NCLEX Endocrine Flashcards

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1

What are the three hormones that are produced by the thyroid gland?

  1. T3
  2. T4
  3. Calcitonin

2

What is the action of calcitonin?

  • Decreases serum calcium by taking calcium out of the blood and pushing it back into the bone

3

What thyroid disease has “too much energy”?

  • Grave’s disease (hyperthyroidism)

4

What are the signs and symptoms of Graves’ disease?

  1. Mind
    • Nervous/irritable
    • Low attention span
  2. Weight
    • High appetite
    • Weight loss
    • Fast GI tract -> diarrhea and increased bowl sounds
  3. Vitals
    • Tachycardia
    • High BP
  4. Exophthalmos
  5. Arrhythmia/palpitations
  6. Thyroid size bigger

5

What type of eye care is needed for someone with Graves’ eye disease?

  1. Wear sunglasses
  2. Apply cool compresses for moisture
  3. Lubricating eye drops
  4. Elevate HOB auto reduce swelling
  5. Steriods and/or surgery

6

For the diagnosis of Graves’ disease, what would T4 (thyroxine) and TSH look like?

  • T4 increased
  • TSH decreased

7

What disease has T4 levels increased and TSH decreased?

  • Graves’

8

What instructions should a pt follow if they are getting a thyroid scan?

  • They must discontinue any iodine containing medication 1 week prior to the thyroid scan and must wait 6 weeks to restart iodine medications

9

What are the treatments for Graves’ disease?

  1. Anti-thyroids
    • methimazole
    • propylthiouracil
  2. Iodine Compounds
    • potassium iodine
  3. Beta Blockers
    • propanolol
  4. Radioactive Iodine therapy
  5. Thyroidectomy (partial/complete)

10

What is the action for methimazole and propylthiouracil?

  • Single dose with less side effects
  • Stops the thyroid from making thyroid hormones
  • Used pre-op to stun the thyroid

11

What drug decreases the size and the vascularity of the thyroid gland?

  • Potassium iodine

12

What patient teaching should given when taking potassium iodine?

  • Give in milk or juice and must use a straw or it will stain teeth

13

What class of drugs decreases myocardial contractility and decreases BP and HR?

  • Beta Blockers

14

What class of drugs should you not give to asthmatics or diabetics because they mask hypoglycemia symptoms?

  • Beta blocker

15

What is the action of radioactive iodine therapy?

  • Curative procedure that destroys thyroid cells and stops making thyroid hormones

16

Must rule out what for a pt to have radioactive iodine therapy?

  • Rule out pregnancy first

17

What are the precautions for radioactive iodine therapy?

  • Stay away from babies for 1 week
  • Don’t kiss anyone for 1 week

18

What is the post op priority for thyroidectomy?

  • Signs of hemorrhage

19

What does it mean when the pt reports feeling pressure on their neck after thyroidectomy?

  • Pt is hemorrhaging

20

Where should the nurse check for hemorrhaging after a thyroidectomy?

  • Look for pooling at the back of the neck and at incision site

21

How could a nurse assess for recurrent laryngeal nerve damage after a thyroidectomy?

  • By listening for hoarseness and a weak voice
  • look for a change in voice

22

What could recurrent laryngeal nerve damage lead to?

  • Vocal cord paralysis
  • When there is paralysis of both cords, air obstruction will occur requiring immediate trach

23

What must be at bedside after a thyroidectomy?

  • Trach set

24

What electrolyte imbalance can occur after a thyroidectomy?

  • Hypocalcemia
  • Parathyroid could have been removed
  • Signs: rigid tight muscles, tetany, seizures, laryngeal spasms

25

What are the signs and symptoms of hypothyroid?

  • No energy
  • Myxedema (waxy and swelling skin)
  • Fatigue
  • No expression
  • Speech slurred
  • Weight gain
  • Slow GI
  • Cold
  • Amenorrhea (no period)
  • Vital signs
    • Low BP
    • Bradycardia

26

What disease has decreased levels of T4 and increased levels of TSH?

  • Hypothyroidism

27

What is drug that treats hypothyroidism?

  • Levothyroxine

28

Is levothyroxine pregnancy safe?

  • Yes

29

What medications can impair the absorption of levothyroxine?

  • Antacids
  • Calcium
  • Iron preparations

30

How long do you need to take levothyroxine?

  • For the rest of your life

31

What are the four actions of glucocorticoids?

  1. Changes the mood
  2. Suppresses the immune system and inflammatory response
  3. Regulates glucose metabolism
    1. Breakdown fats and proteins
    2. Inhibits insulin
      • Hyperglycemic
      • Do blood glucose montioring
      • May need insulin when on steroids

32

What does aldosterone make you retain and makes you lose?

  • Retain: Salt and water
  • Lose: Potassium

33

What are the signs and symptoms for Addison’s disease?

  • Mind and body
  • Weight
  • Blood pressure
  • Electrolyte imbalances
  • Glucose (hypo or hyper)
  • Skin conditions
  • Extreme fatigue
  • Confusion
  • Nausea, vomiting, and diarrhea
  • Anorexia/weight loss
  • Hypotension
  • Hyponatremia
  • Hyperkalemia
  • Hypoglycemia
  • Hyperpigmentation (bronzing color of the skin and mucous membranes)
  • Vitillgo

34

Do you increase or decrease sodium intake for pt with Addison’s disease?

  • Increase

35

How are doses given for corticosteroids?

  • Given twice a day in split doses
  • Client will take 2/3 of the dose in the morning and 1/3 of the dose in the evening

36

What are the signs and symptoms of Cushing’s?

  • Mind
  • Body changes
  • Glucose (hyper or hypo)
  • Electrolyte imbalance
  • Mind
    • Psychosis to depression
  • Body changes
    • Lipolysis (Thin extremities/skin)
    • Moon faced (fat redistribution or fluid retention)
    • Truncal obesity (fat redistribution; lipogenesis)
    • Buffalo hump
    • Abdominal striae
    • Weight gain
    • Oily skin/acne
    • Women with male traits (hirsutism)
    • Growth arrest
  • Glucose (hypo or hyper)
    • Hyperglycemia
  • Electrolyte imbalance
    • Hypokalemia

37

Would cortisol levels be high or low in a pt with Cushing's?

  • High

38

Is Cushing's a fluid volume excess or deficit problem?

  • Fluid volume excess

39

What is the treatment for Cushing's?

  • Adrenalectomy (unilateral or bilateral)
  • Quiet environment (can't handle stress)

40

What is the diet for a pt. with Cushing's?

  • High potassium foods
  • Low sodium foods
  • High protein
  • High calcium

41

What is the blood glucose levels with diabetes?

  • <140 mg/dL
  • 80-130 mg/dL

42

What can be the first sign of Type 1 diabetes?

  • DKA

43

What are the three p's of Type 1 diabetes?

  • Polyuria
  • Polydipsia
  • Polyphagia

44

What acid-base problem occurs with someone with uncontrolled type 1 diabetes?

  • Metabolic acidosis

45

Polyuria can lead to _______

  • Shock

46

Do oral hypoglycemic agents work for Type 1 diabetics?

  • No

47

When are pregnant women screened for gestational diabetes?

  • 1st prenatal visit
  • At 24 to 28 weeks gestation

48

What are complications for the baby with a mother who has gestational diabetes?

  • Increased birth weight
  • Hypoglycemia

49

What is the normal A1C?

  • About 5

50

What would be the A1C levels if the pt had type 1 diabetes?

  • HbA1C 6.5 +

51

What is the fasting plasma glucose?

  • Normal
  • Diabetic
  • Normal
    • 99 or below
  • Diabetic
    • 126 or above

52

What are the signs and symptoms of DKA?

  • Hyperglycemia
  • Dehydration
  • Kussmaul respirations
  • Acid breath "fruity breath"

53

What is the criteria for metabolic syndrome?

  • Waist circumference
  • Lipids
  • Blood pressure
  • Fasting blood sugar
  • Waist circumference
    • Female: > 35 in
    • Male: > 40 in
  • Lipids
    • Triglycerides
      • > 150 mg/dL
    • HDL
      • Males:< 40 mg/dL
      • Females < 50 mg/dL
  • Blood pressure
    • 130/85
  • Fasting blood sugar
    • > 100 mg/dL

54

What syndrome is known to increase the risk for developing type 2 diabetes and cardiovascular disease?

  • Metabolic syndrome

55

What can help with glycemic control in a diabetic diet?

  • Client should be taught how to count carbohydrates

56

What should be included in a diabetic diet?

  • Counting carbs
  • Carbs should include fruits, vegetables, whole grains, and low fat dairy
  • High fiber foods
    • Eliminates the sharp rise/fall in BS

57

Describe the Plate Method

  • 9 inch plates
  • Fill 1/2 with non-starchy vegetables
  • 1/4 with carbs
  • 1/4 with protein

58

What should the client do pre-exercise to prevent hypoglycemia?

  • Eat something before

59

What is the action of Metformin?

  • Reduces glucose production and enhances how glucose enters the cell

60

What should a pt do if undergoing surgery or any radiologic procedure that involves contrast dye and taking metformin?

  • Termporaily discontinue metformin
  • Resume 48 hrs after procedure if kidney function has returned and the creatinine level is normal

61

What are signs of hyperglycemia?

  • Polyuria
  • Polydypsia
  • Polyphagia
  • Hot and dry skun
  • Slow wound healing
  • vision changes

62

What are acute causes that can cause hyperglycemia?

  • Sepsis (infection)
  • Stress (surgery, hospital stay)
  • Skip insulin
  • Steroids

63

What are signs of hypoglycemia?

  • Cool
  • Diaphoretic "clammy"
  • Pale
  • Nervous "anxious" "trembling"
  • Irritable
  • Weakness
  • Hunger
  • Headache

64

If hypoglycemic and awake, what should the pt take?

  • Eat simple carbohydrates (15 grams)
  • Juice, soda, crackers, low fat milk
  • Not fat milk or peanut butter
    • glucose absorption is delayed with foods with lots of fats
  • 15 gram of simple carb -> wait 15 min, if < 70 mg/dL -> 15 grams of sugar

65

If hypoglycemic and unconscious, what should the nurse do?

  • Push D50W IV
  • Injectable glucagon (subq, IM, IV)
  • Reassess in 15 min

66

What are causes for hypoglycemia?

  • Exercise (diabetics)
  • Alcohol
  • Insulin PEAK times

67

What are the complications of diabetes?

  • Renal failure
    • Indicated by creatinine over 1.3
    • Over 1.3 means kidney failure
  • Peripheral neuropathy
    • Nerve damage in the extremities
    • Diabetic feet -> gangree
  • Retinopathy
    • Can lead to blindness
  • Heart
    • Hypertension and atherosclerosis

68

When should you give a patient a food if they are taking insulin?

  • Give foods during peaks

69

What is the onset, peak, and duration for long acting insulin?

  • Onset: 1-2 hrs
  • Peak: None
  • Duration: 24 hrs

70

What is the onset, peak, and duration for NPH?

  • Onset: 1-2 hrs
  • Peak: 4-12 hrs
  • Duration: 18 - 24 hrs

71

What is the onset, peak, and duration for regular insulin?

  • Onset: 30-60 min
  • Peak: 2-4 hrs
  • Duration: 5-7 hrs

72

What is the onset, peak, and duration for rapid insulin?

  • Onset: 5-30 min
  • Peak: 30-90 min
  • Duration: 3-5 hrs

73

What insulin cannot mix with other insulins?

  • Long acting
  • Determir and Glargine

74

What insulin has the highest risk for hypoglycemia?

  • Rapid
  • Lispro, aspart, glulisine

75

What insulin has the lowest risk for hypoglycemia?

  • Long acting - glargine and detemir

76

What insulin is given only IV?

  • Regular

77

Detemir =

  • "Lasts All Year"

78

How to mix regular and NPH insulin?

  • clear to cloudy

79

What insulin cannot be given in an IV?

  • NPH

80

What should a diabetic avoid in their diet?

  • Simple sugars
  • Soda, candy, white bread, juices, pastas, fries, low fat milk

81

What should a diabetic have in their diet?

  • Good carbs
  • High fiber (complex carbs)
  • BROWN - beans, rice, bead, peanut butter
  • WHOLE - whole wheat/grain/milk

82

What type of diabetes leads to DKA?

  • Type 1 diabetes

83

What type of diabetes leads to Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS)?

  • Type 2

84

Does Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) produce ketones?

  • No

85

What are causes of DKA?

  • Sepsis (infection)
  • Sickness
  • Stress (surgery)
  • Skip insulin

86

What are the are the signs and symptoms of DKA?

  • Dry and high sugar 250-500+
  • Ketones and Kussmaul respirations -> rapid fruity breath
  • Abdominal pain
  • Metabolic acidosis (pH 7.35 or less)

87

What are the signs and symptoms of HHNS?

  • High sugar (over 600+)
  • Extreme dehydration
  • Neurological manifestations - confusion

88

What is the priority action for DKA and HHS?

  • Treat the dehydration first
    • 0.9% normal saline

89

What is the treatment for DKA?

  • Treat the dehydration first
    • 0.9% normal saline
  • Lower the sugar slowly
    • Hourly BS checks
    • Over 250 BS = IV regular insulin only
    • Below 200 BS = IQ insulin + D50 IV
  • Add potassium (even if normal)
    • DURING IV insulin

90

What is the treatment for HHNS?

  • Treat the dehydration first
    • 0.9% normal saline
  • Insulin IV = Only regular insulin