Review PN 142

Test 1

A&P

Endocrine SystemGeneral

Multiple Response

• Which of the following are considered “endocrine” glands?– A. Kidney– B. Ovaries– C. Pituitary gland– D. Thymus gland

True/False

• Chvostek’s sign is a carpal spasm caused by inflating a blood pressure cuff above the client’s systolic pressure, leaving it in place for 3 minutes, and noting the response.

Multiple Choice

The endocrine system is composed of groups of cells secreting substances:– A. via a small duct into the bloodstream– B. that first pass through the liver on their way to

other organs– C. directly into the blood or lymph fluid– D. called neurotransmitters

Multiple Choice

• Hormones are chemical substances that:– A. are secreted by the alpha cells of the pancreas– B. target only the Nervous System– C. initiate or regulate the activity of another

organ, system, or gland in another part of the body

– D. are a descriptor for a symptom that begins and ends abruptly

True/False

• Hormones are chemical messengers that travel through the bloodstream to a target organ causing a metabolic change to occur.

Multiple Response

• Hormones affect which of the following:– A. Maintenance of vital functions of the body– B. Response to stress and injury– C. Growth and development– D. Fluid and electrolyte balance

Multiple Choice

• Information is constantly being exchanged between the target organ and pituitary gland via the bloodstream re: the effect of the hormone on the target organ. Through a special process, the pituitary controls the other endocrine glands. This process is called:– A. Positive Feedback System– B. Hypothalmic loop– C. Negative Feedback System– D. The Catacholemine Sensory System

Other

• List the 6 hormones of the anterior pituitary lobe:

Other

• List the 2 hormones of the posterior pituitary lobe:

Fill - In

• There are 2 hormones produced by the posterior lobe of the pituitary gland: These are _________ and __________. ___________ promotes release of ______and stimulates _________ ____________ during labor. ______________, also known as “___________”, causes ___________ to conserve water ____________ urine production.

Matching

• Each layer of the adrenal cortex secretes a hormone called a “steroid”. Match the following steroids with their particular function(s):– Mineralocorticoids

– Glucocorticoids

– Androgen– Estrogen

• Function(s):– A. reserve energy in time

of stress– B. male hormone– C. affects water and

electrolyte balance– D. manages BP– E. glucose metabolism– F. antiinflammatory– G. female hormone

Multiple Choice

• Adrenal Medulla secretes 2 hormones that are significant during times of stress. These are:– A. glucose and glucagon– B. epinephrine and mineralocorticoid– C. epinephrine and norepinephrine– D. Insulin and Thymosin

Multiple Response

• Thyroid hormones are responsible for which of the following functions?– A. growth and development– B. metabolism– C. activation of the nervous system– D. Produces PTH

Multiple Choice

• The function of thyroid hormones is controlled by the release of ____ from the pituitary gland:– A. FSH– B. LH– C. TSH– D. GH

Multiple Response

• The Parathyroid Glands are located on the posterior surface of the thyroid gland. It has the following functions:– A. controls metabolic rate– B. controls Ca++ and Ph metabolism– C. influences fat and protein metabolism– D. produces T3

Multiple Choice

• An imbalance of PTH can affect the neuromuscular and cardiovascular systems. When the serum Ca++ level is too low, nerve cells become excitable and muscles receive too many impulses _____________.– A. Trousseau’s sign– B. Chvostek’s sign– C. Tetany– D. Somogyi effect

Fill In

• When serum Ca++ is too high, it can cause ____________ and __________.– A. spasms and seizures– B. Slowed digestion and regurgitation– C. Kidney stones and decreased urine output– D. Impaired heart function and death

Multiple Response

• One of the larger endocrine system organs is the pancreas. The functions of the pancreas include: – A. influence metabolism of CHO– B. produce insulin and glucagon– C. digestion of protein – D. secretion of bile for fat breakdown

Multiple Choice

• Insulin is secreted in response to _________ levels of serum glucose.– A. low– B. absent – C. elevated

Multiple Response

• Ovaries, at puberty, produce estrogen and progesterone. Estrogen is responsible for:– A. the development of secondary sexual

characteristics in the female– B. deepening of voice– C. maturation of reproductive organs in the female– D. development of muscle mass

Fill - In

• _____________ is a “temporary” endocrine gland.

Multiple Response

• At puberty, the testes produce testosterone which is responsible for _________ in the male:– A. Development of secondary sexual

characteristics – B. maturation of reproductive organs– C. sperm formation– D. development of bone and muscle mass

Multiple Choice

• ___________, a hormone, programs information into T-lymphocytes in utero and infancy to carry out immune reactions to certain antigens.– A. Growth Hormone– B. Adrenocorticotrophic Hormone– C. Thymosin– D. Thyroid Stimulating Hormone

Multiple Response

• Located on the roof of the 3rd ventricle in the brain, the pineal gland secretes a substance called “melatonin”. Melatonin is responsible for which of the following:– A. inhibiting gonadotrophic hormones which

inhibit reproductive activity until puberty– B. induces sleep– C. affects mood– D. relieves depression

Other

• Hormones can be harmful if unchecked. Unmanaged stress can be a leading contributor to stress-induced diseases and disorders.

• List 3 stress-relieving methods

Other

• The main clinical conditions associated with aging of the endocrine system involve the pancreas and thyroid.

• Name 1 condition of each

DISORDERS OF THE PITUITARY GLAND

Multiple Choice

• Acromegaly is a disease of the anterior pituitary gland and is the result of ___________ of GH in the adult.– A. insufficient production– B. absence– C. overproduction

Multiple Response

• Clinical manifestations of acromegaly include:– A. shrinking of the cranium and jaw– B. bulging forehead– C. bulbous nose– D. thick lips, small tongue– E. enlarged hands and feet

Other

• Place and “s” next to subjective data and an “o” next to objective data r/t acromegaly:

• ___ presence of headaches, visual disturbances• ___ c/o ↓ability to perform ADLs• ___ pt. c/o feeling depressed• ___ “I seem to be having more problems with

joint pain”• ___ increasing bone enlargement (measured)• ___ tachycardia, weak pulse

Other

• List 4 diagnostic tests for acromegaly.

Multiple Choice

• Which of the following is the definitive test for a diagnosis of acromegaly:– A. ophthalmic exam– B. Oral Glucose Challenge– C. ↑ TSH– D. Cranial xrays

Multiple Response

• Medical management for acromegaly includes:– A. medications to stimulate GH secretion– B. medications to suppress GH secretion– C. Surgical removal of pituitary tumor(s)– D. Irradiation to destroy GH secreting tumors

Multiple Response

• Nursing Interventions related to the care of a patient with advancing acromegaly include:– A. safety measures for those with visual

impairment– B. monitor cardio-respiratory status and changes– C. Regular diet/texture– D. Administration of pain medication

Multiple Choice

• Earl has a condition known as gigantism. This condition is due to:– A. Insufficient secretion of growth hormone– B. Hyperthyroidism– C. hyperplasia of the hypothalamus– D. overproduction of GH

Multiple Response

• Gigantism may also be caused by a defect in the hypothalamus which directs the anterior pituitary gland to release excess amounts of GH. Clinical manifestations of gigantism include:– A. great height (sometimes > 8’ Tall)– B. Increased muscle development– C. Weakness– D. abnormal body proportions– E. < normal weight

True/False

• The definitive diagnostic test for gigantism is the GH suppression test (glucose loading).

Multiple Response

• Medical management of a client with gigantism includes:– A. surgical removal of a tumor– B. irradiation of the anterior pituitary gland– C. Monthly IV infusion of GH suppression

medication– D. Monthly IV infusion of Calcium to prevent

osteoporosis

Other

• List 3 nursing interventions related to someone with or suspected of having gigantism:

Other

• List 2 appropriate nursing diagnoses related to someone with gigantism.

Multiple Choice

• Dwarfism describes the abnormally small size of people who often have a recessive genetic trait. The clinical cause of dwarfism is:– A. deficiency in Growth Hormone– B. Low TSH– C. Insufficient gonadotropic hormones– D. Hyperplasia of the hypothalamus

Multiple Response

• Clinical manifestations of dwarfism include:– A. height of < 3 feet– B. Normal but delayed sexual development– C. Normal body proportion– D. appear significantly older than chronological

age

Multiple Response

• Interviewing by the nurse for subjective data for people with dwarfism will include questions related to:– A. patient understanding of the condition– B. patient emotional response to condition– C. pt. c/o headache and shortness of breath– D. current height and weight measurements

Multiple Choice

• Though wrist xray and MRI/CT may be used for diagnosing bone age and to r/o pituitary tumor, the definitive test for dwarfism is:– A. Glucose Tolerance Test– B. 17-hydroxyketosteroids (24hr urine collection)– C. ↓ plasma levels of Growth Hormone– D. ↓ serum thyroid hormones

Multiple Response

• Medical Management for those affected by dwarfism includes:– A. Irradiation of the posterior pituitary gland– B. Irradiation of the adrenal cortex– C. Anti-growth hormones– D. Growth hormone injections if appropriate– E. Removal of tumor if present

Multiple Choice

• In the disorder known as “diabetes insipidus”, the secretion and actions of ADH goes awry (wacky!). ADH stands for:– A. Antidiabetic Hormone– B. Antidiuretic Hormone– C. Antedystrophy HCL– D. Adrenodystrophy Hormone

Other - Process

• When there is not enough ADH, imbalance of _________ and _________. This causes __________ urine output. If untreated, ____________ shock can occur.

Multiple Response

• Diabetes Insipidus may manifest which of the following clinical features?– A. polyuria, polydypsia– B. anuria– C. ↑ serum Na+– D. lethargy and weight loss– E. dry skin; poor skin turgor– F. diarrhea

Multiple Response

• Of the following diagnostic tests, which ones can the nurse monitor on a daily or frequent basis:– A. Urine specific gravity– B. Urine ADH– C. Serum Na+– D. Fluid Deprivation Test

Multiple Choice

• Medical management of Diabetes Insipidus has the focus of which rationale:– A. Homeostasis: support the body with ADH

preparations or replacements– B. Offload excess fluid with diuretics– C. Prevent congestive heart failure with fluid

restriction– D. Provide exogenous sodium freely to balance

what was lost with fluid

Multiple Response

• RE: Diabetes Insipidus: Nursing interventions provide feedback to the medical team re: progress toward homeostasis and appropriateness of treatment initiated. Nursing interventions that support this include:– A. Intake and Output measurements– B. Daily weights– C. Skin assessment– D. Urine testing for Specific Gravity – E. Monitor lab results for serum Na+ levels

Other

• List 2 appropriate nursing diagnoses for Diabetes Insipidus

Multiple Choice

• When the pituitary gland releases too much ADH, a condition known as ___________ develops.– A. Diabetes Insipidus– B. Syndrome of Inappropriate Secretion of ADH– C. Diabetes Mellitus– D. Cushing’s Syndrome

Other - Process

• When the body’s system of checks and balances malfunctions, ADH may be released continually kidneys ________ more water, therefore, the urine output is _____, and the body’s circulating fluid volume ________.

Multiple Response

• During SIADH, the patient experiences:– A. hemoconcentration– B. hyponatremia (< 125 mEq/L)– C. fluid overload without peripheral edema– D. hypernatremia (>145 mEq/L)

True / False

• ADH is released in response to stress. Therefore, ↑ stress leads to ↑ release of ADH.

Other

• List 3 manifestations of SIADH that would be considered subjective data.

Other

• List 3 clinical manifestations of SIADH that would be considered objective data.

Multiple Choice

• One serious and potentially fatal complication of SIADH occurs when, due to hemodilution, sodium becomes hypotonic and causes brain cells to swell or expand ICP, progressive lethargy, seizures, etc. This is called:– A. Interstitial edema– B. Water intoxication– C. Malignant hypertension– D. Osmolality crisis

Multiple Choice

• Diagnostic tests for SIADH is made by simultaneous measurements of urine and serum osmolality. When positive for SIADH, the following results will occur:– A. serum is diluted; urine is concentrated– B. serum is concentrated; urine is diluted– C. serum is concentrated; urine is concentrated– D. serum is diluted; urine is diluted.

Multiple Choice

• The goal of medical management is to regain homeostasis in the body. Which of the following equations expresses this in a practical way?– A. Daily fluid intake < daily fluid output– B. Daily fluid output < daily fluid intake– C. Daily fluid intake should = daily fluid output– D. Daily fluid intake should = daily weight

Multiple Choice

• If treatment of SIADH with hypertonic intravenous saline solution and use of Declomycin and Lithium medications is successful, the serum Na+ should show:– A. no change in level from initial lab work– B. Continued lowering– C. Gradual increase– D. Rapid increase

True/False

• The priority nursing intervention for a patient with SIADH is: continual assessment of patient condition to determine whether pt. is improving or deteriorating.

Disorders of the Thyroid and Parathyroid Glands

Multiple Choice

• Graves’ disease is another name for:– A. Hypothyroidism– B. Hypoparathyroidism– C. Hyperpituitarism– D. Hyperthyroidism

Multiple Choice

• Hyperthyroidism is due to ___________ of the thyroid hormones T3 and T4 which cause and exaggeration of the metabolic process.– A. deficiency– B. overproduction– C. fluctuation– D. absence

Multiple Response

• Contributing factors to the cause of hyperthyroidism include:– A. genetics– B. infection– C. Low iodine intake– D. increased occurrence in males

Multiple Choice

• One significant clinical manifestation of hyperthyroidism is edema of the anterior portion of the neck. This is called:– A. exophthalmos – B. goiter– C. hyperplasia– D. cancer

Multiple Response

• Which of the following clinical manifestations would be considered objective data for hyperthyroidism?– A. tachycardia– B. elevated temperature/heat intolerance– C. inactivity or lethargy– D. warm, flushed skin

Multiple Choice

• Which of the following lab patterns helps to confirm hyperthyroidism?– A. ↑ TSH and ↑ Free T4– B. ↑ TSH and ↓ Free T4– C. ↓ TSH and ↓ Free T4– D. ↓ TSH and ↑ Free T4

Multiple Choice

• PTU (propylthiouracil) and Methimazole /Tapazole are medications used in treatment of hyperthyroidism. These are chosen because they:– A. Slow the metabolic rate of thyroid function– B. Slow the distribution of thyroid hormones– C. Block production of thyroid hormone– D. Block the distribution of thyroid hormone

Multiple Choice

• Treatment of hyperthyroidism with radioactive iodine may have an adverse outcome that can be treated. This outcome is:– A. hypoparathyroidism– B. hypothyroidism– C. hypopituitarism– D. thyroid storm

Multiple Choice

• For patients who cannot tolerate antithyroid drugs, are not good candidates for radiation treatment, or have large goiters causing tracheal compression, surgery is the option for treating hyperthyroidism. Which surgery is appropriate?– A. parathyroidectomy– B. adrenalectomy– C. hypophysectomy– D. subtotal thyroidectomy

Multiple Choice

• A risk with a subtotal thyroidectomy is removal of too much tissue. If this occurs, the outcome would be:– A. hypothyroidism– B. hypoparathyroidism– C. thyroid storm– D. recurrent goiter

Multiple Choice

• During the first 12 hrs. post – op subtotal thyroidectomy, the patient runs the risk of a Thyroid Crisis /Storm. This is due to:– A. Barometric effect on thyroid function– B. manipulation of the gland during surgery which

releases large amts thyroid hormone into the bloodstream

– C. Rebound effect on the pituitary gland causing the release of excess TSH

– D. Negative feedback system overriding the positive feedback system

Other

• List 5 s/sx Thyroid Crisis/Storm:

Other

• Nursing interventions for post-op subtotal thyroidectomy are focused on supporting healthy air exchange, good nutrition and support of surgical area.

• List 3 actions that will achieve these aims:

Other

• One of the most important pieces of equipment to be at the bedside post-op thyroidectomy would be a ______________.

Multiple Response

• Patient education r/t post-op thyroidectomy includes:– A. follow – up with medical supervision– B. medication – understanding and compliance

with thyroid replacement medications– C. thyroid function tests– D. Diet

Other - Process

• Due to ___________ secretion of thyroid hormones, the metabolic processes of the body _____________ and a condition of _____________ occurs.

Other

• __________ refers to severe hypothyroidism in adults.

• __________ refers to congenital hypothyroidism.

Multiple Response

• Clinically, in hypothyroidism, because all the metabolic processes slow down, the patient may experience:– A. hypothermia– B. intolerance to cold– C. weight gain– D. ASHD/CAD

Multiple Response

• Subjectively, the patient with hypothyroidism may c/o which of the following:– A. depression– B. mental slowness, forgetfulness– C. lethargy– D. diarrhea

Multiple Response

• Objectively, the nurse may note the following in assessing the client with hypothyroidism:– A. enlarged facial appearance– B. bradycardia– C. weakness, clumsiness– D. thick, coarse hair

Multiple Response

• Low levels of which of the following lab tests provide the underlying stimuli for TSH in hypothyroidism:– A. expect ↑ TSH– B. expect ↓ TSH– C. Low levels of T3, T4, and FT4– D. Absence of thyroid hormone

Other

• The main medical treatment of hypothyroidism is hormone replacement.

• List 2 thyroid hormone replacement medications:

Multiple Response

• Nursing interventions for the patient going home from the hospital would include:– A. Dietary instructions– B. Medication instructions including caution to talk

to the doctor before stopping or changing dose of medication

– C. Bowel care– D. Environmental temperature control

Multiple Choice

• An insufficient dietary intake of iodine may lead to a condition called:– A. Simple Goiter– B. Complex Goiter– C. Hyperplasic Goiter– D. Thyroid cancer

Multiple Response

• Pt. may c/o of which of the following related to the swelling in their neck:– A. Dysphagia– B. Ataxia– C. Dyspnea– D. Hoarseness

Multiple Response

• Objectively, the nurse will assess the following in the person with a goiter:– A. voice changes– B. size of the goiter– C. food/fluid intake– D. ability to walk

Multiple Response

• Conservative medical treatment for a goiter may include:– A. Potassium iodide– B. diet high in iodine– C. diet low in potassium– D. Calcium Citrate

Multiple Choice

• Clinical manifestations of thyroid cancer (slow growing well-differentiated adeno carcinoma) include:– A. spongey, diffusely enlarged thyroid tissue– B. large hard areas of thyroid tissue with firm

proximal lymph nodes– C. firm, fixed, small rounded mass or nodule on

thyroid gland– D. Fluid pockets on either lobe of thyroid gland

Multiple Response

• Diagnostic tests for thyroid cancer include:– A. thyroid scan– B. thyroid function tests– C. needle biopsy– D. RAIU

Multiple Response

• Medical Management of diagnosed thyroid cancer includes:– A. Total thyroidectomy– B. Thyroid replacement therapy– C. Vitamin B12– D. radical neck dissection, radiation, chemo if

metastasized

Multiple Choice

• Overactivity of the parathyroid glands with increased production of parathyroid hormone (PTU) results in a condition known as:– A. hyperthyroidism– B. hyperparathyroidism– C. hyperpituitarism– D. hypersecretory syndrome

Other - Process

• __________ leaves the bones causing _________ calcium to increase. As bones become __________, the formation of _____ _______ and pathological __________ occur.

Multiple Response

• As a result of the bone demineralization process in hyperparathyroidism, the patient will complain of which of the following:– A. severe skeletal pain– B. pain on weight-bearing– C. Vomiting and weight loss– D. slow pulse

Other

• List 4 other clinical manifestations/objective assessment of hyperparathyroidism.

Other

• List 5 diagnostic tests for hyperparathyroidism.

Multiple Response

• Medically, surgical intervention seems to be the only definitive treatment to reverse the process. The surgeries include:– A. removal of tumor– B. removal of one or more parathyroid glands– C. autotransplantation– D. subtotal thyroidectomy

Other

• One nursing priority postoperatively for treatment of hyperparathyroidism is monitoring for hypocalcemia.

• List 3 clinical manifestations of hypocalcemia.

Other - Process

• In hypoparathyroidism, ___________ amounts of parathyroid hormone lead to ________ level of _________ in the blood.

Multiple Choice

• The most common cause of hypoparathyroidism is:– A. tumor– B. congenital defect of glands– C. inadvertent removal or destruction of one or

more parathyroid glands during thyroidectomy– D. infection

Multiple Choice

• For a patient with hypoparathyroidism, lab results show:– A. ↑ serum Ca++ and ↑serum phosphorus– B. ↓ serum Ca++ and ↑ serum phosphorus– C. ↓ serum Ca++ and ↓serum phosphorus– D. ↑ serum Ca++ and ↓ serum phosphorus

Other

• The most serious clinical manifestation of hypoparathyroidism is severe hypocalcemia.

• List 5 clinical manifestations of hypocalcemia

Other

• Laryngeal spasm, stridor, and cyanosis describe some of the objective data experienced by a patient with hypoparathyroidism. List 3 other objective s/sx of this condition.

Multiple Response

• Serum PTH, Phosphorus, and Calicum are checked diagnostically for a person with suspected hypoparathyroidism. If positive for hypoparathyroidism, the results will be:– A. ↓ PTH and serum Ca++ – B. ↑ urinary Ca++ – C. ↑ serum phosphorus– D. ↓ urinary phosphorus

Multiple Choice

• To treat hypoparathyroid tetany, an IV of calcium gluconate or calcium chloride will be given. What is the main nursing caution when administering the above medication IV?– A. Renal Calculi may develop– B. Patient somnolence may result– C. Rapid infusion will lower the BP, and cause

serious cardiac dysrhythmias or cardiac arrest– D. Rapid infusion will trigger HTN and chest pain

Multiple Response

• Nursing priorities includes skilled observation and assessment for:– A. Respiratory function– B. S/Sx hypercalcemia during treatment– C. s/sx cardiovascular slowing and dysfunction– D. constipation

True/False

• Nearly all nursing interventions are related to calcium levels.

Multiple Choice

• Dietary considerations for the patient with hypoparathyroidism includes:– A. high citrus intake– B. low fat, low CHO, low protein– C. increase dairy, dark green leafy vegetables, and

canned fish (with bones)– D. Low potassium diet