Maryville NURS 623 Exam 2 Correctly Answered Questions, Questions and Answers with Explanations (latest Update), 100% Correct, Download to Score A

Which of the serum laboratory findings are present in the client with Cushing's syndrome? Increased cortisol, HYPERnatremia, and HYPOkalemia Alice, age 48, has a benign thyroid nodule. The most common treatment involves: Watchful waiting with an annual follow-up ACE inhibitors are given to clients with diabetes who have persistent proteinuria A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which oral antidiabetic agent is recommended as monotherapy? metformin An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following manifestations are commonly seen in the elderly with hyperthyroidism? a-fib, depression, weight loss Diane has had Cushing's disease for 20 years and has been taking hydrocortisone since her diagnosis. Today, she appears with a thick trunk and thin extremities. She has a "moon face," a "buffalo hump," thin skin with visible capillaries, and a number of bruises that appear to be slow in healing. To what do you attribute these symptoms? excessive levels of cortisol The following is a client's self-monitoring blood glucose log. The client receives 20 units Novolin 70/30 in the morning (a.m.) and 20 units Novolin 70/30 in the evening (p.m.): Fasting a.m. pre-dinner: 90, 150, 105, 144, 101, 172, 98, 201. What changes would you make? increase A.M. insulin Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin under control. He's heard that exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? "Let's try it. You're glycohemoglobin will be lowered and you may lose weight." Which is the only treatment option that is curative for primary hyperparathyroidism? parathyroidectomy Page 2 of 9 The most common worldwide cause of hypothyroidism is: iodine deficiency What should be assessed for during exam on pt with HYPOparathyroidism? chvostek's sign Morton has Type 2 diabetes. His treatment, which includes diet, exercise, and oral antidiabetic agents, is insufficient to achieve acceptable glycemic control. Your next course of action is to ADD LONG-ACTING INSULIN Joy has gout. In teaching her about her disease, which food do you tell her is allowed in her diet? Broccoli What controls the amount of calcium in the blood? Parathyroid Thyroid hormones regulate metabolism Which tests should you order to confirm a diagnosis of hypothyroidism? t3 & Free T4 (preferred over T4) What are the hallmark signs of Grave's disease? enlarged thyroid and increased T3 What is the gold standard screening for thyroid TUMOR/NODULE? ULTRASOUND What is the diagnostic screening for thyroid cancer? FINE NEEDLE BIOPSY What is the preferred treatment of Grave's disease in pregnancy Propylthiouracil (PTU): Before starting anti-thyroid meds what should be checked? LIVER FUNCTIONS what is the goal of thyroid treatment euthyroid state Page 3 of 9 What are signs and symptoms of hypothyroidism overtreatment? hyperglycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema. Hyperthyroidism causes an excessive secretion of which thyroid hormones? T3 & T4 What are S/S of hyperthyroidism? "Hot/buldging/fast" heat intolerance, eye buldge, tachycardia, weight loss, diarrhea, systolic HTN, enlarged thyroid What are S/S of HYPOthyroidism? "cold, slow, tired" cold intolerance, slow speech, fatigue, lethargy, weight gain, constipation, brittle nail/hair What is the most common cause of hyperthyroidism? Graves disease Name the two thyroid hormones produced by the thyroid gland? T3 & T4 Name the hormone produced by the pituitary gland, state the purpose of the hormone TSH; regulate the production of hormones by the thyroid gland IN GRAVES DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________ LOW; HIGH IN HASHIMOTO'S DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________ HIGH; LOW WHAT allows the resolution of hyperthyroidism, although patients then become hypothyroid and require thyroid replacement therapy for life ABLATIVE DOSE IODINE According to the American Association of Clinical Endocrinologists, the usual dose of levothyroxine per day for full replacement? 1.6 mcg/kg per day 50-100 MCG DAY what pt education do you give with levothyroxine? take meds on empty stomach 30 mins before morning meal (may cause insomnia if taken at night) Page 4 of 9 How would you alter the dose for initiating synthetic thyroid replacement with an older patient with hx of cardiac issues? Begin with one-half of the expected replacement dose or 25 to50 mcg/day PO, increasing the dose gradually by 25 mcg/day once every 4 to 6 weeks; cardiac start at 12.5 mcg/day What is the long standing effects of HYPERthyroidism? OSTEOPOROSIS CONSIDER BONE DENSITY TESTING, VIT D, & CALCIUM SUPPLEMENTS IN OLDER PT How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism? FOR LIFE Which treatment FOR hyperthyroidism is recommended for middle age and older adults? Radioactive iodine 131 WHAT works by inhibiting thyroid hormone synthesis at multiple steps. They are used as a treatment to reduce the level of hormone on initiation of radioactive iodine therapy,( not used as primary or sole treatment) ANTI-THYROID MED (Propylthiouracil (PTU) Methimazole (MMI) What should those treated with radioactive die be aware of? AVOID CONTACT WITH INFANTS, CHILDREN, AND PREGNANT WOMEN FOR 7 DAYS What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to differentiate between Grave's disease and subacute thyroiditis and toxic nodular goiters? RADIO IODINE UPTAKE SCAN What is the gold standard test for confirming Hashimoto's? THYROID PEROXIDASE [TPO] ANTIBODY What is the most common type of autoimmune hypothyroid in the US? HASHIMOTO'S What would make you suspicious of thyroid cancer (clinical presentation)? What is the reliable method of diagnosis? PAINLESS LUMP OR NODULE IN THE NECK; FINE NEEDLE BIOPSY What type of hypothyroidism does more than 95% of patients have where there is dysfunction or atrophy of the thyroid gland due to failure of pituitary and/or hypothalamus? Page 5 of 9 CENTRAL HYPOTHYROIDISM What is an endocrine emergency with signs and symptoms of slowed cognitive thinking, poor short-term memory, depression or dementia, hypotension and hypothermia with a mortality rate of 30-40%? MYXEDEMA (SEVERE HYPOTHYROIDISM) What are the common causes of hypercalcemia? PRIMARY HYPERPARATHYROIDISM AND MALIGNANCY the twitching of the facial muscles in response to tapping over the facial nerve 2 cm anterior to ear canal is considered a positive _________ sign; what does it indicate? CHVOSTEK'S SIGN; HYPOCALCEMIA When should a referral be considered for patient with HYPERparathyroidism? CALCIUM STARTS BECOMING HIGH may be caused by cortisol hypersecretion by the adrenal cortex due to cortical hypertrophy from a tumor of the adrenal gland or heavy use of glucosteriods CUSHING'S SYNDROME refers specifically to pituitary adrenoCORTICtropic hormone (ACTH) excess caused by a pituitary tumor (adenoma) Too much cortisol! CUSHING'S DISEASE What labs are done to screen for Cushing's? serum and urine cortisol (two measurements), CMP (GLUCOSE, HYPOKALEMIA CBC (LEUKOCYTOSIS) What is the clinical presentation of Cushing disease? GENERALIZED OR CENTRAL OBESITY MOON FACE BUFFALO HUMP red face, AND STRIAE, HYPERGLYCEMIA What is ADDISON'S DISEASE? primary adrenal insufficiency Autoimmune; adrenal glands do not produce enough cortisol. NEED TO "ADD" ADRENAL HORMONES/ CORTISOL