NUR 235 Test 3- midlands tech

The body uses ___ from food to make T3 and T4?

Iodine

Hyperthyroidism is associated with which of the following?

A. Thyrotoxicosis

B. Myxedma coma

A

Hypothyroidism is associated with which of the following?

A. Thyrotoxicosis

B. Myxedma coma

B

What is the most common form of hyperthyroidism?

Grave's disease (autoimmune)

exophthalmos is associated with?

A. hyperthyroidism

B. hypothyroidism

A

Acropachy is digital clubbing and swelling of the fingers, what is this a clinical manifestation of?

Hyperthyroidism

In hyperthyroidism (fill in the blank with either increased or decreased)

TSH is ____.

T3 is ___

T4 is ___.

Decrseased, Increased, Increased.

What are the three primary treatment options for hyperthyroidism?

- Antithyroid medications

- Radioactive Iodine therapy (RAI)

-Surgery

Which of the following is an antithyroid medication that prevents the production of thyroid hormones?

A. Propranolol

B. Methimazole

C. Nitroglycerin

B

Results (euthyroid) is usually seen within ___ to ___ weeks of taking methimazole.

4-8 weeks

Antithyroid drugs are curative for hyperthyroidism. T or F?

F -- they can allow for remission but are not considered curative.

What antithyroid drug is used for patients who are in the first trimester of pregnancy or need rapid reduction of symptoms?

Propylthiouracil

What must you educate patients who are starting antithyroid medication about?

DO NOT abruptly stop the medication --> this can lead to hyperthyroidism again.

What medication is taken in anticipation for surgery/thyroidectomy as is decreased the vascularity of the thyroid gland?

A. Mathimazole

B. Propylthiouracil

C. Potassium Iodine (SSKI)

D. Propranolol

C

What must you educate patient about if they are taking potassium iodine (SSKI)?

Mix with water/juice after meals and drink with a straw to prevent teeth staining.

Why might someone who has hyperthyroidism be taking propranolol?

Symptomatic relief -- decreases tachycardia, nervousness, irratability, tremors.

Destroys thyroid tissues thus limiting thyroid hormone secretion.

A. Mathimazole

B. Propylthiouracil

C. Potassium Iodine (SSKI)

D. Radioactive Iodine Therapy (RAI)

D

Treatmen of choice for most nonpregnant adults with hyperthyroidism?

A. Mathimazole

B. Propylthiouracil

C. Potassium Iodine (SSKI)

D. Radioactive Iodine Therapy (RAI)

D

Although RAI is typically effective, most patients will have post-treatment ____.

Hypothyroidism (requiring lifelong Synthroid)

What should the diet of a patient with hyperthyroidism look like?

High-cal, high-carb and high-protein foods (remember they have a high metabolism and increased weight loss)

Individuals with hyperthyroidism should avoid what types of food?

Highly seasoned (increases metabolism even more)

High fiber (increases diarrhea even more)

Caffiene (increases anxiousness even more)

How does the diet change for a patient who had a thyrodectomy for treatment of hyperthyroidism?

Lower cal, carb and protein as compared to their diet with hyperthyroidism.

Someone who had a total thyroidectoy may OR may not need lifelong synthroid. T or F?

F - they will require lifelong synthroid

Hashimotos is related to which of the following?

A. Hyperthyroidism

B. Hypothyroidism

B

Which of the following are symptoms of hypothyroidism? SATA

A. Puffy face

B. intolerance to heat

C. fatigue/weakness

D. Weight gain

E. Insomnia

A, C, D

A myxedma coma is charcterized by what three things?

-Subnormal Temp

- Hypotension

- Hypoventilation

In hypothyroidism (fill in the blank with either increased or decreased)

TSH is ____.

T3 is ___

T4 is ___.

increased, decreased, decreased

How should the diet of someone who has hypothyroidism be?

low-cal, low-fat, low-carb, high-fiber (due to constipation)

When should levothyroxine (Synthroid) be taken?

In the morning on an empty stomach

Which type of patient should avoid sedatives? Explain why in your own words.

A. Hypothyroidism

B. Hyperthyroidism

A (amplifies slowness - remember hypothyroidism = slow sloth)

Hyperparathyroidism leads to? SATA

A. Hypocalcemia

B. Hypophosphatemia

C. Hypercalemia

D. Hyperphosphatemia

E. Hypertension

F. Hypokalemia

C, B

Explain how hyperparathyroidism leads to decreased bone density (osteoporosis).

Calcium is pulled out of the bone and into the blood --> places patient at increased risk of fractures.

Which of the following results in decreased bone density (osteoprosis)?

A. Hypothyroidism

B. Hyperthyroidism

C. Hyperparathyroidism

D. Hypoparathyroidism

C

Explain how hyperparathyroidism can lead to the formation of renal calculi?

increased levels of calcium in the blood lead to increased calcium excretion in the urine through filtration of the kidney thus leading to renal calculi.

In hyperparathyroidism (fill in the blank with either increased or decreased)

PTH is ___.

Calcium is ___.

Phosphorus is ____.

Increased, Increased, decreased

Bisphonates is often taken with which of the following?

A. Hypothyroidism

B. Hyperthyroidism

C. Hyperparathyroidism

D. Hypoparathyroidism

C ( for hypercalcemia)

How long would a patient who had a total parathyroidectomy be expected to take calcium supplements?

For life

In hypoparathyroidism (fill in the blank with either increased or decreased)

PTH is ___.

Calcium is ___.

Phosphorus is ____.

Decreased, decreased, increased.

Which vitamin is helpful in enhancing the abosrobtion of high calcium foods/supplements?

Vitamin D

Regulates metabolism, blood glucose levels and critical in the stress response?

A. Glucocorticoids (cortisol)

B. Mineralcorticoids (aldosterone)

C. Androgens (hormones)

A

Regulates sodium and potassium balance?

A. Glucocorticoids (cortisol)

B. Mineralcorticoids (aldosterone)

C. Androgens (hormones)

B

Contributes to the growth and dvelopment in both genders and to the sexual devlopment in men?

A. Glucocorticoids (cortisol)

B. Mineralcorticoids (aldosterone)

C. Androgens (hormones)

C

Cushings syndrome results from long-term exposure to ____ corticosteroids

excess (particularly glucocorticoids)

Long term use of which corticosteroid can lead to cushing syndrome?

Prednisone

If a patient devlops cushing syndrome as a result of prolonged used of corticosteroids.. what must you educate the patient on.

Not abruptly stoping the corticosteroid, instead they will gradually wean themselves off.

Why might a patient with addisons disease need to sit on the edge of the bed for a few minutes before standing?

Prone to orthostatic hypotension

Which of the following are clinical manifestations of Addisons disease? SATA

A. Bronze colored skin

B. Purple stria

C. Anorexia

D. Nausea

E. Progressive weakness

A, C, D, E (purple stria = cushing syndrome)

Which of the following are clinical manifestations of cushing syndrome? SATA

A. Hypertension

B. Acne

C. Muscle wasting

D. Anorexia

E. Nausea

F. Moon face

A, B, C, F (anorexia and muscle wasting = Addisons disease)

What are the most common manifestations of Addisonian crisis? (hint; there are 5)

-Hypotension

- Dehydration

- Decrease sodium

-Increased potassium

- severe abdominal pain

Hydrocortisone is the hormone replacement for low ____.

Cortisol (glucocorticoids)

If a patient has Addisons disease what might we need to educate them on as far their diet.

They will need to increase their dietary salt intake.

Fludrocortisone is responsible for replacing ____.

Mineralcorticoids (aldosterone)

Indivduals who have Addisons disease will need to increase their corticosteroids in times of stress -- why?

Their body is not producing its own cortisol, which is a stress hormone, so when they're under significant stress their maintenance corticosteroid dose is not enough and a "stress dose" is required.

When should corticosteroids be taken?

In the morning with food (to decrease GI upset)

What are the two early symptoms of cirrhosis?

Fatigue and enlarged liver

Spider angiomas and palmar erythema are a result of the liver nit being able to metabolize _____.

Steroid hormones

Which of the following are late clinical manifestations of cirrhosis? SATA

A. Fatigue

B. Spider angiomas

C. Palmar erythema

D. Jaundice

E. Enlarged liver

F. Smaller liver

G. Peripheral neuropathy

B,C,D,F,G

What causes peripheral neuropathy in cirrhosis patients?

Dietary deficiencies of thiamine, folic acid and cobalamin

In male cirrhosis patients what do we see secondary to decreased metabolism of hormones?

Gynecomastia

In female cirrhosis patients what do we see secondary to decreased metabolism of hormones?

Amenorrhea

What is the most life threatening complication of cirrhosis?

Esphogeal and gastric varices (very fargile/abnormal veins --> can lead to hemorrhage --> patient can bleed to death.

Why do you often see cirrhosis patients on lasix or spironolactone?

Due to peripheral edema.

What may be prescribed to treat peripheral edema in cirrhosis patients?

Lasix and spironolactone

A patient in for cirrhosis of the liver starts to experience sleep disturbances and trouble concentrating... what do you suspect is the cause?

Hepatic encephalopathy

What is the most common/ classic sign that a patient is trending towards a hepatic coma?

Asterixis

Your cirrhosis patient starts to develop azotemia (nitrogen-waste product build up in the blood) and oliguria... what do you suspect?

Hepatorenal syndrome (renal failure due to advanced liver disease)

There is typially structural abnormality of the kidneys in hepatorenal syndrome. T or F?

F

Which of the following labs will be elevated/prolonged for a cirrhosis patient? SATA

A. AST

B. ALT

C. Total protein

D. Albumin

E. bilirubin

F. Ammonia

G. PT

H. Cholesterol

A,B,E,F,G

Which of the following labs will be decreased for a cirrhosis patient? SATA

A. AST

B. ALT

C. Total protein

D. Albumin

E. bilirubin

F. Ammonia

G. PT

H. Cholesterol

C,D,H

What medications should cirrhosis patients avoid? (hint; there are 3)

-Aspirin (increased bleeding)

-Tylenol (hepatotoxic)

-NSAIDs

For a chirrhosis patient experiencing ascites, they are put on a sodium restriction of ____g per day.

2

Why might albumin be given to a patient with ascites?

Maintain intravascular volume and low BP

Why might propranolol be given to a patient with cirrhosis of the liver?

Reduces the risk of esophageal and gastric varicies hemorrhage/rupture.

What medication if often used to reduce ammonia formation?

Lactulose (acts as a laxative and excretes ammonia through BM)

Why should we minimize constipation/encourage fluids in a cirrhosis patient?

If they were to develop hepatic encephalopathy it can worsen the amount of ammonia being held on to.

How often should a neurologic check be performed if a patient has hepatic encephalopathy?

q2h

What OTC products can be used for management of pruritus secondary to Jaundice?

Baking soda or Alpha Keri baths

How should a patient be positioned for a paracentesis?

High-fowlers or sitting on the side of the bed

A cirrhosis patient develops melena/hematochezia... what do you suspect?

Varcies bleeding

Describe the pain of pancreatitis.

-Sudden onset

- LUQ or mid-epigastric (radiates to the back)

- Pain decreased in fetal position

- Not relived by vomiting or antacids

- Eating worsens

A patient presents with S/S of acute pancreatitis, upon examination you feel a palpable mass in the abdominal area... what do you suspect and what if your next priority?

-A pseudocyst

- Contact HCP as this can rupture causing peritonitis potentially leading to sepsis. Surgical intervention is needed ASAP

Explain the difference between a pseudocyst and a pancreatic abscess.

A pancreatic abscess is an infected pseudocyst-- both can be felt as a palpable mass and require immediate surgical intervention/drainage to prevent rupture.

Serum ___ and ____ will be elevated within 24 hours of onset of symptoms of pancreatitis.

amylase and lipase (digestive enzymes)

Acute panceratitis patients should be kept on a full liquid diet. T or F?

F -- they should be kept NPO

What poistion changes might relieve pain of an acute pancreatitis patient?

- Draw knees to abdomen

- Side lying with HOB elevated at 45 degrees

Dopamine helps prevent/alleviate shock by increasing the ___.

BP

Which of the following is less stimulating to the pancreas?

A. High-carb

B. Low-carb

A

When should pancreatic enzyme replacement medications be taken?

With meals

What are the five rights of delegation?

• Right task (remember nurse practice act)

• Right circumstances

• Right person (refer to job description and experience)

• Right direction/communication

• Right level of supervision: appropriate monitoring, evaluation, intervention, as needed and feedback

Principle of doing good. Doing actions that promote good and bring about a benefit to someone. A. Beneficence B. Nonmaleficence C. Veracity D. Autonomy

A. Beneficence

The principle of doing no harm. A. Beneficence B. Nonmaleficence C. Veracity D. Autonomy

B. Nonmaleficence

A person decides for someone else. The person believes that the decision maker knows more about the situation and knows what is best. A. Utilitarianism B. Paternalism C. Respect for others D. Beneficence

B. Paternalism

Ethical decisions are made according to the accomplishments of the greatest good for the greatest number of people. Diminishes the need of an individual for the needs of the larger group society. A. Utilitarianism B. Paternalism C. Respect for others D. Beneficence

A. Utilitarianism

An obligation to tell the truth. Implies honesty, transparency, and trustworthiness. A. Veracity B. Fidelity C. Justice D. Respect for others

A. Veracity

Keeping one's promises or commitments. It requires a high level of accountability. A. Veracity B. Fidelity C. Justice D. Respect for others

B. Fidelity

Where can standards of care be found?

State nurse practice act, professional organizations, federal guidelines, hospital policy and procedure manuals, and job descriptions.

Malpractice must have what five elements?

- Duty (standard of care established)

- Foreseeability (anticipating risk)

- Breach of duty (failure to meet standard)

- Causation (direct link to injury; hardest to prove)

- Injury (actual harm)

How is ammonia (a potential toxin) excreted by the body after liver conversion?

The liver converts ammonia into urea, which is then excreted in the urine.

What is bilirubin converted to in the small intestines during excretion?

Urobilinogen

What endocrine abnormality causes spider angiomas and palmar erythema in cirrhosis?

Increased circulating estrogen due to the liver's inability to metabolize steroid hormones.