Hormonal Regulation Case Study

Dan arrives in the ED reporting frequent urination and states, “I am drinking water like crazy, but I can’t seem to get enough.” Which underlying problem best explains these symptoms?
A. Excess insulin causing glucose loss in urine
B. Lack of antidiuretic hormone causing water loss
C. Excess aldosterone causing sodium retention
D. Kidney failure causing fluid retention

B. Lack of antidiuretic hormone causing water loss

Rationale:
Dan’s excessive urination and extreme thirst indicate inability to conserve water, which occurs when ADH is deficient or ineffective, as seen in Diabetes Insipidus.

Dan’s assessment reveals dry mucous membranes, decreased skin turgor, flushed skin, and capillary refill greater than 3 seconds. These findings indicate:
A. Fluid volume overload
B. Adequate hydration
C. Severe dehydration
D. Heart failure

C. Severe dehydration

Rationale:
Dry mucous membranes, poor skin turgor, delayed capillary refill, and flushed skin are classic signs of dehydration, consistent with excessive fluid loss.

Dan’s vital signs are HR 112 and BP 98/52. What is the best interpretation of these findings?
A. Normal compensatory response to fever
B. Signs of fluid volume overload
C. Compensatory response to hypovolemia
D. Early septic shock

C. Compensatory response to hypovolemia

Rationale:
Tachycardia and hypotension occur when the body attempts to maintain perfusion in the setting of low circulating volume due to dehydration.

Dan’s urine output is 3000 mL in the last 2 hours. How should this finding be interpreted?
A. Normal renal function
B. Oliguria
C. Severe polyuria
D. Acute kidney failure

C. Severe polyuria

Rationale:
Normal urine output is ~30–50 mL/hr. Dan’s output far exceeds this, indicating uncontrolled water loss, a hallmark of Diabetes Insipidus.

Dan’s lab results show high serum sodium, high hematocrit, and high serum osmolality. What do these results suggest?
A. Fluid overload with dilution
B. Loss of sodium through urine
C. Concentration of blood due to water loss
D. Renal sodium retention

C. Concentration of blood due to water loss

Rationale:
Loss of free water concentrates blood components, resulting in hypernatremia, increased hematocrit, and elevated serum osmolality, all consistent with dehydration.

Based on Dan’s symptoms, assessment findings, vital signs, and labs, what is the most likely diagnosis?
A. SIADH
B. Heart failure
C. Diabetes Insipidus
D. Diabetic ketoacidosis

C. Diabetes Insipidus

Rationale:
The combination of extreme polyuria, polydipsia, dehydration, hypotension, hypernatremia, and high serum osmolality strongly supports Diabetes Insipidus.

What treatment should the nurse anticipate recommending to the provider for Dan?
A. Fluid restriction and hypertonic saline
B. Desmopressin and fluid replacement
C. Loop diuretics and sodium restriction
D. Insulin infusion and electrolyte replacement

B. Desmopressin and fluid replacement

Rationale:
Desmopressin replaces the action of ADH in Diabetes Insipidus, while fluids correct dehydration and prevent hypovolemic complications.

Which outcome best indicates that Dan’s condition is improving?
A. Increasing urine output
B. Decreasing serum sodium levels
C. Worsening hypotension
D. Persistent thirst

B. Decreasing serum sodium levels

Rationale:
As fluid balance is restored and ADH action improves, serum sodium normalizes, urine output decreases, and hydration status improves.

Willy presents with dyspnea, recent weight gain, crackles in the lungs, bounding pulses, urine output of 20 mL in 4 hours, low serum sodium, low serum osmolality, and high urine osmolality.

A (Multiple Choice):
A. Diabetes Insipidus
B. SIADH
C. Heart failure
D. Acute kidney injury

B. SIADH

Low serum sodium and osmolality with inappropriately concentrated urine and fluid overload are hallmark findings of SIADH.

What treatment will you recommend to the physician?
A. Encourage oral fluids
B. Administer desmopressin
C. Fluid restriction
D. IV hypotonic fluids

C. Fluid restriction

Rationale:
SIADH causes excess water retention. Fluid restriction is the first-line treatment to prevent worsening hyponatremia.

What nursing actions should you take?
A. Strict intake and output monitoring
B. Daily weights
C. Monitor neurologic status
D. All of the above

D. All of the above

Rationale:
SIADH requires close monitoring of fluid balance, neurologic changes, and subtle weight gain to prevent complications.

What outcomes indicate improvement in Willy’s condition?
A. Increasing urine output and weight gain
B. Normalizing serum sodium and reduced crackles
C. Persistent hyponatremia
D. Worsening dyspnea

B. Normalizing serum sodium and reduced crackles

Rationale:
Improvement is reflected by corrected sodium levels and resolution of fluid overload signs.

What patient teaching is required?
A. Increase fluid intake daily
B. Avoid monitoring body weight
C. Follow prescribed fluid restriction
D. Stop medications when symptoms improve

C. Follow prescribed fluid restriction

Rationale:
Patient adherence to fluid restriction is essential to prevent recurrence of hyponatremia.

A patient is post-thyroidectomy and at risk for airway compromise and electrolyte imbalance.
A. Hypothyroidism
B. Postoperative airway risk
C. Diabetes Insipidus
D. SIADH

B. Postoperative airway risk

Rationale:
Following thyroidectomy, airway obstruction and hemorrhage are the most immediate concerns.

What treatment will you recommend to the physician?
A. Immediate fluid restriction
B. Calcium supplementation if indicated
C. Insulin therapy
D. Diuretics

B. Calcium supplementation if indicated

Rationale:
Damage to the parathyroid glands may cause hypocalcemia, requiring calcium replacement.

What nursing actions should you take?
A. Assess airway and voice quality
B. Monitor for bleeding
C. Perform whisper test
D. All of the above

D. All of the above

Rationale:
Post-thyroidectomy care focuses on airway patency, bleeding, and nerve injury assessment.

What outcomes indicate improvement?
A. Stridor and hoarseness
B. Stable vital signs and clear airway
C. Tingling in fingers
D. Increasing neck swelling

B. Stable vital signs and clear airway

Rationale:
Improvement is shown by absence of airway compromise, bleeding, or hypocalcemia.

What patient teaching is required?
A. Ignore voice changes
B. Report numbness or tingling immediately
C. Hyperextend the neck
D. Restrict calcium intake

B. Report numbness or tingling immediately

Rationale:
Tingling or numbness may indicate hypocalcemia, which requires prompt treatment.

Gertrude presents with weight loss, diarrhea, heat intolerance, palpitations, anxiety, goiter, and exophthalmos.
A. Hypothyroidism
B. SIADH
C. Hyperthyroidism
D. Diabetes Insipidus

C. Hyperthyroidism

Rationale:
These findings indicate excess thyroid hormone and increased metabolic activity.

What treatment will you recommend to the physician?

A. Levothyroxine
B. Antithyroid medication and beta-blocker
C. Fluid restriction
D. Desmopressin

B. Antithyroid medication and beta-blocker

Rationale:
Treatment targets hormone production and symptom control.

What nursing actions should you take?
A. Monitor cardiac rhythm
B. Promote rest and reduce stimulation
C. Monitor weight and intake
D. All of the above

D. All of the above

Rationale:
Hyperthyroidism affects cardiac, metabolic, and neurologic systems, requiring close monitoring.

What outcomes indicate improvement?
A. Increased heart rate
B. Continued weight loss
C. Stabilized heart rate and improved tolerance to heat
D. Worsening anxiety

C. Stabilized heart rate and improved tolerance to heat

Rationale:
Hyperthyroidism causes increased metabolic rate and sympathetic stimulation, leading to tachycardia and heat intolerance. Improvement is demonstrated by cardiovascular stabilization and improved thermoregulation, not continued weight loss, anxiety, or tachycardia.

What patient teaching is required?

A (Multiple Choice):
A. Increase caffeine intake
B. Stop medications abruptly
C. Avoid excess heat and report palpitations
D. Limit calorie intake

C. Avoid excess heat and report palpitations

Rationale:
Patients with hyperthyroidism are sensitive to heat and at risk for cardiac complications such as dysrhythmias. Avoiding heat exposure and promptly reporting palpitations helps prevent worsening symptoms and potential thyroid storm.

Mattie reports fatigue, weight gain, constipation, cold intolerance, dry skin, hair thinning, and decreased reflexes.

A (Multiple Choice):
A. Hyperthyroidism
B. Hypothyroidism
C. SIADH
D. Depression

B. Hypothyroidism

Rationale:
Fatigue, weight gain, constipation, cold intolerance, dry skin, hair thinning, and decreased reflexes are classic signs of decreased thyroid hormone levels, which slow metabolic processes throughout the body.

What treatment will you recommend to the physician?
A. Beta-blockers
B. Levothyroxine
C. Fluid restriction
D. Antithyroid drugs

B. Levothyroxine

Rationale:
Levothyroxine is synthetic T4 hormone replacement, the standard first-line treatment for hypothyroidism, used to restore normal thyroid hormone levels and metabolic function.

What nursing actions should you take?
A. Encourage warmth
B. Monitor for bradycardia
C. Assess bowel patterns
D. All of the above

D. All of the above

Rationale:
Hypothyroidism affects multiple systems:

• Encouraging warmth addresses cold intolerance

• Monitoring for bradycardia assesses cardiovascular effects

• Assessing bowel patterns evaluates slowed GI motility
  All are appropriate nursing actions.

What outcomes indicate improvement?
A. Continued fatigue
B. Improved energy and bowel regularity
C. Weight gain
D. Cold intolerance

B. Improved energy and bowel regularity

Rationale:
Effective treatment improves metabolic function, leading to increased energy levels and normalization of bowel motility. Continued fatigue, weight gain, and cold intolerance indicate persistent hypothyroidism.

What patient teaching is required?
A. Take levothyroxine daily on an empty stomach
B. Stop medication once symptoms improve
C. Take with calcium supplements
D. Skip doses if feeling better

A. Take levothyroxine daily on an empty stomach

Rationale:
Levothyroxine is best absorbed on an empty stomach, usually in the morning. Calcium, iron, and inconsistent dosing reduce absorption and effectiveness. Therapy is lifelong, and doses should never be skipped or stopped abruptly.