MED SURG II Exam II CH 44, 45

Question 1

Know in acromegaly, what the purpose of the “glucose-tolerance test” is, what it measures.

Answer 1

To remove pituitary tumor.

Question 2

Know what the pre-operative teaching is for a pt scheduled for transphenoidal hypophysectomy.

Answer 2

Do not sneeze

Question 3

Know excess of what, causes the large flattened features of the pt w acromegaly.

Answer 3

Excess GH production.

Question 4

Know the classic s/s of diabetes insipidus

Answer 4

Massive diuresis, dehydration, thirst,

Question 5

Know why a pt w “Addison Disease” must take hydrocortisone

Answer 5

(Regulate the excretion of potassium and sodium)

Question 6

Know what nephrogenic DI is and how it differs from neurogenic DI

Answer 6

Nephrogenic DI is an inherited defect in which the renal tubules of the kidney do not respond to ADH, resulting in adequate water reabsorption by the kidneys. In this case, ADH is produced in sufficient amounts but the kidneys do not respond to it appropriately.
In Neurogenic DI, a defect in either the production or secretion of ADH exist.

Question 7

Know why a pt w Addison disease would have a disturbed body image r/t the color of their skin.

Answer 7

(hyperpigmentation, smoky or bronze color of skin)

Question 8

Know what a “cardinal indication” of pheochromocytoma is.

Answer 8

Hypertension w a diastolic pressure of 115 mm Hg or higher

Question 9

Know what the s/s of “Adrenal crisis” are, when caring for a pt w Addison’s Disease.

Answer 9

Hypotension, tachycardia, dehydration, confusion, hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia. - Life threatening!!!

Question 10

Know what the purpose of the laboratory test to measure the serum level of ACTH is

Answer 10

to measure and detect elevations or deficiencies in the pituitary gland -> adrenal gland -> ACTH

Question 11

Know what would be included in the discharge plan for a pt w Addison Disease r/t “risk for injury”.

Answer 11

Instruct the pt who has dizziness w position changes to call for help when getting out of bed and to rise slowly to prevent falls. Exercising the legs before standing.

Question 12

Know why a pt in adrenal crisis, after receiving the initial dose of IV Solu Cortef, would need continued IV Solu Cortef.

Answer 12

To provide a loading dose and maintenance infusion (The half-life of IV hydrocortisone is 60-90 minutes, so the pt’s blood level must be maintained by continuous infusion. If the blood level falls, then the pt may have a relapse.) **(

Question 13

Know what a nurse would include in a teaching plan w a pt who has Addison Disease.

Answer 13

• Wear a medical alert tag and carry an emergency kit w dexamethasone.
• Take glucocorticoid agents in divided doses in the morning and afternoon w food.
• Increase your medication dosage as ordered when under stress.
• Notify the physician or go to the ER if you are unable to take oral medications for more than 24 hours.
• Remember that lifelong therapy and monitoring are needed.
• Report s/s of inadequate and excessive hormone replacement.

Question 14

Know what medication would cause a long term asthma pt to develop “Cushing Syndrome”

Answer 14

Prolonged administration of high doses of corticosteroid agents.

Question 15

Know what the “Hallmark findings” are expected when assessing a pt wCushing Syndrome

Answer 15

• Truncal obesity (excess adipose in body trunk)
• Protein wasting (slender extremities and very thin and friable skin)
• Facial fullness, often called a “moon face”
• Purple striae on the abdomen, breasts, buttocks, or thighs
• Osteoporosis (a significant finding in premenopausal women)
• Hypokalemia of uncertain cause

Question 16

Know the instructions the Nurse would give a pt w Cushing Syndrome for self care

Answer 16

• Avoid people w infections because you have increased risk of infections; report any temperature elevation to you physician.
• Mood swings and changes in appearance are usually corrected w tx.
• Avoid activities that could result in trauma because you have increased risk of bleeding and fractures.
• It is critical that you continue drug therapy under medical supervision.

Question 17

Know what a Nurse would anticipate when assessing a pt w Simmonds Cachexia, r/t hypopituitarism

Answer 17

(muscle and organ wasting)

Question 18

In documenting a care plan for a 10-year old boy w hyperpituitarism, know what the Nurse would tell the pt r/t “Disturbed self image”

Answer 18

( Pt should be educated about the excessive growth they will experience)

Question 19

Know what the nursing care for a pt is, who had a hypophysectomy, in which the whole pituitary was removed.

Answer 19

( Hormone replacement of life, check WBC count, check for CSF leaks. pg 1004 under assessment )

Question 20

Know what causes are for Addisonian Crisis

Answer 20

This usually results from a sudden marked decrease in available adrenal hormones. Precipitating factors are adrenal surgery, pituitary destruction, abrupt withdrawal of steroid therapy (often a result of a pt unwittingly stopping medications) and stress. **(

Question 21

Know what discharge planning for the pt who underwent a hypophysectomy is focused on.

Answer 21

NO straining or heavy lifting bending of the waist, hormone replacement therapy for life

Question 22

Know what nursing responses from the Nurse, would be best for the pt’s family and the family, if the pt has gigantism.

Answer 22

Demonstrate acceptance, allow pt to share feelings.

Question 23

For a pt w hypopituitarism, who must take medications for the rest of their life, know what the teaching plan would include

Answer 23

• Continue your prescribed drug therapy, and notify your physician of any side or adverse effects.
• Notify your physician if you have increased urine output, thirst, weight loss, and general feelings of malaise or weakness. You may need additional tx.
• Prolonged use of nasal sprays can cause ulceration of mucous membranes, chest tightness, upper respiratory infections, and respiratory problems.
• Keep office or clinic appointments to identify and changes in pituitary function.
• Schedule activities and regular rest periods to avoid excessive fatigue.
• Wear a medical alert bracelet.
• Drowsiness, listlessness, and headache are signs of water intoxication, which may result from vasopressin therapy.

Question 24

Be familiar w the drug “Sandostatin” and what it is used for and how it works.

Answer 24

Suppresses secretion of growth hormone. Most effective drug for acromegaly.

Question 25

If a patient c/o headache and nuchal rigidity after a hypophysectomy, based on these assessments, what should the Nurse do?

Answer 25

Obtain WBC count, monitor for s/s of infection

Question 26

If a physician orders a T3 and T4, know what levels of these tests would indicate hypothyroidism.

Answer 26

A decreased level in T3 and T4

Question 27

If a pt starts taking potassium iodide SSKI, know what the nurse should instruct the pt to do.

Answer 27

Dilute liquids in water, fruit juice, or milk. Reduce the unpleasant taste and tooth-staining potential by having the pt use a straw. Monitor the pt for s/s of excessive iodine. Give SSKI after meals.

Question 28

If a pt w hyperthyroid, cannot get to sleep, know what the Nurse should suggest.

Answer 28

Encourage the pt to arrange the day to allow periods of rest. Caffeine should be avoided because of its stimulating effects. Encourage bedtime rituals, which may be helpful in preparing for sleep. For the hospitalized pt, provide a restful environment and a soothing back rub to promote relaxation. Give sedatives as ordered to promote sleep.

Question 29

Know what significant instructions to give a pt who is scheduled for a thyroid scan (123 I)

Answer 29

Tell pt that he or she will be given the isotope in liquid form and will return to radiology 24 hours later for the scan. W 123I, the scan is done after 3 to 6 hours. The pt will have to lie still on his or her back for 20 minuets during the scan. For 1 week before the test, the pt should not consume iodine. Iodine is in radiographic dyes, some oral contraceptives, weight control drugs, multivitamins, all thyroid drugs, and some food, (especially seafood).

Question 30

If a pt had a lab test that showed a high level of thyroid-stimulating hormone (TSH) and a low level of T4, know what that would indicate.

Answer 30

hyperthyroidism

Question 31

Know what “Exophthalmos” is and when it goes away.

Answer 31

Exophthalmos is bulging of the eye. Severe inflammation is tx w a 2-4 week course of prednisone. After acute inflammation subsides, surgery may be required.

Question 32

Know the pathophysiology of Graves Disease and how to explain that to a pt.

Answer 32

Graves disease, which is the most common type of hyperthyroidism, is thought to be an autoimmune disorder. Antibodies activate TSH receptors, which in turn stimulate thyroid enlargement and hormone secretion. - subtotal thyroidectomy and lifelong medication.

Question 33

If a pt was 1 day post-op after subtotal thyroidectomy and noted the pt’s color was poor, pulse and respirations were rapid, and the pt felt warm to touch, know what the Nurse’s initial implementation should be.

Answer 33

Thyroid storm or crisis

Question 34

If a pt had been given the drug “Propylthiouracil”, know what nursing implementations should include

Answer 34

(Monitor for bleeding Used for hyperthyroidism, flipping from hypo to hyper, watch for weight gain and fatigue)

Question 35

Know what an appropriate nursing diagnosis for a pt recently diagnosed w hyperthyroidism would be.

Answer 35

• Decreased cardiac output
• Disturbed sleep pattern
• Hyperthermia
• Imbalanced nutrition: less than body requirements
• Risk for injury
• Disturbed sensory perception
• Diarrhea

Question 36

If a newly dx pt w hypothyroidism begins a drug regimen, know what Nurse instructions should be given relative to hormone replacement.

Answer 36

Inform pt they will have usually require lifelong replacement therapy. They should be monitored periodically to evaluate the response to therapy.

Question 37

Know what pre-surgical teaching includes for a pt scheduled for sub-total thyroidectomy.

Answer 37

• If all of your thyroid gland is removed, then you will need lifelong replacement of thyroid hormones.
• If only part of your thyroid gland was removed, then you may fell tired for a while; however, this should improve as the remaining gland increases hormone production.
• Thyroidectomy scars usually heal so that they are eventually barely noticeable.
• Take your drugs exactly as prescribed.
• Nervousness and palpitations may be adverse effects of thyroid replacement drugs.; notify the physician if they occur.
• Support head while rising.

Question 38

After a pt undergoes thyroidectomy, know what explanation you would give the pt for the tracheostomy tray on the bedside table.

Answer 38

Because of the location of the thyroidectomy incision, edema or bleeding can cause pressure on the trachea. Without prompt intervention, the pt with airway obstruction could die. This is used as an emergency tx of airway obstruction. pt could have a laryngeal spasm.

Question 39

Know how a Nurse should assess for hemorrhage in a post thyroidectomy pt.

Answer 39

Frequently inspect the dressing and behind pt’s head and neck for bleeding and take vital signs.

Question 40

Know how foods such as soybeans, turnips and rutabagas can have an effect on persons w a thyroid disorder.

Answer 40

These foods act as goitrogen agents, meaning that they suppress thyroid hormone production.

Question 41

Know why an older persons daily dose of thyroid hormone, taken for many years, might need to be reduced.

Answer 41

(Metabolisim decreases w age)

Question 42

A pt who is 2 days post-op total thyroidectomy, has a carpopedal spasm of the hand. Know why this would occur and what the spasm is called.

Answer 42

Trousseau sign, indicative of hypocalcemia

Question 43

Know how the Nurse would address the nursing diagnosis of “Risk for impaired skin integrity, r/t dry skin” in a pt w hypothyroidism. What intervention would the nurse provide?

Answer 43

Liberally apply lotions and creams to help maintain moisture and control itching. Reduce the frequency of bathing to prevent additional drying of the skin.

Question 44

Know how the Nurse initiates “Chvostek sign” and what it indicates.

Answer 44

Chvostek sign is a spasm of the facial muscle when the face is tapped over the facial nerve. It is indicative of hypocalcemia.

Question 45

Know what a pt w hyperparathyroidism would exhibit in their history.

Answer 45

(Kidney stones, high risk of renal caculi)

Question 46

If a pt who has hyperparathyroidism and is to receive the drug Calcitonin (Calcimar), know what the pt should be tested for, before receiving this drug.

Answer 46

Sensitivity test should be done before receiving this drug.

Question 47

Know what an appropriate nursing diagnosis for a pt w hyperparathyroidism would be, HINT: R/t urinary elimination

Answer 47

• Impaired urinary elimination r/t renal calculi *

Question 48

If a pt w hypoparathyroidism c/o fatigue and lack of energy, know what the Nurse should be aware of.

Answer 48

Hypocalcemia, cardiac dysrhythmias, decreased cardiac output.

Question 49

Know why a Nurse should recommend the use of salt that is iodized.

Answer 49

to prevent goiter

Question 50

Know how a pt w hypothyroidism can live a full and normal life, r/t the pt’s medication.

Answer 50

Hypothyroid pts usually require lifelong hormone replacement therapy.