoholic beverage = 2 fat exchanges.
insulin may need to be decreased.

Question 2

Pt taking insulin glargine (Lantus) and Regular insulin (Humulin R)

Answer 2

Draw them up in separate syringes. insulin glargine cannot be mixed with any other insulin in the same syringe.

Question 3

Hypoglycemia

Answer 3

cool clammy skin, anxious

Question 4

Hyperglycemia

Answer 4

rapid, deep respirations. dehydration- orthostatic hypotension.

DKA- abdominal cramping.

Question 5

Insulin has been effective

Answer 5

fasting blood glucose 106.

Question 6

Postprandial glucose

Answer 6

after meal- needs to be <180

Question 7

Bedtime glucose

Answer 7

100-140

Question 8

Preprandial glucose

Answer 8

90-130

Question 9

Propylthiouracil (PTU)

Answer 9

Treatment goals have been met when client reports increase in weight. PTU is given to suppress thyroid hormone and allow for weight gain. Causes reduction in appetite, bowel movements, and sweating.

Question 10

DKA

Answer 10

ph low, carbon dioxide normal, bicarbonate low. metabolic acidosis.

Question 11

SIADH

Answer 11

pt retains fluids, causes dilutional hyponatremia- sodium 110 needs to be reported.

Question 12

DM, peripheral neuropathy. protect feet:

Answer 12

check bath water temp with thermometer. Examine feet daily. Shop for shoes later in the day when feet are slightly swollen. Change body position regularly, not just when uncomfortable.

Question 13

DI

Answer 13

increased hematocrit, dehydration, low urine SG- increased urine output.
Tachycardia. Increased BUN r/t dehydration.

Question 14

Pheochromocytoma, priority intervention

Answer 14

avoid palpating the abdomen- palpation could cause sudden release of catecholamines from the adrenal gland precipitating a hypertensive crisis.

Not priority- ensure adequate hydration to maintain blood volume, manage headaches with analgesics, private darkened room to promote rest.

Question 15

24 hours after total thyroidectomy. report to pcp-

Answer 15

laryngeal stridor- harsh high pitch sound on inspiration, indicates respiratory obstruction.

expected findings- productive cough, pain on hyperextension of neck, hoarse weak voice

Question 16

Thyroid replacement meds

Answer 16

take on empty stomach to absorb best. 30 min before breakfast. Will prob experience increased appetite.

Question 17

Pt being screened for pheochromocytoma, scheduled for vanillymandelic acid test.

Answer 17

Restrict caffeine 2-3 days prior to the test. Discard first morning void, begin collecting urine after that.
Avoid aspirin and antihypertensives during collection.

Question 18

DKA

Answer 18

blood glucose over 300, deep kussumal respirations, weight loss, increased urine output

Question 19

Screening for Cushings, labs

Answer 19

blood glucose elevated.

lymphocytes, potassium, calcium decreased.

Question 20

Foot care

Answer 20

apply lotion to dry areas of feet, avoid application between toes- avoid bacterial growth.
Dont let feet air dry after shower- dry between toes.
wear closed toe shoes.
dont use orc meds- can impair skin integrity.

Question 21

Thyroid storm

Answer 21

Propanolol (inderal)- reduces the effects of thyroid hormone on the heart. decreases rapid heart rate caused by excess thyroid stimulation.

Question 22

desmopressin acetate (DDAVP) for pt with DI, metered dose spray

Answer 22

blow nose prior to using nasal spray for better absorption.
Dont need to breathe deeply- spray needs to be absorbed in the nose not the lungs.
Sit upright without tilting the head to administer the spray.

Question 23

Acute adrenal insufficiency

Answer 23

administer hydrocortisone succinate (Solucortef)- needed to replace the cortisol deficiency that occurs with adrenal insufficiency.
also want to decrease potassium- encourage fluids.

Question 24

HG A1C

Answer 24

indicates glucose levels over a 3 month period.

Question 25

Hyperthyroidism

Answer 25

tremors, heat intolerance, restlessness, irritability, wide eyed, startled

Question 26

Cushings Disease

Answer 26

increased hair growth, hirsutism, increased BO, weight gain, thinning of the skin

Question 27

Hypothyroidism

Answer 27

hypotension, wt gain, constipation, bradyc

Question 28

Long term effects of corticosteroid therapy

Answer 28

osteoporosis b/c depletes calcium in bones, development of moon shaped face (fat face, upper back, trunk), increased risk of infection (decreased lymphocytes), muscle wasting of extremities (due to depletion of nitrogen which causes decreased muscle mass), weight gain secondary to deposition of fat in certain areas of the body and fluid retention

Question 29

Test for Addisons Disease

Answer 29

ACTH Stimulation test

Question 30

Hyperglycemic hyperosmolar nonketoic syndrome (HHS) labs

Answer 30

Glucose 846, serum pH 7.40. With hhs the pt produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. ph is expected range, glucose is above 600

Question 31

after thyroidectomy–> hypocalcemia

Answer 31

tingling and numbness of hands and feet- paresthesias, hyperactive DTR, increased GI motility, weak thready pulse.

Question 32

Adrenal insufficiency

Answer 32

elevated serum calcium level, low sodium, weight loss

Question 33

DM teaching

Answer 33

call dr if BS is over 250. take insulin even when sick. check urine for ketones when BS is above 240. check blood sugar q4 when sick.

Question 34

DI receiving intranasal aqueous vasopressin (Pitressin), teaching:

Answer 34

increased urination and thirst indicate the need for another dose of vasopressin therapy.