Week 6 Endocrine 2

Question 1

The thyroid gland is situated

Answer 1

on the anterior surface of the trachea, just below the thyroid cartilage. The thyroid gland has two lobes that are connected by the isthmus and it has an average weight of approximately 34 grams. The size will vary over the lifespan and in relation to nutritional, environmental and genetic factors.

Question 2

Alteration in the function of the thyroid gland are some of the most common endocrine disorders. Disorders of the thyroid gland include:

Answer 2

inflammation
hyperthyroidism
hypothyroidism
benign and malignant nodules
goitre

Question 3

The thyroid gland produces two types of hormones

Answer 3

→ T3 (triiodothyronine) and T4 (thyroxine)

Question 4

The thyroid-stimulating hormone (TSH) → regulates the systhesis and release

Answer 4

of T3 and T4 → secreted by the pituitary gland

Question 5

Synthesis of T3 and T4 requires

Answer 5

iodine → we obtain iodine with the food we eat, for example, fish and other seafood, eggs, chicken, liver, milk, yoghurt

Question 6

Thyroid Hormone Function
Thyroid hormones affect almost every cell in the body and are responsible for energy metabolism, growth and development.

Answer 6

Increases cellular metabolism → a strong and immediate, short-lived increase

Increases body temperature, heart rate & force of contraction, blood pressure, oxygen consumption and enhances oxygen delivery.

Regulates bone production → growth and development

Question 7

If the release of T3 and T4 increases speeds up core bodily functions, what would a lack of T3 and T4 do?

Answer 7

Slow body activities down.

Question 8

Hyperthyroidism

Answer 8

→ Overproduction and sustained synthesis of T3 and T4 (hyperactivity)

Question 9

Hyperthyroidism
Aetiology and Cause

Answer 9

The most common cause of hyperthyroidism is Graves disease

An autoimmune disorder
→ The immune system produces antibodies that attack and stimulate the thyroid gland to produce and excrete excessive amounts of T3 and T4

Most common disorder of the thyroid for people in Australia

More common in women than men, aged 20-40

Mostly linked to hereditary factors

Other causes, thyroid cancer, excessive iodine intake, goitre

Question 10

Hyperthyroidism
Diagnosis

Answer 10

Blood pathology → thyroid function test
→ decreased TSH & increased T4 will confirm diagnosis

Radioactive iodine uptake test
→ differentiates between types of hyperthyroidism

Comprehensive assessment with objective / subjective data collection and physical assessment

Question 11

Hyperthyroidism
Clinical Manifestations

Answer 11

Most people with hyperthyroidism have an enlarged thyroid or a nodular thyroid.

Signs and symptoms reflect increased metabolism which speeds up bodily functions:

Cardiovascular: tachycardia, systolic hypertension, palpitations, bounding rapid heart rate, arrythmias, systolic murmurs, angina

Respiratory: tachypnoea, dyspnoea on mild exertion

Gastrointestinal: increased appetite, increased thirst, weight loss, increased peristalsis, increased bowel sounds, splenomegaly

Integumentary: thin brittle nails, alopecia, palmar erythema, excessive sweating, warm and moist skin, fine silky hair

Musculoskeletal: fatigue, muscle weakness, muscle wasting, peripheral oedema, osteoporosis

Nervous System: fine tremor, nervousness, anxiety, insomnia, mood changes, difficulty concentrating, fatigue, difficulty focusing eyes, depression

Reproductive: amenorrhea, changes in libido, impotence, fertility issues, gynaecomastia in men
Other: intolerance to heat, eyelid retraction, stare, exophthalmos, goitre, rapid speech

Question 12

Hyperthyroidism
Treatment and Management

Answer 12

The goal of management is to block the adverse effects of excessive secretion of T3 and T4 and prevent complications. Choice of treatment depends on age, preferences, comorbidities and pregnancy.

Medication:
Anti-thyroid medications e.g. carbimazole or methimazole
→ reduces the synthesis of new T3 and T4
Takes weeks to stabilise hyperthyroidism due to existing stores of thyroid hormone within the gland.

Radioactive iodine therapy:
Radioactive iodine → absorbed by the thyroid
destroys thyroid cells → results in the decreased production of T3 and T4

Surgery:
One of six procedures may be undertaken

Partial thyroid lobectomy
Thyroid lobectomy
Thryoid lobectomy with isthmusectomy
Subtotal thyroidectomy
Total thyroidectomy
Radical total thyroidectomy

Question 13

Radioactive iodine therapy:

Answer 13

Radioactive iodine → absorbed by the thyroid
destroys thyroid cells → results in the decreased production of T3 and T4

Administered orally as an outpatient procedure

6-8 weeks to stabilise hyperthyroidism

Not suitable for pregnant women as radioactive iodine crosses the placenta → affecting the development of the foetal thyroid gland.

It is not always possible to control how much of the thyroid gland is destroyed, so patients may go on to develop hypothyroidism as a result of treatment.

Question 14

Partial thyroid lobectomy

Answer 14

removal of the upper or lower portion of one lobe

Question 15

Thyroid lobectomy

Answer 15

• removal of one entire lobe

Question 16

Thryoid lobectomy with isthmusectomy

Answer 16

• removal of one lobe and the isthmus

Question 17

Subtotal thyroidectomy

Answer 17

• removal of one lobe, the isthmus and most of the other lobe

Question 18

Total thyroidectomy

Answer 18

• removal of the entire gland

Question 19

Radical total thyroidectomy

Answer 19

• removal of the entire gland and cervical lymphatic nodes.

Question 20

Hyperthyroidism
Complications:

Answer 20

Thyrotoxicosis

Thyroid storm

Acute, severe, life-threatening emergency

Caused by excessive amounts of T3 and T4 released into circulation often as a result of excessive stressors, e.g. trauma, infection, surgery (thyroidectomy)

All same clinical manifestations of hyperthyroidism are present in severe form
→ severe tachycardia, heart failure, shock, hyperthermia, restlessness, irritability, seizures, vomiting, diarrhoea, delirum, coma and death

Treatment
→ Aim is to reduce circulating T3 & T4, manage symptoms and provide supportive therapy, e.g. fluid replacement, reducing temperature, respiratory support.

→ β-adrenergic blockers for symptomatic relief → block sympathetic nervous stimulation → decrease HR, decrease nervous systom responses

→ Most require nutirional support due to severe increase in metabilic rate → up to 6 meals a day plus high protein and carbohydrate snacks

Question 21

Hypothyroidism

Answer 21

→ Underproduction and secretion of thyroxine with high levels of circulating TSH

→ Sometimes a person will have normal levels of thyroxine, with an abnormal level of TSH

Question 22

Hypothyroidism
Types

Answer 22

Three types

Primary hypothyroidism
→ Hashimoto’s Disease
Secondary hypothyroidism
Transient hypothyroidism

Question 23

Primary hypothyroidism

Answer 23

→ caused by Hashimoto’s disease with destruction of thyroid tissue through atrophy

Question 24

Hashimoto’s Disease

Answer 24

→ an autoimmune disorder that creates antibodies which attack the thyroid gland

Question 25

Secondary hypothyroidism

Answer 25

→ caused by pituitary gland disease with decreased TSH secretion

Question 26

Transient hypothyroidism

Answer 26

→ related to subacute thyroiditis or discontinuance of thyroid replacement therapy

Question 27

Hypothyroidism causes

Answer 27

Most common cause is the autoimmune disorder, Hashimoto’s Disease

The immune system produces antibodies that attack the thyroid gland (as if it is a bacteria or virus) → initial response is the increased secretion of T3 and T4 → temporary hyperthyrodism → also results in inflammation of the thyroid gland → overtime the ongoing inflammation prevents the thyroid gland from producing T3 and T4 → destruction of the thyroid gland → reduced excretion of T3 and T4

Other causes → insufficient dietary intake of iodine, treatment for hyperthyroidism such as removal of the thyroid gland or radiation treatment, medications such as lithium or amiodarone

Question 28

Hypothyroidism
Aetiology

Answer 28

Insidious onset

More common in women aged 20-30 and older adults

Risk increased with pregnancy, bipolar, Downs syndrome, other autoimmune disorders e.g. type 1 diabetes, rheumatoid arthritis, MS

Question 29

Hypothyroidism
Diagnosis

Answer 29

Blood pathology → thyroid function test → low plasma levels of free T4 and raised TSH level confirms hypothyroidism.

Comprehensive assessment with objective / subjective data collection and physical assessment

Question 30

Hypothyroidism
Clinical Manifestations

Answer 30

Where overproduction of thyroid hormones result in increased metabolism, an underproduction results in decreased metabolism and decreased body activity. Some people will have hypothyroidism but remain asymptomatic. Usually, the first symptoms experienced will be weight gain and feeling overtired → easily overlooked and dismissed.

Cardiovascular: bradycardia, decreased force of contractions, hypotension, cardiac hypertrophy, distant heart sounds, anaemia, heart failure, angina

Respiratory: bradypnoea, dyspnoea, decreased breathing capacity

Gastrointestinal: decreased appetite, weight gain and difficulty losing weight, constipation, nausea and vomiting, distended abdomen, enlarged tongue

Integumentary: dry, itchy, coarse skin, dry and sparse hair, and diffuse alopecia, decreased sweating, poor mucosa turgor

Musculoskeletal: fatigue, muscle weakness, muscular aches and arthralgia, altered sensation hands/feets (paraesthesia), delayed tendon reflexes, peripheral oedema, cool extremities

Nervous System: apathy, fatigue, poor memory and difficulty concentrating, slow mental processes, slow slurred speech

Reproductive: menorrhagia then later, amenorrhea, decreased libido, infertility

Other: cold intolerance, dysphonia, myxoedema (puffy face, hands and feet)

Question 31

Hypothyroidism
Treatment and Management:

Answer 31

Medication

Treatment is through oral replacement therapy of thryoid hormones → levothyroxine.

→ Low-dose synthetic thyroxine (25-50mcg daily) initially
→ Gradually increasing in increments on a monthly basis until the serum TSH level is normal.

Question 32

Hypothyroidism
Complications

Answer 32

Myxoedema coma

→ An extreme and decompensated form of hypothyroidism
→ Nervous system clinical manifestations, such as mental sluggishness, drowsiness and lethargy, may progressively result in severe alterations in consciousness and coma
→ Life-threatening medical emergency
→ More common in older aged adults
→ Can be precipitated by infection, medications, trauma and exposure to cold temperatures
→ Clinical manifestations → cardiovascular collapse, hypothermia, hypotension, hypoventilation, hyponatraemia, hypoglycaemia and lactic acidosis

Treatment → support of vital functions and intravenous thyroid hormone replacement

Question 33

The pituitary gland is

Answer 33

pea-sized, weighs approximately 500mg, located at the base of the brain, behind the nose, and is attached to the inferior aspect of the hypothalamus.

Question 34

The pituitary gland has two lobes:

Answer 34

the anterior and the posterior lobes.

Question 35

The hypothalamus is

Answer 35

responsible for secreting several hormones to influence numerous glands, affect a variety of bodily functions and to maintain homeostasis. It forms the structural and functional basis of the endocrine system.

The posterior lobe of the pituitary gland takes messages from the brain, via the hypothalamus, to produce adequate hormones that affect many parts of the body, including stimulating other hormones. It is therefore often referred to as the ‘Master Gland’.

Question 36

The pituitary gland produces:

Answer 36

Growth hormone

Prolactin

Adrenocorticotrophic hormone (ACTH) → targets cells in the adrenal gland

TSH → targets cells in the thyroid gland

Follicle stimulating hormone (FSH) → targets cells in the ovaries

Luteinising hormone (LH) → targets cells in the ovaries

Question 37

Growth hormone

Answer 37

→ important for growth, development of muscles and bones, cellular growth and division → acromegaly is a disorder that occurs when the pituitary gland produces too much growth hormones

Question 38

Pituitary Gland
Disorders

Answer 38

Due to it’s overarching affect on other glands, disorders of the pituitary gland can result in a vast range of clinical manifestations and these can be very challenging to diagnose.

They share these traits:

→ The pituitary gland may increase or decrease the production and secretion of multiple hormones simultaneously.

→ Hormone imbalances can result in extreme signs and symptoms, some of which mimic other diseases → misdiagnosis
→ Pituitary disorders have an insidious onset → delayed diagnosis

Pituitary disorders are often caused by a pituitary tumor → underproduction or overproduction of a range of hormones.
→ Most pituitary tumors are benign.

When a tumor grows on or near the pituitary gland, the tumor can:
→ Change hormone production, leading to symptoms such as weight gain, stunted or excessive growth, hypertension, decreased libido and fluctuations in mood.
→ Press against the pituitary gland, optic nerves or brain tissue, causing visual impairment or headaches.

Question 39

Anti Diuretic Hormone (ADH) is produced by

It’s primary function is

Answer 39

ADH is produced by the hypothalamus and stored and released by the pituitary gland.

It’s primary function is to control how the body stores and releases water.

Question 40

Diabetes Insipidus

Answer 40

Secreted when plasma osmolarity rises → main function is to decrease the amount of water lost from the kidneys.

Decreased ADH → excess water is lost from the body through urine → triggers increased intake water → diabetes inspidus (DI).

Question 41

There are two main types of diabetes inspidus (DI):

Answer 41

1) Neurogenic DI (or central DI)

2) Nephrongenic DI

Question 42

Neurogenic DI (or central DI)

Answer 42

→ caused by brain tumours, head trauma or brain surgery → damages the posterior pituitary gland.

Question 43

Nephrongenic DI

Answer 43

→ inability of the renal tubules to sense the presence of ADH → can be hereditary or result from renal failure.

Question 44

diabetes inspidus results in:

Answer 44

Increased urinary output → as much as 20L per day

Increased thirst (polydipsia) and dehydration

Hypernatraemia and hyperosmolarity → evidenced by a low specific gravity on urinalysis.

If caused by trauma → symptoms of DI generally appear within 3-6 days and may be short-lived resolved early (e.g. raised ICP) → may also be chronic.

Question 45

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Answer 45

The syndrome of inappropriate anti-diuretic hormone hypersecretion (SIADH), is a condition in which the pituitary gland produces too much arginine vasopressin.

SIADH → aldosterone is supressed → increases renal excretion of sodium → retention of fluid within the cells.

Question 46

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Patients present with:

Answer 46

Water retention
Hyponatraemia
Decreased urinary output with concentrated urine
Hyper-osmolality
Neurological manifestations such as headaches or confusion

Question 47

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
CAUSES:

Answer 47

A malignant tumour (e.g. carcinoma of the lung or pancreas)
Pituitary surgery
Head injury
Medications

Question 48

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
DIAGNOSIS:

Answer 48

Diagnosis is made by excluding other causes of hyponatraemia → delayed treatment.

Thorough patient history and physical examination of hypovolaemia (decreased skin turgor, dry mucous membraines, tachycardia) or hypervolaemia (ascites or oedema), urine output and osmolality are essential.

Question 49

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
TREATMENT:

Answer 49

Goal of teatment is to treat the underlying cause, e.g. if due to medication, discontinuing the medication will often resolve hyponatraemia.

Fluid restriction - based on urine output

If symptoms are severe → furosemide and intravenous hypertonic (3%) saline → decreases the circulatory volume and prevents sodium excretion

Demecloyclcline (tetracycline antibiotic) with the side effect of inducing excessive urination and inhibiting vasopressin action may be beneficial in chronic situations and helps maintain an adequate fluid balance

Vasopressin antagonists may be prescribed

Monitoring of sodium levels and correction of hyonatraemia must be undertaken with caution in order to prevent cerebral osmotic demylination.

Question 50

Adrenal Gland

Answer 50

There are two, small, highly vascularised pyramid-shaped adrenal glands located close to the upper pole of each kidney, behind the peritoneum. Each gland has two distinct portions: the inner medulla and the outer cortex. Both portions have different structures and hormonal functions

Question 51

Adrenal Cortex

Answer 51

Weighs 80% of the adrenal gland

Outer part of the adrenal gland

Has 3 different zones

Cells are stimulated by the adrenocorticotrophic hormone (ACTH) from the pituitary gland

Secretes several hormones including steroid hormones
*Cortisol → glucocorticoid → needed to maintain life and protect the body from stress → has metabolic, anti-inflammatory and growth-suppressing effe cts → will also increase BGL → named for their effects on glucose metabolism
*Aldosterone → mineralocorticoid → targets the kidneys to retain water and sodium in the blood → essential for water and electrolyte balance
*Androgens → sex hormones → oestrogen and testosterone → gonadcorticoids

Cholesterol is a precursor for steroid hormone synthesis

Question 52

Adrenal Medulla

Answer 52

Weighs 20% of the adrenal gland

Inner part of the adrenal gland

Secretes catecholamines → adrenaline, noradrenaline and dopamine → all considered neurotransmitters because when they are secreted by the adrenal medulla, they are released straight into circulation → flight or fight response

Question 53

Cushing’s syndrome

Answer 53

→ Hyperactivity of the adrenal cortex → overproduction of corticosteroids, in particular, glucocorticoids

Question 54

Cushing’s syndrome
Aetiology

Answer 54

A chronic disorder
More common in women than men
Usually diagnosed between 20 and 40 years, although it can occur at any age.

Question 55

Cushing’s syndrome
Cause:

Answer 55

Several causes
Iatrogenic → long-term use of exogenous glucocorticoid → commonly used in inflammatory conditions such as asthma, rheumatoid arthritis and lupus erythematosus

Pituitary adenoma (Cushing’s disease) → hypersecretion of ACTH → 80% of cases

Ectopic tumours → ACTH secreting tumours e.g. small cell lung cancer, pancreatic tumour

Adrenal causes → excessive production of cortisol → benign or malignant tumour.

Question 56

Cushing’s syndrome
Clinical Manifestations:

Answer 56

Can be seen in all body systems and are related to hypersecretion of corticosteroids:

→ Rapid weight gain, particularly of the trunk and face
→ Hirtuism (facial hair growth) → especially in women
→ An irregular or absent menstrual cycle, testicular atrophy
→ Muscle wasting and weakness
→ Fat pads along the collar bone
→ Hyperhidrosis (excessive sweating)
→ Thinning of the skin
→ Mood swings, irritability, anxiety, depression
→ The appearance of purple lines over the abdomen, thighs or buttocks (as a result of weakening and rupture of the deeper layers of skin).

Question 57

Cushing’s syndrome
Diagnosis:

Answer 57

Plasma cortisol & ACTH levels

24-hour urine collection → elevated free cortisol

Imaging → CT, MRI, x-ray

Question 58

Cushing’s syndrome
Treatment & Management:

Answer 58

Goal of treatment is to regain balanced hormone levels

Treatment depends on underlying cause
→ If a tumour → surgical removal of the tumour or the adrenal gland. Usually only one adrenal gland is removed; however in the presence of an adrenocorticotropic hormone-producing tumour, bilateral adrenalectomy may be performed.
→ Radiation therapy

Medication
→ Hormone replacement
→ Suppress the synthesis or secretion of cortisol from the adrenal gland
→ Where the cuase is induced iatrogenic Cushing’s syndrome, the reduction or ceasing of medication will resolve the symptoms → should only be under the medical supervision → sudden withdrawal of medication may cause adrenal supression → life-threating Addisonian crisis.
→ Symptom management

Question 59

Adrenocortical Insufficiency

Answer 59

→ Hypoactivity of the adrenal cortex

Question 60

Adrenocortical Insufficiency
Aetiology and Cause

Answer 60

The most common cause is Addison’s disease (primary cause)

Results from complete destruction or dysfunction of the adrenal cortex
→ The adrenal cortex no longer produces aldoserone, glucocorticoids or adrenal androgens

A chronic disorder

Linked to an autoimmune response
→ Antibodies attack the adrenal tissue → dysfunction, destruction

Often associated with other disorders of the endocrine system

Affects >2500 Australians
→ Most common in people <60 years of age, affecting both males and females equally

Secondary cause is reduced ACTH secretion
→ Corticosteroids and androgens are reduced
→ Mineralocorticoids remain within normal limits
→ Caused by pituitary disease

Question 61

Adrenocortical Insufficiency
Risk factors include:

Answer 61

Adrenal haemorrhage
Bacterial or fungal infections e.g. tuberculosis
AIDS
Removal of both adrenal glands
Cancers or tumours affecting both adrenal glands

Question 62

Adrenocortical Insufficiency
Clinical Manifestations

Answer 62

Lethargy
Muscle weakness
Weight loss
Hypotension
Hypoglycaemia
Hyponatraemia
Hyperkalemia
Hyperpigmentation

Question 63

Adrenocortical Insufficiency
Treatment and Management

Answer 63

→ Usually requires the use of long-term medications to relieve the clinical manifestations:

Glucocorticoid (prednisolone)
→ Also effective in treating many other diseases and disorders
→ Indication → primary and secondary adrenal insufficiency
→ Dose → 15-25mg daily
→ Action → replacement of cortisol

Precaution
→ Long-term use often leads to serious complications and adverse reactions → not recommended for minor chronic conditions
→ Should not be ceased abruptly
→ Needs to be taken early in the morning and with food

Question 64

Nursing Management
Providing nursing care of a patient experencing an endocrine disorder requires:

Answer 64

Collection of data
→ Targeted health history questions
→ Subjective data collection
→ Objective data collection (Eg Head to toe assessment, Vital signs)
→ Past history → surgery, pregnancies
→ Medications
→ Other information gathering (Medical notes, Family / carer information)

Risk assessments
→ Skin integrity
→ Falls risk
→ Risk for pressure areas
→ Psychosocial status
→ Nutritional assessment (hydration assessment)

Diagnostics
→ You will be required to have an understanding of the normal ranges for blood results. If you are not familiar of the normal ranges, you should know where to find the normal ranges, e.g. pathology resources (Thyroid function test, Glucose levels, HbA1c, Liver function test, Full blood count, Urea, electrolyte and creatinine)
→ ECG
→ Ward urinalysis test or urine studies
→ BHCG
→ Weight and height

Preparation and care related to interventions
→ Surgical care
→ Radiation

Supportive care
→ Emotional support
→ Education
→ Reassurance

Nursing referrals
→ Nurses can initiate referrals within the interprofessionl team (Diabetes educator, Support groups, Dietician)

Question 65

Patient education is vital in the management of endocrine disorders, and can include:

Answer 65

Education on condition

Why replacement therapy must be lifelong

Replacement therapy dosages and appropriate timing of dose

The importance of not missing a dose

Symptomatic relief can be prolonged

There is a potential for overreplacement which can lead to hyperactivity of a gland

How to recognise signs and symptoms → symptom management

Question 66

Concomittent drug use
Many hormone replacements can interact with several other medications.

Answer 66

Some examples include:
Anticoagulants → increases the risk of bleeding

Thyroxine, oral hypoglycaemia agents and insulin → interferes with action and stimulates hepatic gluconeogenesis and glycogenolysis

Aspirin and levothyroxine can increase the risk of bleeding

Question 67

Blood glucose levels must be closely monitored when patients are receiving this medication because it can result in glucocorticoid induced diabetes and hyperglycaemia.

Levothyroxine

Endogenous insulin

Prednisolone

Sulfonylureas

Answer 67

Prednisolone

Question 68

Your patient has developed peripheral neuropathy, a chronic complication of diabetes mellitus. Considering this diagnosis, which of the following nursing management strategies would you ensure that you implement?

Stool chart

Fluid balance chart

Neurovascular assessment

Falls risk assessment

Answer 68

Falls risk assessment

Question 69

Exophthalmos (bulging of the eyes) is a classic sign of this endocrine disorder.

Cushing’s syndrome

Hyperthyroidism

Addison’s disease

Hypothyroidsim

Answer 69

Hyperthyroidism

Question 70

Patients diagnosed with this condition have excessive levels of adrenocorticotropic hormone (ACTH) or corticosteroids which can cause hypoglycaemia and pronounced changes in physical appearance.

Cushing’s syndrome

Addison’s disease

Hashimoto’s disease

SIADH

Answer 70

Cushing’s syndrome

Question 71

Your patient is soon to return to the ward after having a thyroidectomy performed. You know that you will need to perform routine post-op vital signs and regular wound assessments. Considering the type of surgery that was performed, what other essential assessment will you need to complete due to potential swelling, at the same time as when you are reassessing the patient’s vital signs?

Hide answer choices

Neurological assessment

Falls risk assessment

Secondary assessment

Airway and breathing assessment

Answer 71

Airway and breathing assessment

Question 72

Long-term corticosteroid use can lead to Cushing’s syndrome. Which of the following statements is true?

It can also occur from overproduction of cortisol by the adrenal glands.

It is also known as hypocortisolism and is due to abnormally high levels of the hormone cortisol.

It is genetic and characterised by weight loss, lethargy and brittle bones

It is caused by an under-production of insulin from the pancreas

Answer 72

It can also occur from overproduction of cortisol by the adrenal glands.

Question 73

A patient has been diagnosed with Hashimoto’s disease. An important nursing intervention when
caring for this patient is:

Pain assessment chart

Neurological observation chart

Skin integrity chart

Wound assessment chart

Answer 73

Skin integrity chart

Question 74

A patient with Grave’s disease develops the following: heart rate 160 per minute, temperature 40.2⁰C,
severe vomiting and seizures. These are classic clinical manifestations of:

Addison’s crisis

Thyrotoxicosis

Diabetic ketoacidosis

Myxoedema coma

Answer 74

Thyrotoxicosis

Question 75

This drug is used to treat hyperthyroidism. Adverse effects include the potential to cause birth defects
if used in the first trimester of pregnancy.

Levothyroxine

Prednisolone

Sulfonylureas

Carbimazole

Answer 75

Carbimazole

Question 76

Hydrocortisone is used to treat Addison’s disease. Which of the following is an important nursing consideration when educating the patient on safe use of this drug?

This medication is best taken on an empty stomach.

This medication should not be ceased abruptly.

This medication has no serious complications.

This medication is best taken to management minor conditions.

Answer 76

This medication should not be ceased abruptly.