NUR 410 Med-Surg: Exam 3 Latest Update
Questions with Excellent Solution Graded
A+ Guaranteed Pass
- *ACTH* (nl to inc; or dec depending on cause)
- If it stops sending messages then they know the problem is not the pituitary gland, but in the adrenal
gland
- You need a lot of cortisol in the morning when you wake up and then at night it drops
- W/ Cushing syndrome it is always high and there is not a regulatory - Answer -What is there to
know about DST in cushing syndrome?
- *fludrocortisone (Florinef)
- Given am
- monitor BP - Answer -What is there to know about mineralocorticoid in addison disease?
- *Head trauma* (self limiting and transient)
- CVA
- Guillian-Barre
- SLE
- Pituitary surgery - Answer -What is their to know about the CNS causes of SIADH?
- *High fever*
- *tachypnea*
- *profound weakness*
- *severe abd, back & leg pain*
- severe N/V
- confusion
- *low Na+*
- *high K+*
- low BS
- *dehydration*
,- *severe hypotension*
- tachy
- *circulatory collapse* (lack of perfusion/pallor)
- coma - Answer -What are the CM of addison's crisis?
- *Inc Na*
- especially with excess heat/humidity
- careful potassium - Answer -What is the diet in addison disease?
- *Polydipsia and Polyuria* (up to 12 liters/day, reports of 20 L/day)
- *Low urine specific gravity* (<1.005) dilute urine (low solute)
- *Low urine osmolality* (<100 mOsm) dilute
- *Elevated serum osmolality*(hyperosmolality >295 mOsm/kg; involving serum Na)
- *Fluid volume deficit/electrolyte abnormalities*, particularly if pt stops drinking (i.e.Dehydration &
Hypernatremia)
- Weight loss
- Constipation
- Poor skin turgor
- Hypotension
- Tachy
- Hypovolemic shock
- CNS manifestations: irritability, mental dullness, coma - Answer -What are the CM of diabetes
insipidus?
- *Severe hypertension*
- *Resistant to treatment*
- *May be very labile*
- *Severe pounding H/A*
- *Tachy/palpitations/angina/EKG changes* (BP can be persistent, fluctuating, intermittent (episodic),
paroxysmal)
- *Profuse diaphoresis*
- Hyperglycemia
- Weight loss
, - Anxiety
- provoked by many meds: antiHTN, opioids, radiologic contrast media, Tricyclic antidepressants -
Answer -What are the CM of pheochromocytoma?
- 24 hr Urinary: free cortisol (dec/low) (better than a blood test)
- Serum cortisol (dec)
- Serum ACTH: *Inc* in Primary (adrenal gland doesn't make cortisol); *Dec* in secondary (Pituitary
doesn't produce ACTH adequately)
- ACTH stimulation test
- Serum glucose, Na (dec)
- potassium, BUN (inc)
- Anemia
- CT/MRI - Answer -What is the diagnostic tests for addison disease?
- 285-295 mmol/kg
- <265 is hypo-osmolality
- >320 is hyper-osmolality - Answer -What is the normal serum osmolality?
- ACTH deficit resulting in lack of glucocorticoids & androgens
- Disorder of pituitary function
- Overuse or abrupt w/drawal of exogenous corticosteroids (AIDS, TB can destroy adrenals) -
Answer -What is the secondary disease of addison disease?
- Adequate ADH but decreased renal response to ADH
- Onset & fluid losses less significant than with central
- Causes: drug therapy, renal damage/renal failure, hereditary, electrolyte imbalances (Drugs, i.e. Lithium
therapy is one common drug cause
- other causes: hypokalemia, hypercalcemia, pregnancy-gestational
- Vasopressin receptors (V) on kidney, kidney does not respond to ADH, or damage of receptors -
Answer -What is there to know about Nephrogenic DI?
- ADH (vasopressin) is synthesized in the hypothalamus & transported/stored in posterior pituitary gland
- Answer -What does the posterior pituitary gland store?
- Adrenal & Pituitary for inoperable tumors
- aka drug induced Medical Adrenalectomy
Questions with Excellent Solution Graded
A+ Guaranteed Pass
- *ACTH* (nl to inc; or dec depending on cause)
- If it stops sending messages then they know the problem is not the pituitary gland, but in the adrenal
gland
- You need a lot of cortisol in the morning when you wake up and then at night it drops
- W/ Cushing syndrome it is always high and there is not a regulatory - Answer -What is there to
know about DST in cushing syndrome?
- *fludrocortisone (Florinef)
- Given am
- monitor BP - Answer -What is there to know about mineralocorticoid in addison disease?
- *Head trauma* (self limiting and transient)
- CVA
- Guillian-Barre
- SLE
- Pituitary surgery - Answer -What is their to know about the CNS causes of SIADH?
- *High fever*
- *tachypnea*
- *profound weakness*
- *severe abd, back & leg pain*
- severe N/V
- confusion
- *low Na+*
- *high K+*
- low BS
- *dehydration*
,- *severe hypotension*
- tachy
- *circulatory collapse* (lack of perfusion/pallor)
- coma - Answer -What are the CM of addison's crisis?
- *Inc Na*
- especially with excess heat/humidity
- careful potassium - Answer -What is the diet in addison disease?
- *Polydipsia and Polyuria* (up to 12 liters/day, reports of 20 L/day)
- *Low urine specific gravity* (<1.005) dilute urine (low solute)
- *Low urine osmolality* (<100 mOsm) dilute
- *Elevated serum osmolality*(hyperosmolality >295 mOsm/kg; involving serum Na)
- *Fluid volume deficit/electrolyte abnormalities*, particularly if pt stops drinking (i.e.Dehydration &
Hypernatremia)
- Weight loss
- Constipation
- Poor skin turgor
- Hypotension
- Tachy
- Hypovolemic shock
- CNS manifestations: irritability, mental dullness, coma - Answer -What are the CM of diabetes
insipidus?
- *Severe hypertension*
- *Resistant to treatment*
- *May be very labile*
- *Severe pounding H/A*
- *Tachy/palpitations/angina/EKG changes* (BP can be persistent, fluctuating, intermittent (episodic),
paroxysmal)
- *Profuse diaphoresis*
- Hyperglycemia
- Weight loss
, - Anxiety
- provoked by many meds: antiHTN, opioids, radiologic contrast media, Tricyclic antidepressants -
Answer -What are the CM of pheochromocytoma?
- 24 hr Urinary: free cortisol (dec/low) (better than a blood test)
- Serum cortisol (dec)
- Serum ACTH: *Inc* in Primary (adrenal gland doesn't make cortisol); *Dec* in secondary (Pituitary
doesn't produce ACTH adequately)
- ACTH stimulation test
- Serum glucose, Na (dec)
- potassium, BUN (inc)
- Anemia
- CT/MRI - Answer -What is the diagnostic tests for addison disease?
- 285-295 mmol/kg
- <265 is hypo-osmolality
- >320 is hyper-osmolality - Answer -What is the normal serum osmolality?
- ACTH deficit resulting in lack of glucocorticoids & androgens
- Disorder of pituitary function
- Overuse or abrupt w/drawal of exogenous corticosteroids (AIDS, TB can destroy adrenals) -
Answer -What is the secondary disease of addison disease?
- Adequate ADH but decreased renal response to ADH
- Onset & fluid losses less significant than with central
- Causes: drug therapy, renal damage/renal failure, hereditary, electrolyte imbalances (Drugs, i.e. Lithium
therapy is one common drug cause
- other causes: hypokalemia, hypercalcemia, pregnancy-gestational
- Vasopressin receptors (V) on kidney, kidney does not respond to ADH, or damage of receptors -
Answer -What is there to know about Nephrogenic DI?
- ADH (vasopressin) is synthesized in the hypothalamus & transported/stored in posterior pituitary gland
- Answer -What does the posterior pituitary gland store?
- Adrenal & Pituitary for inoperable tumors
- aka drug induced Medical Adrenalectomy
