Endocrine

Question 1

Autoimmune [Graves’ Disease]
Excessive dosing of thyroid medications
Thyroid tumor (benign or malignant)

These are all causes of what complication?

Answer 1

Thyroid crisis

Question 2

A patient that recently had sepsis/infection, undiagnosed hyperthyroidism, radioactive iodine therapy, trauma, and untreated DKA are at risk for?

Answer 2

Thyroid crisis

Question 3

A patient present to the ER with a fever of 101 F, tachycardia, sweating, tremors and confusion most like has clinical manifestation of what complication?

Answer 3

Thyroid storm/crisis

Question 4

What are priority interventions for a nurse caring for a patient experiencing a thyroid crisis? should she wait for confirmed labs to initiate care?

Answer 4

NO. The nurse should start care immediately by administering IV beta blockers FIRST to stabilize CV and maintain airway

Question 5

How often must the nurse assess VS on a patient with thyrotoxic crisis, what interventions are important?

Answer 5

The nurse must asses vital signs Q 30min and report any increase of 1 degree, antipyretic, cooling blankets, and ice packets to maintain temperature. Methamozole and Iodine should be giving to reduce TH synthesis and release, glucocorticoids to prevent the conversion of T3–> T4, and IV fluids NS for hydration .

Question 6

This can occur due to infection, decrease in insulin intake, stress, illness, trauma, and increase in growth hormone. and is described by insulin deficiency.

Answer 6

Diabetic Ketoacidosis

Question 7

A patient presents to the ER with polyuria, polydipsia, and polyphagia, the patient appears to have kussmaul respirations, and a fruity breath. The patient has now had changes in LOC, tachycardia, and hypotension. What is the patient experiencing and what is the nurse priority interventions?

Answer 7

This patient is experiencing DKA. The nurse will need restore fluid volume immediately by starting an initial bolus of isotonic 0.9% NS in the first hour followed by continuous infusion. Once ECF volume is restored the nurse will need to switch to 0.45 NS.
Once fluid replacement is initiated the nurse will need to lower blood glucose 50-75mg/dL/hour (VERY SLOWL REDUCTION).

Question 8

While administering fluid replacement for a patient with DKA the nurse must assess for what complication?

Answer 8

The nurse will need to monitor for fluid volume overload, cerebral edema bc LOC should IMPROVE not decline, and intake and output

Question 9

Once fluid volume is restored how much insulin will the nurse administer? what are important assessments following admin?

Answer 9

IV insulin 0.1U/kg bolus followed by continuous infusion of 0.1 units/kg/hr. Once acidosis is corrected the nurse will switch to sub Q and the pt tolerates oral fluids. The nurse will need to check K+ level before administering initial dose of insulin, monitor for hypoglycemia, and change IV solution to DK when serum glucose 200-250 to prevent hypoglycemia

Question 10

What are labs and diagnostics seen with DKA

Answer 10

Hyperglycemia of >300mg/dL
Presence of ketones
metabolic acidosis
sodium and potassium electrolyte disturbances.

Question 11

How is Acidosis corrected in a patient with DKA.

Answer 11

Acidosis is correct by insulin administration.

Question 12

What is the protocol for insulin administration for pt with DKA in regards o potassium levels.

Answer 12

The nurse will need to check potassium level q 1-2 hrs bc K+ levels are suspected to drop with insulin administration,
If very first K+ <3.3 then NO INSULIN, administer K+
K+ 3.3-5 = give insulin w/ K+ iv fluids
K+ high end= NO k+ until levels are lower
Do NOT add K+ to IV if urine output is less than 30ml/hr
monitor, sodium, phosphorus, and cardiac monitoring

Question 13

A patient presents to the ER with polyuria, polydipsia and polyphagia, fluid volume deficit, drowsiness and change in LOC. What is the patient experiencing as seen with labs such as BS >600mg/dL, Osmolality >320, and electrolyte disturbances

Answer 13

This patient is likely experiencing Hyperglycemic Hyperosmoloar nonketotic syndrome.

Question 14

What are the priority interventions for the nurse caring for a patient with HHNS?

Answer 14

The nurse will need to restore fluid volume/hydration, and Reduce serum blood sugar by administering intravenous insulin to decrease glucose between 50-70mg/dL. Add D5 to IV once serum BS < 250, and administer electrolyte replacement

Question 15

The patients present to the ER after drinking alcohol and having no food and also double dosing on insulin with manifestations of sweaty, shaky, hungry, tingling , confusion, fatigue and weakness. What is the patient problem and what are the priority interventions?

Answer 15

The patient is experiencing hypoglycemia. The nurse will ALWAYS treat for hypoglycemia and give glucose to a patient that is unsure of cause and unconscious. Give 50% Dextrose 1/2-1 amp. Monitor for hypoglycemia and complications of hyperglycemia

Question 16

This is caused by hyposecretion of ADH and excess loss of water and sodium in the kidneys common types include central (post.pit), nephrogenic (kidneys not responding), and drug related (lithium use)

Answer 16

Diabetes Insipidus,

Question 17

What are primary causes of DI

Answer 17

Malformation/destruction of hypothalamic-hypophyseal system or secondary causes including autoimmune, head injury, infection, cancer

Question 18

A patient that has urinated 4L urine in a 24 hrs period, is excessive thirsty, has tachycardia, hypotension, dry mucous membranes and changes in LOC is most likely experiencing what? what are common labs and diagnostics for this disorder?

Answer 18

This patient most likely has Diabetes Insipidus which hyposecretion of the hormone ADH. Common lab finding include decreased urine specific gravity, urine osmolality, and ADH levels, increased serum osmolality and hypernatremia

Question 19

What are priority interventions for patients with DI

Answer 19

The patient will need to be on strict I&O, Hydration and IV fluids (hypotonic). ADH spray Demopressin, monitor serum sodium and daily weights

Question 20

A patient with this disorder has excess H2O retention and Hyponatermia and has manifestation of weight gain, hypothermia, decrease urine out, and changes in LOC. This patinet likely has what condition? what is this caused by?

Answer 20

This patient has Syndrome of inappropriate antidiuretic hormone (SIADH) typically cause by CNS disorder, cancer, exogenous ADH screting tumors in the lung cancers, pneumonia, lunc abscess and active TB

Question 21

Increased urine osmolality , urine specific gravity, and serum ADH.
Decreased serum osmolality
These labs are commonly seen in what condition

Answer 21

SIADH

Question 22

What are priority interventions when caring for a patient with SIADH

Answer 22

FLUID RESTRICTION! no tap water (hypotonic) only NS. NO diuretic due to decreases in sodium levels . Administer medication like “vaptin” vasopressors receptor antagonist to block vasopressin at site of reception. Hypertonic sodium for hyponatermia, and Declamycin for seizure precaution

Question 23

What are important measures to take when caring for a patient with SIADH

Answer 23

Seizure precautions- when administering declamycin, strict I/O and daily weights, monitor for neurologic status and constipation

Question 24

This is a catecholamin producing tummore that causes excessive epinepherine and norepinepherine secretion., commonly preciptated by valsalva stimulation, abdominal palpation, medication, and tyramine. What is this condition?

Answer 24

Pheochromocytoma.

Question 25

Facial flushing/fluttering in chest
Increased BP and HR 
Glucose High 
Headaches 
Tremors 
Frequent Sweating
Loss of weight
Increased anxiety
Growing tumor causing back/abd pain 
Heat Intolerance 
Tired and weak

These are all s/s of what condition? What intervention and diagnostics are necessary?

Answer 25

Pheocromoctoma-FIGHT/FLIGHT

The patient will get a CT san to assess for the presence of adrenal tumors and blood/urine test. The patient my need to undergo an adrenalectomy. Pre-surgical care should consist of hydration and stabilizing blood pressure

Question 26

Following an adrenalectomy the nurse will need to prioritize what post-surgical interventions?

Answer 26

DO NOT PALPATE THE ABDOMEN!! The nurse will need to maintain blood pressure control to prevent orthostatic hypotension, maintain volume status by monitoring fluids and promote rest.