REVIEW for TEST #2 PN 142 ENDOCRINE SYSTEM. Disorders of the Adrenal Gland.

REVIEW for TEST #2

PN 142 ENDOCRINE SYSTEM

Disorders of the Adrenal Gland

Multiple Choice

• ACTH stands for:– A. Antidiuretictropic Hormone– B. Anticorticotropic Hormone– C. Adrenocalcicotropic Hormone– D. Adrenocorticotropic Hormone

Multiple Choice

• Another name for Adrenal Hyperfunction is:– A. Addison’s disease– B. Graves’ disease– C. Cushing’s Syndrome– D. SIADH syndrome

Multiple Response

• Adrenal Hyperfunction (Cushing’s Syndrome) may be caused by which of the following?– A. Drinking too much sugar– B. a tumor of the adrenal cortex– C. Hyperplasia of adrenal tissue resulting from

overstimulation of the adrenal glands by ACTH– D. Prolonged or overuse of corticosteroid drugs

Multiple Response

• The overabundance of glucocorticoids, minoralocorticoids, and sex hormones leads to what clinical manifestations of Cushing’s?– A. weight loss and wasting syndrome– B. moonface– C. buffalo hump– D. thing arms and legs

Multiple Response

• Lab results (blood and urine) for Cushing’s Syndrome include which of the following?– A. ↓ K+– B. proteinuria– C. hyperglycemia– D. renal calculi

Multiple Choice

• Upon interview of an adult with Cushing’s syndrome, the patient c/o feeling very discouraged, has difficulty concentrating, and has thought of harming herself. What would be the appropriate response on the part of the nurse?– A. “ Would you like me to call the doctor for some

medication that will help you feel better.”– B. “ Can you share with me more of your concerns?”– C. “I really hope you are not going to do something harmful

to yourself. Your family would feel really bad.”– D. “ I think that you should rest and think this over while you

are here.”

Multiple Response

• Some key features of Cushing’s syndrome include which of the following objective data?– A. fragile skin; slow wound healing– B. weight gain; abdominal enlargement with straie– C. Hirsuitism in women– D. high pitched voice

Other

• Diagnostically, blood and urine checks will confirm or rule out the medical diagnosis of adrenal hyperfunction (Cushing’s).

• Place an “↑” in front of the lab test if the results are expected to be elevated

• Place a ↓ in front of the lab test if the results are expected to be lower than the normal range___ Plasma Cortisol ___ Plasma ACTH___ 17-ketosteroids ___ 17-hydroxysteroids

Other

• List 3 diagnostic tests other than blood and urine for evaluating a patient with Cushing’s Syndrome.

Multiple Choice

• The goal of medical management of adrenal hyperfunction is:– A. relieve fluid excess– B. treat the causative factor– C. administer Mitodane therapy– D. surgery

Multiple Response

• Medical treatment of the causative factor for adrenal hyperfunction includes:– A. Adrenalectomy for adrenal tumors– B. Radiation of pituitary gland/tumor(s)– C. Surgical removal of pituitary tumors– C. Medication – Mitodane therapy

Other - Process

• Mitodane Therapy _________ the peripheral metabolism of _________ causing a decreasing ________ and ___________ level; __________ cortisol production.

• This therapy is also known as: ______________ _______________.

Multiple Response

• Dietary management for people with Cushing’s syndrome is an important part of medical treatment. Which of the following would be included in adjusting the diet of a person with Cushing’s?– A. Low Na+– B. High K+– C. Low calorie and CHO– D. High calcium

Multiple Response

• Nursing interventions include patient and family education in preparation for discharge. Which of the following nursing interventions would be included in the pt/family discharge preparation?– A. Importance of compliance with medication

regimen– B. Medic-alert bracelet– C. Avoid being around people with infections– D. Instruct s/sx Addison’s disease and report

occurrence of these to their MD.

Multiple Choice

• Adrenocortical insufficiency refers to which disease process?– A. Cushing’s Syndrome– B. SIADH– C. Adrenal Hypofunction (Addison’s Disease)– D. Diabetes Insipidus

Multiple Choice

• Adrenal Insufficiency occurs when the adrenal glands do not secrete adequate amounts of glucocorticoids, mineralocorticoids, and androgens. The most common cause of this problem is:– A. antibodies destroy adrenal cortex tissue

(autoimmune)– B. adrenalectomy– C. primary Addison’s disease– D. adrenal tumor

Other - Process

• Deficiencies in __________ and _________ lead to disturbance in _______, _____, and ________ metabolism and ___________ and ______________ imbalance, dehydration, water loss, and _____________.

Multiple Response

• Clinical manifestations of Addison’s disease are related to imbalance of adrenal hormones, nutrients, and electrolytes. Which of the following would be included:– A. Craving for salt– B. progressive weakness and fatigue– C. postural hypotension– D. diarrhea

Multiple Choice

• Identify the significance of the following lab results as they relate to Adrenal Hypofunction: hyponatremia, hyperkalemia– A. impending adrenal crisis– B. impending thyroid storm– C. impending SIADH– D. nonspecific dehydration

Multiple Response

• Identify the goals of medical management for the person with Addison’s disease:– A. restore fluid and electrolyte balance– B. replacement of deficient adrenal hormones– C. diet high in Na+ and low in K+– D. Rapid response to s/sx Adrenal Crisis

Other

• List 4 relevant nursing interventions for the person with Addison’s disease.

Multiple Response

• When preparing the patient with Addison’s disease for discharge home, the nurse instructs the patient and/or family member in which of the following:– A. Use and carry IM hydrocortisone– B. Adhere to medication regimen– C. Report ALL illness to MD– D. frequent bedrest

Other

• List 4 clinical manifestations, s/sx., of Addisonian (adrenal) crisis.

• Describe the treatment for Addisonian Crisis

Multiple Choice

• A rare tumor of the Adrenal Medulla is called:– A. Catecholease mass– B. pheochromocytoma– C. Adrenal Medullatoma– D. Corticocytoma Medullary

Other – Process

• A _____________ causes ___________ secretion of _____________ and ____________ which, in turn, causes ____________ ________.

Multiple Response

• Clinical manifestations of pheochromocytoma include which of the following:– A. Severe HTN (300/175)– B. severe headache– C. abdominal or chest pain– D. excessive urinary output

Other

• Describe subjective information that a patient with pheochromocytoma may complain of:

Multiple Response

• Objectively, the nurse may notice any or all of the following with a patient with pheochromocytoma:– A. ↑ BP, PULSE, RESPIRATORY RATE– B. Presence of tremors, diaphoresis– C. glycosuria, hyperglycemia– D. dilated pupils

Other

• List 3 diagnostic tests for pheochromocytoma.

Other

• Pre-operatively, the patient will be given medications r/t the cardiovascular system.

• List 1 calcium channel blocker and 1 beta-blocker medication and the purpose of each.

Multiple Choice

• Post op adrenalectomy, the patient needs to monitored closely by the nursing staff for the following. Which of the following would be a priority nursing intervention?– A. monitor for BP changes and s/sx of

cardiovascular collapse– B. Adequate rest and avoidance of stress– C. IV fluid administration and medication

administration– D. Intake and Output

DIABETES MELLITUS

True/False

• Diabetes Mellitus is a systemic metabolic disorder that involves the improper metabolism of CHO, fats and proteins.

Multiple Response

• Diabetes Mellitus, a multisystem disease is related to which of the following problems:– A. a decrease or absolute lack of insulin

production– B. impaired insulin utilization– C. none of the above– D. a and b

True or False

• Though the exact cause of DM is unknown, there is an autoimmune component to this disease.

Other

• List 3 contributing factors, not mentioned above, that are r/t the cause of DM.

Fill-in

• There are __ main types of DM. Type __ was formerly called: ____________ ___________ ____________ ____________. Type __ was called: ___-________ ______________ __________ _____________.

Compare – Fill in

• Type 1 – main problem

• Process

• Type 2 – main problem

• Process

Compare

• Type 1 Signs/symptoms • Type 2 Signs/symptoms

Complete

• Metabolic Syndrome is a name for a group of risk factors that occur together and increase the risk for _________, ________, __________.

True/False

• All of the risk for metabolic syndrome are related to obesity.

Multiple Response

• The 2 most important risk factors for metabolic syndrome are:– A. extra weight around the middle and upper parts

of the body– B. Absence of insulin due to destruction of beta-

cells of the pancreas– C. Insulin resistance – body uses insulin less

effectively than normal– D. Excess blood clotting

True/False

• Hormone changes and lack of exercise are also considered risk factors for metabolic syndrome.

Multiple Response

• Which of the following clinical manifestations are associated with metabolic syndrome?– A. BP =/> 130/85 mm/Hg– B. FBS =/> 100 mg/dL– C. Waist circumference of 35+ inches or greater

for men and women– D. Low HDL cholesterol– E. Low triglycerides

Multiple Choice

• The goal of treatment for metabolic syndrome is: – A. lifestyle changes– B. daily exercise– C. reduce your risk of heart disease and diabetes– D. help you feel young again

Multiple Response

• People with metabolic syndrome have an increased long-term risk for:– A. developing heart disease– B. type 2 diabetes– C. stroke– D. rheumatoid arthritis

Other - Process

• In normal metabolism, the end products of digestion are absorbed into the ________ circulation and carried to the __________ where they can be _______ ______________ or __________ for later use.

Other - Process

• The liver can change ___________ and _______ _______ into ____________ which serves as fuel for muscles and as an energy source for the brain.

• __________ must be present for muscles and other body cells to utilize glucose.

Other - Process

• Even though excess glucose is available in the bloodstream, the body cannot utilize it without the help of ___________ cells are not __________ polyphagia develops.

Other

• List the 3 classic symptoms of diabetes mellitus:

Other - Process

• Because CHO cannot be utilized properly, the body breaks down __________ and ______. The result of this is ↑ ketone bodies in the bloodstream the development of __________ _____________.

Multiple Response

• Insulin plays a role in the breakdown, processing, and utilization of glucose, fatty acids, and protein. Which of the following descriptions are appropriate to the role of insulin?– A. insulin stimulates the active transport of glucose into cells– B. without adequate insulin, fat stores break down and

increase the amount of triglycerides stored in the liver– C. Without adequate insulin, protein storage stops and large

amounts of amino acids are dumped into the blood stream development of gout

– D. Increased fatty acids in the liver ↑ atherosclerosis

True/False

• As ketone bodies accumulate in the bloodstream, imbalances of Na+, K+, and bicarbonate result.

Other

• If you were interviewing a patient with Type 2 diabetes, what kind of subjective and objective information would you anticipate?– List 3 subjective and 3 objective items of

information and observation.

Multiple Response

• Which of the following results would indicate a need for further evaluation by a health care provider ?– A. FBS >126mg/dL– B. random blood glucose of 100mg/dL– C. a 2 hr post prandial level >200mg/dL– D. HgbA1C of 7.5

True/False

• For a medical diagnosis of “Prediabetes” , a person will have impaired fasting glucose and /or impaired glucose tolerance.

True/False

• For “prediabetic” individuals, education on weight reduction and increasing physical activity is important.

• Other: These 2 interventions can reduce ___________ ____________ .

Multiple Choice

• In the medical management of diabetic clients, the overall goal is:– A. achieve optimal serum lipid levels– B. prevention and treatment of acute complications– C. provide optimal calories for maintaining or

attaining reasonable weight and normal growth and development

– D. Assist people with diabetes in making changes in nutrition and exercise habits leading to improved metabolic control

Multiple Response

• The nurse plays a significant role as a teacher in the support of diabetes self care. Which items below would be included in this role for the nurse?– A. dietary information– B. medication routine– C. SMBG– D. exercise

Other

• Nutritional therapy is aimed at what 3 goals?• List them:

Multiple Response

• To achieve these nutritional goals, what practical steps can the nurse encourage the diabetic patient to take?– A. Reduce total fat intake– B. Maintain SMBG checks– C. Know lab results: FBS, HgbA1C, Lipids– D. Meet with dietician

Other

• List 3 home care issues/considerations for the visiting nurse re: his/her diabetic patient:

Multiple Choice

• When planning meals, the diabetic client should be aware that different CHO foods affect the blood glucose level in different ways. This varying effect is called:– A. quantitative index– B. qualitative index– C. the glycemic index– D. HgA1C index

True/False

• Insulin-dependent diabetics should evenly distribute their food throughout the day and plan a mid-afternoon and bedtime snack.

Other

• What is the most significant benefit r/t diabetes that exercise can provide?

Fill In

• Emotional and physical stress can _____ blood glucose levels and ______________.

Multiple Response

• During acute illness, the diabetic or his/her caregiver should plan on which of the following:– A. increase SMBG – even every 1-2hrs– B. make diet modifications – poss. changing solids

to liquids for a period of time– C. check urine for ketonuria– D. notify their MD of the illness and any elevated

sugars > 250mg/dL and/or degree of ketones

Multiple Response

• For the diabetic having surgery, preplanning adjustments in the diabetic regimen will promote optimal healing during the recovery period. Some of those adjustments would include:– A. Type 2 diabetic who usually takes an oral

hypoglycemic, should anticipate administration of insulin before, during, and after surgery when he/she is NPO.

– B. IV fluids and insulin– C. ↑ CBG checks– D. Less urine output for 2-3 days

True/False

• Insulin and oral hypoglycemics are the drugs of choice to treat diabetes mellitus.

Multiple Choice

• Insulins differ in regard to which of the following:– A. onset– B. duration– C. action– D. peak – E. all of the above

Multiple Response

• The most common action times for the various insulins are:– A. rapid– B. short– C. intermediate– D. long

Multiple Choice

• The proper routine administration of insulin is by injection into:– A. muscle– B. Vein– C. Subcutaneous tissue– D. intradermal tissue

Multiple Choice

• All insulin administration requires the proper syringe. The concentration on the insulin bottle should match the syringe indication. An example of this would be:– A. a U-100 syringe used with an insulin preparation

that has U-100 printed on the label.– B. a U-100 bottle of insulin used in a 30 unit syringe– C. a U-50 bottle of insulin used with a U-100 syringe– D. none of the above

Multiple Choice

• When practicing accuracy in the delivery of insulin to the diabetic client, the nurse would observe ONE IMPORTANT DISTINCTION. This distinction would be:– A. writing “units” on the MAR and instead of “u”– B. the U-100 syringe is marked in 2-unit increments; and

the U-30 and U-50 syringes are marked in 1-unit increments

– C. the Joint Commission specifies that only needles with a gauge of 25-30 units be used

– D. all insulin be kept refrigerated

Multiple Response

• Appropriate insulin injection sites include which of the following:– A. abdomen– B. upper arms– C. posterior thighs– D. hips and buttocks

True /False

• Because of differing anatomical absorption rates of insulin in the various sites, injections should be given in the available sites in one area before moving to another site.

True/False

• In providing appropriate storage for insulin, the following is recommended:– Store all open bottles of insulin in the refrigerator

True/False

• In terms of “best practice”, nurses administering insulin injections MUST ALWAYS have another licensed person check and document the type of insulin and dose in the syringe.

Other

• When is the most clinically important time for a nurse to be alert for a hypoglycemic reaction for whatever type of insulin is given?

Fill In

• Oral hypoglycemic medication is used to treat _________ _____ diabetes mellitus. This is ______ oral __________ or a substitute for oral _________.

Matching - match the categories on the L with their action on the R

• Sulfonylureas

• Meglitinides

• Alpha-Glucosidase Inhibitors

• Thiazolidinediones

• Biguanide

• Increases insulin sensitivity at the insulin receptor sites on the cells

• Stimulates the pancreas to release insulin

• Reduces hepatic glucose production and lowers FBS levels; enhances tissue response to insulin

• Inhibits delay of CHO absorption from the small intestine

• Stimulates increased release of insulin from the pancreas

Matching – match the category on the L to a specific medication on the R

• Sulfonylureas

• Meglitinides

• Alpha-Glucosidase Inhibitor

• Thiazolidinediones

• Biguanide

• Metformin

• Glypizide, Glyburide

• Avandia

• Prandin

• Miglitol (glycet)

Other

• On a daily basis, what would be considered “routine” for the nurse caring for a diabetic patient?List 3 nursing interventions:

Multiple Response• Because neuropathy is a concern for diabetic

patients, good foot care is a priority for nursing care. “Good foot care” includes which of the following:– A. routine podiatry care– B. daily inspection– C. trimming callouses– D. applying hot water bottle or heating pad for c/o

cold feet.

Complete

• On sick days the Type 1 diabetic must continue their insulin. Explain what happens when the body does not have insulin during illness: (slide 54)

Fill In

• During the nursing assessment, a physical exam will be performed by the nurse. In addition to the basic head – toe assessment, the nurse will take note of the presence of _______ _______ on the breath of the diabetic patient. This is a characteristic sign of someone with elevated blood sugar.

Other

• List 3 nursing diagnoses appropriate for a diabetic patient.

Complete

• Among the acute complications for a person with diabetes is the possibility of coma – also referred to as “diabetic coma” or “diabetic ketoacidosis (DKA)”. There are 3 different causes for DKA.

• List the 3 causes for a coma for a diabetic person:

Complete

• A diabetic person is also at risk for development of infections and their complications.

• List 3 contributing factors (sl. 63)

Fill In

• Diabetic Ketoacidosis is a life-threatening condition caused by ________ of _________. ____________ results with an accumulation of ________ in the blood.

Other

• List 5 early signs of DKA

Other - Process

• If DKA goes untreated, it will lead to ____________, __________, ____________, with _________ _________, ________, ____________, ________ __________ and ________ rate, ____________ ____________ and ____________. (sl. 65)

Other

• List 3 late signs of DKA.

Multiple Response

• Treatment of DKA is aimed at correcting 3 main problems. These are:– A. dehydration– B. electrolyte balance– C. acidosis– D. alkalosis

Other – Fill In

• Acute hypoglycemia occurs when the blood glucose level is < 45-50 mg/dL. When glucose falls rapidly, __________, ________, __________, and ___ are secreted in an attempt to ______ the glucose level.

Other

• List 5 or more symptoms of acute hypoglycemia.

Multiple Response

• Acute hypoglycemia can occur when a person’s blood sugar level falls over several hours. This is due to a lack of __________ _________ to the brain tissue.– A. interstitial sodium– B. essential glucose– C. plasma cortisol– D. oxygen replacement

Fill In

• Treatment of acute hypoglycemia is usually ________g of quick-acting ______ followed by complex ______ and ______.

Fill In

• After the initial treatment of hypoglycemia with quick acting CHO, the nurse should stay with the patient and check ________ ______ every ____________ until it is > 70mg/dL for adults; 80-100mg for older adults and children

Multiple Response

• “End organ disease” results from damage to blood vessels in a diabetic. Which of the following would be considered “end organ disease”?– A. pedal neuropathy– B. blindness– C. cardiovascular problems– D. renal failure

Multiple Response

• Other long-term complications of diabetes include:– A. MI, Stroke– B. gangrene, amputation– C. Pain and parasthesis– D. bowel/bladder dysfunction

Other

• The nurse is getting ready to do Mrs. M.’s discharge teaching re: preventing long-term complications.

• List 5 guidelines for the patient that would be included in these instructions.