Chapter 35 – The Endocrine System
Organs and Structures of the Endocrine System
Pituitary gland connects to the hypothalamus via the hypophyseal stalk. Has two parts
o Adenohypophysis – anterior pituitary
o Neurohypophysis – posterior pituitary
Thyroid gland has two lobes and lies below the larynx over the thyroid cartilage, in front of and on either
side of the trachea
Parathyroid glands are four to six small glands that are located on the posterior surface of the thyroid gland
Adrenal glands are located on the anterior upper surface of each kidney; each is composed of the cortex and
medulla
Pancreas sits in the upper left aspect of the abdominal cavity, both found in islets of Langerhans
o Beta cells – secrete hormone insulin
o Alpha cells – secrete glucagon
Pineal gland is in the midbrain, in the cranial vault
Thymus gland lies at the base of the neck in the front of the thoracic cavity
Heart is midchest and functions as an endocrine gland when it secretes the hormones atrial natriuretic
peptide (ANP) or B-type (or brain) natriuretic peptide (BNP- -
-
Target tissue – make do something or stop do something, system talk to each other to make things work, if
not that’s where diabetes and such comes in
thyroid gland –figure 35.1 metabolic rate, keep electrolyte regulated, T3, T4
Mineralocorticoids – work with kidney
Insulin – gatekeeper of cells
Heart – tell kidney to get rid of sodium, so start losing water
Functions of the Endocrine System
When the muscle is stretched, the heart secretes hormones with a diuretic effect
Endocrine system alters chemical reactions and controls the rate at which chemical activities take place
within cells
Hormones secreted change the permeability of cell membranes and select the substances that can be
transported across cell membranes
Endocrine hormones activate a particular mechanism in a cell, such as the system that controls cellular
growth and reproduction.
Table 35.1 The Principal Endocrine Glands and Their Hormones
Effects of the Pituitary Hormones
Any type of dysfunction of the pituitary gland will affect one or more of the hormones as well as their
target organs
Posterior pituitary gland does not produce hormones; it stores and then releases oxytocin and antidiuretic
hormone (ADH), which are produced in the hypothalamus
The anterior pituitary produces hormones that are secreted into the bloodstream as a result of “releasing
hormones” from the hypothalamus
Effects of the Thyroid Hormones
The thyroid gland secretes the hormones thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin. The 3
and 4 indicate how many iodine atoms are attached.
T3 is the more potent form of thyroid hormone. T4 is converted to T3 by removing an iodine atom from the
T4 molecule
Intake of protein and iodine is needed so synthesize both thyroid hormones
Thyroid hormones activate the cellular production of heat; stimulate protein and lipid synthesis,
mobilization, and degradation (breakdown); and stimulate the manufacturer of coenzymes from vitamins
Regulate many aspects of carbohydrate metabolism and affect tissue response to epinephrine and
norepinephrine
Figure 35.2 Effects of Hormones from the Pituitary Gland
Functions of the Parathyroid Glands
Parathormone or parathyroid hormone is produced and secreted by the parathyroid glands
Low calcium level will stimulate release of parathormone, which increases the plasma level of calcium. A
high calcium level will inhibit the release of parathormone
Acts on the renal tubules to increase the excretion of phosphorus in the urine and to stimulate the
reabsorption of calcium. It also stimulates the production of the active form of vitamin D, which enhances
calcium absorption in the small intestine. Parathormone also acts on bone, causing the release of calcium
from the bone into the bloodstream
-
Calcitonin (released by the thyroid gland) is the balance to parathormone that causes calcium to go into the
bones and allows for renal excretion to reduce calcium levels in the blood
Deficiency of parathyroid hormone produces muscle cramps, twitching of the muscles, and in some cases
severe convulsions because of hypocalcemia
Normal calcium level – 8.6 – 10.3
Regulates plasma level of calcium
Functions of the Adrenal Gland Hormones
Adrenal medulla (middle portion) secretes two hormones, epinephrine and norepinephrine (called
catecholamines), in response to stimulation from the sympathetic nervous system
Epinephrine prepares the body to meet stress or emergency situations and prevents hypoglycemia.
Norepinephrine functions as a pressor (causing blood vessel constriction) to maintain blood pressure. Blood
pressure maintenance could be during flight or right
Functions of poo and pee could be relaxed because we don’t need those in emergency situation, need
functions that run and fight
Hormones secreted by the adrenal cortex are called adrenal corticosteroids
Two major types of hormones secreted by the adrenal cortex are the mineralocorticoids (aldosterone) and
the glucocorticoids (cortisol)
Androgenic hormones have effects similar to those of the male and female sex hormones
Mineralocorticoids affect the electrolytes, particularly sodium, potassium, and chloride
o Primary mineralocorticoid is aldosterone, which promotes conservation of water by acting on the
kidney to retain sodium in exchange for potassium. Water stays with sodium, and potassium is
excreted in the urine
Without mineralocorticoids, a person would die within 3 to 7 days
o Hormones directly control fluid balance, blood volume, cardiac output, exchange of nutrients, and
wastes in each cell; mineralocorticoids affect all chemical processes and glandular functions
within the body
Glucocorticoids are essential to the metabolic systems for proper use of carbohydrates, proteins, and fats
Primary glucocorticoid is cortisol, or hydrocortisone. Cortisol acts to increase glucose levels in the blood.
Cortisol also helps counteract the inflammatory response
Both aldosterone and cortisol are controlled by adrenocorticotropic hormone (ACTH)
releasing hormone from the hypothalamus and ACTH secreted by the anterior pituitary
Figure 35.4 Effects of Epinephrine and Control of its Secretion
Hormonal Function of the Pancreas
Endocrine – secretes into the bloodstream, produce the hormones insulin and glucagon
Exocrine – secretes through duct to the target tissue
Beta cells I responsible for producing and secreting insulin. Insulin is needed for the cells of the body to be
able to use glucose as fuel. The Alpha cells release Glucagon, which stimulates the liver to change
glycogen to glucose.
Figure 35.6 Blood Glucose Regulation
Effects of Aging on the Endocrine System
Negative feedback loop – got enough of insulin, sugar whatever it may be, whatever level need, kick back
and say “no more”
Pituitary gland becomes smaller
Thyroid becomes more lumpy or nodular; beginning around age 20 metabolism gradually declines
Hormones that usually decrease with older age include aldosterone, renin, calcitonin, and growth hormone;
Specific hormones decrease in older woman are estrogen and prolactin and older men - testosterone
Hormones that may increase with older age include follicle stimulating hormone FSH, luteinizing hormone
LH, norepinephrine, and ADH
hormones that remain unchanged include thyroid hormones T3 and T4 , cortisol, insulin, epinephrine,
parathyroid hormone, and 25-hydroxyvitamin D
Although insulin levels remain unchanged with age, decreased glucose tolerance may occur because of
changes in the cell receptor sites; older adults experience hypoglycemia more quickly than younger people
and may progress to dangerously low levels of blood glucose before signs and symptoms are obvious . This
decreased glucose tolerance because of cell receptor change can place older adults at risk for
hyperglycemia and the onset of type 2 diabetes
-
Although thyroid hormone levels may decrease with aging, the body makes up for it by decreasing the rate
at which thyroid hormone is broken down; therefore, resting levels of thyroid hormone are usually normal
in older adults. However thyroid disorders are twice as common in older adults . Hypothyroidism is the
most common thyroid disorder, especially in older women
The Endocrine System
The endocrine system regulates metabolism, growth and development, sexual function, and reproductive
processes.
A primary function of the endocrine system is to synthesize and release hormones directly into the
bloodstream. The cells and tissues that are affected by a specific hormone are called its target cells or target
tissues.
Some of the endocrine hormones such as the thyroid hormones affect practically every cell in the body.
Others such as sex hormones exert their special effects on only one organ system. Hormones from one
endocrine gland can affect another endocrine gland. The pituitary gland for example secretes several
different kinds of hormones that affect other endocrine glands. For this reason, the pituitary gland is often
referred to as the “master gland” of the body.
The endocrine system and the nervous system are two major control systems of the body and their
regulatory functions are interrelated. However, the endocrine system typically controls body processes that
occur slowly such as cell growth whereas the nervous system controls body processes that occur more
rapidly such as breathing and body movement
The secretion of a particular hormone normally depends on the need. If an endocrine gland receives the
message that its hormone is in short supply, it will synthesize and release more of that hormone. If the
hormonal need of a target tissue is being satisfied, production or secretion of the hormone would be
inhibited, a concept known as negative feedback.
Endocrine System Disorders
Causes
o Endocrine disorders are caused by an imbalance in the production of hormone or by an alteration
in the body's ability to use the hormones produced. Dysfunction can occur at any point in the
production secretion feedback regulation cycle.
o Primary endocrine dysfunction means that an endocrine gland is either oversecreting or
undersecreting hormones - situations referred to as hypersecretion and hyposecretion.
Hyposecretion is usually the result of destruction of endocrine glandular tissues by an
inflammatory process or other destructive mechanism that interferes with normal endocrine
function. Infection, mechanical damage, or an autoimmune response may cause such an
inflammatory response in a gland.
o Secondary endocrine dysfunction occurs from factors outside the gland itself. Medications,
trauma, hormone therapy, and other factors may cause secondary dysfunction. Such dysfunction
may be temporary or permanent, endocrine function often returns to normal if the cause is
corrected for example the medication is continued.
Prevention
o Preventing most endocrine disorders is not possible through lifestyle changes, however, there are
some dietary considerations regarding the thyroid gland that may be beneficial.
o Goiter, an overgrowth of the thyroid, may be prevented by sufficient intake of iodine. Iodine is
available in foods grown near the ocean an in seafood. Iodized salt is the major source for most
people.
Diagnostic tests and procedure
o Blood samples, urine samples, scans, ultrasounds, radiographs, MRI.
o Abnormalities in thyroid gland activity are among the most common endocrine disorders. To
detect abnormalities, a group of tests called a thyroid panel is performed. A thyroid panel
measures TSH, T4, T3, thyroid antibodies, calcitonin, and thyroglobulin.
o Adrenal gland function is evaluated by laboratory testing, including electrolyte panels, glucose
levels, and hormone levels. A 12 lead electrocardiogram ECG may be performed if cardiac
dysrhythmias are suspected.
o Diagnosis of diabetes mellitus is based on one of the four abnormalities
 Symptoms of diabetes mellitus plus a random glucose level greater than or equal to 200
 A fasting glucose level greater than or equal to 126
 A hemoglobin A1C level greater than 6.5%

o
o
o
A glucose tolerance test revealing a postprandial glucose greater than or equal to 200, 2
hours after 75 grams of glucose is administered
In a glucose tolerance test the patient is given a set amount of glucose to evaluate insulin secretion
and ability to metabolize glucose
The hemoglobin A1C test measures blood glucose or a period of many weeks
Thyroid test results are altered by iodine-based contrast media for radiologic studies. Furosemide,
phenytoin, heparin, aspirin, and other drugs may affect thyroid tests
Table 35.2 Diagnostic Tests and Procedures of the Endocrine System
Test
Purpose
Description
Blood Tests
TSH
Normal value: 0.3-5
mcU/mL
Pituitary hormone
levels: LH, FSH, GH,
ACTH, TSH, prolactin
to differentiate between
pituitary dysfunction and
primary thyroid
dysfunctional assists with
diagnosis of
hyperthyroidism
To detect oversecretion or
deficiency of pituitary
hormones
Serum T4 (total
thyroxine)
Normal: 4.5-12
To assess thyroxine in
blood to evaluate thyroid
function
Serum T3 (total
triiodothyronine)
Normal: 70-190
Calcitonin
Normal: M - <19
F - <14
Used for differential
diagnosis of cancer of the
thyroid
venous blood sample
Cortisol
Normal: 0800 – 5-23
1600 – 3-13
To assess quarters or
production by adrenal
glands
sample venous blood
BNP
Normal: <100
BNP levels vary greatly
by laboratory
To identify elevated
levels for evaluation of
CHF and to monitor the
effectiveness of treatment
standard venous blood
draw
Thyroid Scans
Nursing Implications
requires a venous blood
sample levels vary
through the day, with
lower levels at 10 a.m.
and highest levels at 10
p.m.
sample of venous blood is
drawn for immunoassay
tests, check laboratory
procedure manual
venous blood sample
Aspirin, iodine-containing
medications, contrast
media, and other drugs
may affect results, check
with laboratory
If base level is within
normal, the pentagastrin
stimulation test may be
administered by injection
to test for calcitonin
secretion
blood samples are then
drawn 1 1/2 and 5
minutes after injection
Explain that a specimen
may be collected two or
three times in 24 hours to
evaluate circadian and
effects on cortisol
secretion
Keep stress to a
minimum
levels >500 are 90%
predictive of CHF. biotin
affects results. sample
should be taken a
minimum of eight hours
after the dose
monitor venipuncture site
for bleeding, apply
bandage or dressing
Aspirin, iodine-containing
medications, contrast
media, and other drugs
may affect results, check
with laboratory
To assess function of
thyroid gland
to measure the rate of
iodine uptake by the
thyroid
trace dose of radioactive
iodine is given orally
test may not be performed
during pregnancy or
lactation
explain the amount of
radioactive iodine used is
small and will not make
the patient radioactive
explain procedure and
time it will take
instruct how to collect 24
hour urine specimen if
required
17hydroxycorticosteroids
17-OHCS
Normal: 2-8/24 – F
3-9/24 – M
to determine levels of
glucocorticoid
metabolites
instruct patient in
collection procedure
note start and end time of
collection on laboratory
slip
17-ketosteroids
17-KS
Normal: 6-17/24 – f
6-20/24 – M
Older than age 65: 4-8/24
Fluid Deprivation Test
to determine amount of
androgen metabolites In
the urine
Collect a 24-hour urine
specimen in a container
with preservative
medications may
interfere, consult with
health care provider and
laboratory about
medications patient is
taking
Collect 24-hour urine
specimen
Radioactive Iodine
Uptake
Urine Tests
To detect diabetes
insipidus
while patient is NPO,
hourly urine output,
specific gravity, and
osmolality are measured,
along with body weight
and vital signs
vasopressin is given
subcutaneously; hourly
measurements are
continued for several
hours
Table 35.3 Diagnostic Tests for Detecting and Monitoring Diabetes Mellitus
Test
Purpose
Description
To determine level of
requires a fasting venous
Fasting Blood Glucose
Normal: 70-100
circulating glucose, to
blood sample
Older Adults: rises 1
detect hyperglycemia or
mg/dL per decade of age
hypoglycemia
To determine need for
venous blood sample
2-h postprandial blood
glucose tolerance tests, to drawn 2 hours after a
glucose
Normal: 0-50 - <140
determine change in
meal
50-60: < 150
diabetes therapy
60+: <160
to detect abnormal
venous blood sample is
Glucose Tolerance Test
Normal:
glucose metabolism, to
drawn after a 10-to-12Fasting <110
hour fast patient is usually
instruct patient in
collection procedure
note start and end time of
collection on laboratory
slip
Explain procedure to the
patient
provide urine collection
containers remind patient
to avoid hourly
Nursing Implications
explain importance of
fasting state to the patient
explain the importance of
arriving for blood
sampling exactly 2 hours
after finishing a meal
instruct patient to eat a
balanced diet fast for 11 –
12 hours
1 - <180
2 - <140
3 – 70-115
4 – 70-115
Hemoglobin A1C
Normal: 4% - 5.9% of
total hemoglobin
Good diabetic control
<7%
assist in diagnosis of
diabetes mellitus
Fructosamine assay
normal: 1.5 – 2.7
to determine degree of
diabetic control of blood
sugar over preceding two
to three weeks
To determine degree of
diabetic control of blood
sugar over the preceding
two to three months
given a prepared liquid of
300 milliliters that
contains a specific
amount of glucose
a sample of venous blood
is required, fasting is not
necessary
sample of venous blood is
required, fasting is not
necessary
explain to the patient the
need for this test to be
done periodically to
monitor effectiveness of
diabetic therapy and
determine degree of
control over the disease
process
less influenced by age
than A1C, serum albumin
level will affect results
Table 35.4 Average of Blood Glucose Based on A1C Levels
A1C Level
Average Blood Glucose
4%
68
5%
97
5.7% to 6.4%
pre-diabetes
6%
126
greater than 6.5%
type 2 diabetes
7%
154
Chapter 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
Disorders of the Pituitary Gland
Hypersecretion or hyposecretion of hormones can be caused by various pathology. pituitary tumors can
stimulate the release of excessive amounts of a hormone, which can cause disorders such as Cushing
syndrome, syndrome of inappropriate antidiuretic hormone SIADH or acromegaly. Damage to the pituitary
may result in hyposecretion of hormones, resulting in conditions such as Addison disease, diabetes
insipidus die, or dwarfism.
Pituitary Tumors
If the tumor is large enough, there is increased pressure within the optic chiasm the part of the brain with
optic nerve fibers cross, which have not reliable damage the optic nerve
s/s
o Headache from the pressure of the tumor in visual disturbance , with possible blindness, systemic
symptoms may be very can progress very slowly. Personality changes, weakness, fatigue, vague
abdominal pain can be present for years before the condition is diagnosed correctly
Diagnosis
o Diagnosis of a pituitary tumor begins with a complete history and physical examination. MRI and
a high-resolution computed tomography CT with contrast media may be used to identify the extent
of the tumor. Laboratory studies will be done to see which hormones are affected
Treatment
o hormone therapy designed to reduce levels of hormone production
o some specialists prefer to remove the pituitary tumor surgically and then treat the site with
radiation to be sure that all tumor cells have been destroyed
o Hypophysectomy surgical removal of the pituitary gland is most commonly performed micro
surgically
o the usual approach is transsphenoidal via the nose or at the junction of the gums and upper lip
Hyperfunction of the Pituitary Gland
Excessive secretion of growth hormone GH results in gigantism in children, leading to excessively tall
stature, because the bone growth plates have not yet closed.
In adults the result is acromegaly, when prolactin or gonadotrophin are excessive, alteration in fertility and
sexual function may occur. ACTH and TSH can also be secreted in excess. Excessive ADH causes
syndrome of inappropriate ADH the society age
Gigantism causes the lips too thick and, the nose and largest, and forehead develops a bulge. The hands and
feet become enlarge and adults, the first sign may be that the patient shoes no longer fit. Muscle weakness
may occur with acromegaly and osteoporosis in joint pain are common
removal of the pituitary adenoma is indicated if a tumor is the cause
Hypofunction of the Pituitary Gland
Characterized by a decrease in the level of one or more of the pituitary hormones
most common cause of pituitary hypofunction is a tumor , other causes include autoimmune disorders,
infection, or destruction of the pituitary.
Sheahan syndrome involves infarction of the gland secondary to postpartum hemorrhage
most common pituitary hormone deficiency involves a decrease in the amount of GH and gonadotropins .
This decrease results in metabolic problems and sexual dysfunction.
Signs and symptoms of pituitary hypofunction depend on the cause of pituitary failure and the hormones
involved
Diabetes Insipidus
Characterized by the production of copious amounts of dilute urine. DI results from decreased production
of ADH which regulates absorption of water in the kidney tubules. When ADH is not present enough
sufficient amount, the water is not reabsorbed from the tubule and is excreted as urine. The most common
forms of DI or central and nephrogenic. Most commonly occurs after trauma or surgery in the area of the
pituitary or hypothalamus and may be temporary or permanent
The patient experiences profound diuresis, production of large amount of urine, often as much as 3 to 20
liters in every 24-hour period. Other symptoms include thirst, weakness, fatigue, nocturia. Patient will
exhibit signs of deficient fluid volume, such as tachycardia, hypertension, weight loss, and constipation. If
untreated the patient will demonstrate signs of shock and central nervous system manifestations,
progressing from irritability to eventual coma from hypernatremia and severe dehydration
Treatment includes replacement of fluid and electrolytes, along with hormone therapy, represents the basis
of treatment of DI.
diabetes insipidus was named based on the polyurea that is similar to diabetes mellitus , however diabetes
insipidus has no effect on the blood glucose level
Syndrome of inappropriate anti diuretic hormone SIADH
excessive amounts of ADH are produced, resulting in fluid retention. Numerous factors can cause SIADH,
including malignancies and tumors pressing on the pituitary
signs and symptoms include confusion, seizures, and loss of consciousness, accompanied by weight gain
and edema. Hyponatremia from fluid access, with serum sodium less than 120 , occurs frequently
diagnosed by performing urine and serum osmolality test
treatment is aimed at correcting the underlying cause, restricting fluids to 500 to 1000 milliliters a day
Disorders of the thyroid gland
abnormalities in the thyroid gland activity and resultant changes in the levels of thyroid hormones are
among the most common disorders affecting the endocrine system. The thyroid gland secretes the hormone
T4 and T3 an thyrocalcitonin. The secretion of thyroid hormones is regulated by the hypothalamic pituitary
thyroid control system. All three organs are involved in the closed loop negative feedback system low
thyroid and norepinephrine serum levels can activate the hypothalamus.
Goiters
A goiter is a greatly enlarged thyroid gland. One type of goiter is caused by a deficiency of iodine in the
diet. Iodine deficiency can be prevented by increasing iodine intake. The first sign is usually an enlarged
neck.
If goiter resulting from iodine deficiency is treated early, the growth of the gland can be arrested, and in
some cases the enlargement will eventually disappear
Supplemental thyroid hormone is given in the form of levothyroxine
-
patients with goiter may develop toxic goiter when given iodine-based contrast media for imaging
procedures. Pre-medication with beta blockers may help prevent the condition
iodine preparation should be given while diluted and administered through a straw because they can stain
the teeth. Adverse effects of iodine preparations can glue GI upset, metallic taste, skin rashes, allergic
reactions, and epigastric pain.
Hyperthyroidism
Adult woman between 30 years old and 50 years old of age
primary hyperthyroidism is the result of an abnormality of function involving the thyroid gland itself and
causes excessive circulation of thyroid T4 and T3 hormones
it is possible for only the T3 level to be elevated if the patient has Graves' disease, toxic nodular goiter, or
toxic adenoma of the thyroid
Secondary hyperthyroidism usually as a result of an abnormality in another gland such as the pituitary
gland producing too much TSH and therefore overstimulating the thyroid gland
Primary hyperthyroidism can result from an autoimmune disorder such as Graves' disease, also called toxic
goiter. Medications containing iodine such as amiodarone an antidysrhythmic heart medication can
predispose to hyperthyroidism.
Earliest symptoms of hyperthyroidism may be weight loss despite a good appetite and nervousness.
Symptoms can include weakness, insomnia, tremulousness, agitation, tachycardia, palpitations, exertional
dyspnea, ankle edema, difficulty concentrating, diarrhea, increased thirst and urination, decreased libido,
scanty ministration, and infertility
Older adults may exhibit atypical presentation such as shortness of breath, palpitations, or chest pain.
Simple fatigue and slowing down may be the only presentation in this patient population.
If hyperthyroidism is not diagnosed correctly and continues untreated for any length of time period the
patient can develop cardiomyopathy, heart failure, and cardiac related death. Patients with hyperthyroidism
also exhibit an enlarged thyroid gland known as toxic goiter an abnormal protrusion of the eyeball or
exophthalmos
hyperthyroidism may be treated medically by administering radioactive iodine and anti-thyroid drugs, mild
sedatives, and beta-adrenergic blocking agents to control tremor, temperature elevation, restlessness, and
tachycardia
anti-thyroid drugs are prescribed as the initial treatment of hyperthyroidism/ Methimazole (Tapazole) is the
main drug used. The patient must take the antithyroid drug at the prescribed time and strictly according to
schedule.
Radioactive iodine 131 I, also known as ablation therapy, is the definitive treatment for hyperthyroidism , it
destroys thyroid tissue. Main disadvantage of ablation therapy is the possibility of hypothyroidism,
deficient activity of the thyroid gland, caused by over effective treatment.
After treatment all body fluids can be radioactive for a short time. Because the iodine circulates in the
blood and is excreted by the kidneys, precautions must be taken when handling needles, syringes, none
other equipment likely to be contaminated with blood and when handling bedpans, journals, and specimen
containers likely to be contaminated with urine
all patients receiving radioactive iodine must be observed for signs of thyroid crisis resulting from radiation
induced thyroiditis
Use of aspirin is contraindicated in patients with thyrotoxicosis. Aspirin interferes with protein binding and
increases the free form of T3 and T4. Aspirin is used as an anti-platelet medication for cardiovascular
disorders and is commonly found in combination analgesic medications
Sometimes it is difficult for the patient's family to accept and cope with the emotional outbursts and mood
changes that occur when the disease is not under control period once hormone levels returned to the normal
range, the mental and physical symptoms should subside.
Thyroidectomy
Patients who do not respond well to anti thyroid drug therapy, who are unable to take radioactive iodine, or
who have greatly enlarged thyroid glands or candidates for a subtotal thyroidectomy.
2/3 of the glandular mass is removed. The remaining portion of the gland is left intact so that production
and release of thyroid hormones can continue.
Preoperative nursing care reports nervousness, tense, apprehensiveness to the surgeon. These symptoms
may indicate improper control of the thyroid gland and may predispose the patient to the postoperative
complication of thyroid crisis
-
Thyroid storm also known as thyroid crisis or thyrotoxicosis is another possible complication of
thyroidectomy. In the postoperative setting, the condition is caused by a sudden increase in the output of
thyroxine carbon manipulation of the thyroid as it is being removed. Thyroid storm can also be triggered by
other factors than related to surgery
Symptoms of thyroid storm are produced by a sudden and extreme elevation of odd body processes
causes of thyroid storm
o administration of drugs or dyes containing iodine
o pregnancy and childbirth
o myocardial infarction or cardiac emergencies
o infection
o severe emotional distress
o trauma or surgery
Report any changes in vital signs or behaviors in patients with thyroid disorders
use caution with radiology contrast studies, radiocontrast agents have iodine as a base. Imaging studies
routinely use these substances. Patients with iodine deficiency or at risk for iodine induced hyperthyroidism
Hypothyroidism
caused by inflammation of the thyroid gland that damages tissues, iodine deficiency, decreased TSH
secretion, hypothalamus dysfunction, atrophy of the thyroid gland, or treatment of hyperthyroidism that
results in destroying too much thyroid cells and therefore deficient of thyroid hormone.
o Congenital hypothyroidism (cretinism)
Children with hypothyroidism have delayed physical and mental growth and become very sluggish within a
few weeks after birth
Older adults who exhibit lethargy, slow thought processes, and lack of enthusiasm could be demonstrating
signs of hypothyroidism rather than a brain disorder such as dementia, hypothyroidism is particularly
common in older woman.
Self-care management of hypothyroidism
o take levothyroxine on an empty stomach , same time each day, contact your health care provider if
you experienced unusual bleeding, bruising, chest pain, palpitations, sweating, nervousness, or
shortness of breath
o report signs of myxedema (low thyroid production) such as dizziness respiratory distress low
blood sugar hypothermia in hyperthyroidism such as weakness palpitations agitation increased
urination thirst diarrhea insomnia
Myxedema Coma
Rare but life threatening. Can be precipitated in patients with hypothyroid by abrupt withdrawal of thyroid
therapy , acute illness, anesthesia, use of sedative or narcotics, surgery, or hypothermia. Signs are loss of
consciousness, along with hypo tension, hypothermia, respiratory failure, hyponatremia, and hypoglycemia.
Disorders of the Parathyroid Glands
Hypoparathyroidism is most commonly caused by atrophy or dramatic injury to the parathyroid glands.
This can occur as a result of accidental removal or destruction of parathyroid tissue during a thyroidectomy.
Signs include hypocalcemia include mild tingling, numbness, muscle cramps, mental changes, such as
irritability. Chvostek sign manifest as muscle irritability when the facial nerve is gently tap. Trousseau Sign
manifest as a carpal spasm felicitated by inflating a BP cuff 20 above the systolic blood pressure . Tetany is
a serious sign resulting from a lowered serum calcium level. In tetany muscular twitching and spasm occur
because of extreme irritability of neuromuscular tissue.
Disorders of the Adrenal Glands
Pheochromocytoma
o Rare tumor of the adrenal medulla that secretes catecholamines (epinephrine and norepinephrine)
o Signs and symptoms include tachycardia and severe hypertension that can be intermittent or
persistent. Profuse diaphoresis, severe headache, palpitations, nausea, weakness, and pallor may
also be present
o May be removed laparoscopically of the tumor (adrenalectomy)
Addison Disease (Adrenocortical Insufficiency)
o Characterized by decreased function of the adrenal cortex, resulting in a deficit of all three
hormones secreted by the adrenal cortex, cortisol, aldosterone, and testosterone. The major
problems are related to insufficiencies of the mineral corticoids and glucocorticoids. The
insufficiency of the androgenic hormones can be compensated by the ovaries and testes.
o
insufficient production of the adrenocortical hormones can result from a disorder affecting the
adrenal cortex itself, primary insufficiency, from a disorder affecting the pituitary gland that
stimulates the adrenal secretion, secondary insufficiency.
o Signs and symptoms include generalized malaise and muscle weakness, muscle pain, orthostatic
hypotension, and vulnerability to cardiac dysrhythmias.
o Managing Addison disease
 the importance of taking the medication every day and never stopping corticosteroids
suddenly, they need to be tapered off slowly . Signs and symptoms such as worsening
weakness, hypertension, confusion, infection, should be reported to the health care
provider
Acute adrenal insufficiency or adrenal crisis
conditions that decrease the amount of circulating cortisol interfere with the ability of the blood vessels to
constrict. Patients with Addison disease have a decrease in or absence of adrenal cortical secretion,
primarily cortisol.
Decreased levels of cortisol result in decreased sensitivity of the blood vessels to sympathetic stimulation.
It is the sympathetic stimulation that maintains vascular tone. lack of vascular tone causes basal dilation,
producing hypotension. Cortisol helps maintain blood pressure in cardiovascular function, so that the acute
lack of it will decrease blood pressure and produce typical signs and symptoms of shock.
Access adrenocortical hormone Cushing syndrome
symptoms typical of Cushing syndrome are manifestations of excess levels of the hormones from the
adrenal cortex
o excessive secretion of ACTH by the pituitary , secreting tumor of the adrenal cortex, ectopic
production of ACTH by tumors outside the pituitary, Iatrogenic Cushing syndrome for prolonged
use of steroid therapy, the most common cause.
A 24- hour urine test should be performed. If cortisol is elevated, a dexamethasone suppression test should
be ordered, for the test the patient is given a steroid at night and blood in urine cortisol levels are then
measured in the morning.
Signs are caused by excessive levels of cortisol. Include painful fatty swellings in that interest scapular
space called Buffalo hump and facial area called moonface, an enlarged abdomen with thin extremities,
bruising after even minor trauma, impotence, a menorrhea, hypertension, and weakness from abnormal
protein catabolism with loss of muscle mass. Unusual growth of body hair called here suit ISM can occur in
women and St purple markings in the abdomen area can occur because of collection of body fit
Figure 36.6 Common Characteristics of Cushing Syndrome
Chapter 37 Care of Patients with Diabetes and Hypoglycemia
Diabetes Mellitus
Group of disease in which there is disturbance in metabolism and use of glucose.
Type 1 Diabetes is secondary to a malfunction of the beta cells of the pancreas. Beta cells are responsible
for making insulin. Because insulin is involved in the metabolism of carbohydrates, proteins, and fats,
diabetes mellitus is not limited to a disturbance of glucose homeostasis but alters other body functions as
well
Type 2 diabetes prevention
o increasing intake of nuts, berries, yogurt, coffee, and see in an overall healthful diet to decrease the
risk of type 2 diabetes
o insulin resistance in which insulin interaction with glucose becomes less efficient, and therefore
glucose metabolism is abnormal
gestational diabetes
o stress of pregnancy
Types of diabetes mellitus
type 1 – insulin-dependent diabetes mellitus
o 5-10% of all cases
o Occurs when body's immune system destroys insulin producing beta cells. There is no way to
prevent type one diabetes.
o People who have type one diabetes require injections of exogenous , from outside the body,
insulin to maintain life because they produce little or no endogenous, inside the body, insulin on
their own
o more prone to serious complication, ketosis, associated with an excess production of ketone
bodies, leading to ketoacidosis, metabolic acidosis
o develop early in life
type 2 – non-insulin dependent diabetes mellitus
o makes up 90% to 95% of all known cases of diabetes
o begin with insulin resistance, in which insulin interaction with glucose becomes less efficient, and
therefore glucose metabolism is abnormal . More insulin is produced by the pancreas to maintain
cellular metabolism
o tends to develop later in life than type 1 , patients with type 2 rarely develop diabetic ketoacidosis
o Type 2 diabetes is being diagnosed more frequently in children and adolescents, particularly in
American Indians, African Americans, and Hispanic Americans
Latent autoimmune diabetes in adults LADA is a form of type one diabetes it is believed that the presence
of islet cell antibodies in the blood will eventually destroy the beta cells and insulin production will cease
o patients with LADA are usually not overweight, have no signs of metabolic syndrome, and may
have a history of personal or familial autoimmune disease,
o diagnosis
 onset after age 30 years
 islet cell antibody circulating in the blood
 insulin is not required sooner than six months after diagnosis
35% to 60% of women with gestational diabetes are diagnosed with type 2 diabetes in the same years after
delivery the baby also carries an increased risk of type 2 diabetes
genetic factors, metabolic factors, emotional or physical stress, obesity
with rate weight reduction and increased physical activity, blood glucose can be restored to normal levels
and maintain there, hence the import of diet and exercise in the manage of type 2 diabetes
The classic symptoms of diabetes mellitus regardless of type, are related to an elevated blood glucose level
or hyperglycemia. Hyperglycemia increases the concentration of the Inter vascular fluid, raising its osmotic
pressure and pulling water from the cells and tissues into the blood, causing cellular dehydration. The
kidneys try to get rid of the extra glucose in the urine. Glucose is a large enough molecule to have
automatic properties and pulls water with it when are limited in the urine.
o Glycosuria – loss of glucose and water in the urine also causes electrolyte loss
o Polydipsia – cellular dehydration causes thirst and a resultant increased intake of water
o Polyuria – osmotic diuresis increases urination
Polyphagia – hunger, result of the body’s effort to increase its supply of energy, even though the
intake of more carbs does not meet the energy needs of the cells because insulin is not available or
effective at allowing glucose into the cells
Fatigue and muscular weakness occur because the glucose needed for energy is not metabolize properly
weight loss in patients with type one diabetes occurs from the loss of body fluid and absence of sufficient
insulin for use of glucose, the body begins to metabolize its own proteins and stored fat for energy. The
oxidation of fats is incomplete and fatty acids are converted into ketone bodies and acetone. When the
kidney is unable to handle accumulated ketones in the blood, ketosis occurs.
People with diabetes are prone to infection, delayed healing, and vascular diseases. The increased risk for
infection is not to be partly a result of decreased normal function of leukocytes in abnormal phagocyte
function but is primarily from the hyperglycemic environment. Another contributing factor to infection and
delayed healing may be decreased blood supply to the tissues because of Arthur sclerotic changes in the
blood vessel.
Older adults experience hypoglycemia more quickly than do younger people, and older adults are more
prone to hypoglycemic episodes. Diet is the cornerstone of diabetic treatment
Practice good foot care and wearing appropriate shoes and socks. This is very important if there is
peripheral neuropathy resulting in decreased sensation.
Walking, swimming, or stationary bicycle riding are among the safest activities for this group . Exercise
should begin slowly and build up to 30 to 45 minutes, three or four times a week. The gradual increase
helps prevent hypoglycemia, stress fractures, and cardiovascular complications. Older patients with
diabetes are at risk of developing hypoglycemia up to 24 hours after exercising if the exercise is to
strenuous
before my XL exercise when insulin or an oral anti diabetic agent is at its peak of action can bring on an
acute hypoglycemic reaction
because the sulfonylureas from the same family of drugs as the sofa might antibiotics, they must be given
with caution to persons known to have an allergy to sulfa drugs
Metformin is the preferred drug for type 2 diabetes
o
-
-
-
-
Table 37.2 Hypoglycemic Agents
Table 37.3 Common Types of Insulins: Onset, Peak, and Duration of Action
Insulin Therapy
Every insulin dose must be verified by another nurse that is a drawn up every time
patients must be careful when dialing the dose of insulin into a pen injector. If performed incorrectly, the
number of the dosage will be transported. This could happen if the pen is held in the left hand or if the
number scale is held upside down
insulin injections are rotated within one body area to enhance absorption. Insulin enters the bloodstream at
different speeds when given at different sites. The abdomen has the quickest absorption rate, followed by
the upper arms. The thighs and buttocks have the slowest absorption, unless the injection is given before
exercise when blood flows to those areas will be increased.
Insulin pump
deliver a continuous infusion of insulin through an automated system composed of a battery driven
electronic brain an electric motor in dry mechanism, and a syringe.
Table 37.4 Comparison of Hypoglycemia and Ketoacidosis
Diabetic Ketoacidosis
Caused by incomplete metabolism of fats resulting from an absence of insufficient supply of insulin. When
insulin is not present in adequate amounts to meet metabolic needs, the body breaks down protein and fat
for energy. This produces an abundance of the byproducts of fat metabolism, which are potent organic
acids called ketones. In an attempt to rid itself of acidosis produced by ketones, the body increases
respiratory rate in depth called kussmaul respirations
If you suspect a patient is in diabetic ketoacidosis, immediately ensure that there is at least one patent IV
access and anticipate in order for IV therapy
Long-term problems
Damage to blood vessels and organs
blindness, renal failure leading to dialysis, and nontraumatic lower limb amputation
cardiovascular disease , peripheral vascular disease , neuropathy , retinopathy , diabetic neuropathy
CH. 35 – NCLEX Questions
1. A patient is scheduled to have a RAIU thyroid scan. What important teaching should be covered?
a. Thyroid medications should not be taken before a test, radioactive iodine tracer will be given
orally several hours before the actual imaging, if other imaging studies are using contrast are to be
done, the RAIU should be done first, after the procedure, increase fluid intake for 24 hours pg. 848
2. A patient complains of muscle cramping and twitching. Based on knowledge of the endocrine system,
which hormonal deficiency should be evaluated?
a. Parathyroid hormone pg. 843
3. You are taking care of a patient with a thyroid disorder. Which laboratory results would confirm the
diagnosis of a primary thyroid problem rather than a secondary problem?
a. Decreased T3 and T4
4. You are carding for several patients who have endocrine problems. For which patient are you most likely to
perform a urine dipstick for ketone bodies?
a. A patient with diabetes mellitus
5. A patient is on corticosteroid therapy for an acute exacerbation of a respiratory disease. The initial
assessment confirms a patient problem of a fluid volume excess. The underlying cause for this problem
would be
a. Artificial increase in corticosteroids
6. You formulate a care plan for a postmenopausal woman who is admitted for hip fracture. Nursing
assessments support the patient problem of Potential for Injury. The most likely cause for the diagnosis
would be
a. Inadequate estrogen secretion
7. Older adults have physiologic increases in circulating ADH. Based on knowledge of the function of ADH,
which condition should you monitor for
a. Fluid overload
8. A patient is admitted with hyperthyroidism. The initial assessments suggest the patient problem of altered
nutrition, less than body requirement. An appropriate expected outcome would be
a. Patient will maintain weight
9. You are caring for a patient who had part of the thyroid gland removed. Based on the knowledge of a&p
which abnormal laboratory value is of particular concern for this patient
a. Serum calcium of 7 mg/dL
10. You are preparing a patient for a glucose tolerance test. Which instruction must be included
a. Eat a balanced diet for 3 days prior to the test, maintain a normal level of activity, no eating,
drinking, or smoking during the test, report dizziness, nervousness, weakness and confusion
Ch. 35 Evolve
1. The diabetic patient has been instructed on ketone testing. Which statement indicates the need for further
instruction?
a. “Ketone testing should be done each morning when I am in a fasting state.”
2. The hemoglobin A1c test results of the patient are 8.2%. The nurse knows which word best describes the
patient’s glycemic control?
a. Poor: A hemoglobin A1c result of less than 7% is considered good diabetic control. Normal
hemoglobin A1c values are between 4% and 5.9%. A hemoglobin A1c value of 8.2% indicates
poor diabetic control.
3. A patient has completed glucose tolerance testing. The results are normal. Which result is reflective of this
finding?
a. 2-h test results of 135 mg/dL
4. A patient is scheduled to have a glucose tolerance test. What information should be included in the
instructions provided to the patient?
a. “Fasting is required for 10 to 12 h before the test.”
5. A patient is admitted to the hospital with a suspected diagnosis of hyperthyroidism. She asks the LPN/LVN
about the thyroid scan for which she is scheduled that morning. The nurse should tell her that it is done for
which purpose?
a. To evaluate the thyroid’s ability to accumulate iodine
The nurse who works primarily with older adults knows that which of the following is a significant agerelated change of the endocrine system?
7. When an individual is under a great deal of stress for a prolonged period of time, which hormone would be
expected to be secreted in increased amounts?
a. Epinephrine
8. When a patient has alterations in serum calcium and phosphorus levels, which gland is dysfunctional?
a. Parathyroid
9. A patient is scheduled for thyroid function tests in the morning. Patient preparation for this diagnostic
procedure includes which interventions?
a. Explaining to the patient that the dose of radioactivity she will be exposed to during testing is very
small
b. Asking the patient if she has recently eaten shrimp or clams
10. The nurse is caring for a patient with a deficiency of cortisol. The nurse correctly recognizes which
information about this disorder?
a. Cortisol works to counteract the body’s response to inflammation.
b. This patient is at an increased risk for hyperglycemia.
c. Cortisol can be classified as a glucocorticoid
Ch 35 SG Questions
The patient is experiencing fatigue with loss of energy and is currently undergoing multiple diagnostic tests
to diagnose a possible endocrine disorder. She states, "I just want to know what is going on. I'm so tired of
these tests." What is the most therapeutic response?
o You sound really frustrated about the diagnostic testing
A patient is diagnosed with a thyroid disorder. The nurse anticipates that the patient is mostly likely to have
problems with
o Metabolic rate
Which patient is most likely to have a nursing diagnosis of Imbalance nutrition: less than body
requirements?
o Patient with hyperthyroidism
The patient is undergoing a hypertonic saline test to detect diabetes insipidus. One of the nursing
responsibilities is to teach the patient to:
o Produce a urine specimen in the marked container each hour
The doctor orders a dexamethasone suppression test to assist in the diagnosis of Cushing's disease. An
appropriate nursing action would be to
o Check orders for drugs to be withheld
A patient is being tested to determine the degree of diabetic control of blood sugar over the preceding 6-8
weeks. What is the correct test to make this determination?
o Hemoglobin A1C
Which patient has the greatest risk for injury related to bone fracture?
o Patient with a parathyroid disorder. Parathyroid is associated with calcium
The doctor orders laboratory tests for several serum electrolytes. Which set of electrolytes would most
likely reflect the parathyroid function?
o Calcium and phosphorus
The patient needs several diagnostic tests to rule out endocrine disorders. Which task would be appropriate
to assign to the nursing assistant?
o Deliver the urine specimen to the laboratory
The physician orders an aldosterone urine test for a patient. No one on the unit, including the charge nurse,
is familiar with this test. What should the nurse do?
o Check the laboratory policy and procedure manual
6.
NCLEX Book Questions Ch. 36
https://quizlet.com/129629271/chapter-37-care-of-patients-with-pituitary-thyroid-parathyroid-and-adrenaldisorders-questions-flash-cards/
1. A 50 y.o. man outputs 15 L of urine within a 24 hour period. He has poor skin turgor with low blood
pressure and increased heart rate. The nurse would plan to administer which medication?
a. Desmopressin Acetate (DDAVP)
2.
A 45 y.o. man has muscle cramps and weakness. He is weak and confused. Serum sodium is 115 mEq/L.
The nurse should report the condition and obtain an order to
a. Give hypertonic enema
3. A 35 y.o. woman report episodes of emotional extremes with uncontrollable crying and depression
followed by intense physical activity and euphoria. She complains of drying eyes and difficulty
swallowing. Her symptoms confirm a nursing diagnosis of ineffective coping. What is an etiology for this
diagnosis?
a. Excessive Thyroid Hormone Secretion
4. A patient received large doses of radioactive iodine for hyperthyroidism. Which nursing interventions
should be included
a. Monitor vital signs
b. Properly handle contaminated materials
5. The nurse is caring for a post-thyroidectomy patient. What should the nurse monitor for?
a. Bleeding and swelling
b. Increase in pulse
c. Difficulty swallowing
d. Difficulty breathing
6. A patient complains of severe muscle cramping and muscle twitching after a thyroidectomy. The following
orders are obtained. Place the nursing actions in priority order
a. Administer calcium gluconate
b. Place on ECG monitor
c. Seizure precautions
d. High-calcium diet
7. The nurse is reviewing the medications that each of her patients will receive during the shift. Which patient
is likely to receive levothyroxine?
a. Patient who has hypothyroidism
8. A 25 y.o. woman complains of amenorrhea on weakness, easy bruising, and painful, fatty swelling on the
back. Which assessment question would be most appropriate to ask this patient?
a. Have you been taking steroid therapy for a prolonged period?
9. The nurse provides patient instructions regarding taking iodine preparations. It is important for the nurse to
include which instructions?
a. Dilute the preparations well
b. Use a straw to prevent straining of the teeth
c. Report severe epigastric pain
d. Anticipate a metallic taste
10. The nurse is caring for a patient with adrenocortical insufficiency (Addison's Disease). Which set of
laboratory values would be the primary interest for this patient?
a. Serum sodium, white blood cell count, and blood glucose
Ch 36 Evolve
1. A patient who has hyperthyroidism exhibits symptoms of anxiety, nervousness, and agitation. Which
intervention should be included in the patient’s care?
a. Keeping environmental stimuli to a minimum
2. A patient has diabetes insipidus (DI). The LPN/LVN should plan to provide information on which
medication?
a. Vasopressin
3. A patient is diagnosed as having Addison disease. This condition is the result of which disturbance?
a. Insufficiencies of the mineralocorticoids and glucocorticoids
4. In the postoperative period, the LPN/LVN should observe a patient who has had a thyroidectomy for which
signs of thyroid crisis
a. Extreme temperature elevation and rapid pulse rate
5. The patient presents to the clinic with acromegaly, muscle weakness, and osteoporosis. Laboratory results
show elevated growth hormone levels. These symptoms, along with computed tomography scan findings,
most closely correlate with which disorder?
a. Benign pituitary adenoma
6. A patient has just returned from the post anesthesia care unit after a hypophysectomy. The nurse knows to
keep the patient in which position?
a. Semi-Fowler
The nurse is supervising the care of a patient by unlicensed assistive personnel (UAP) after
hypophysectomy. Which action by the UAP would prompt the nurse to intervene immediately?
a. Providing the patient with tissues to blow her nose
8. The patient presents to the clinic with a gross enlargement of the anterior neck. The nurse knows that this is
most likely caused by a deficiency in which substance
a. Iodine
9. The nurse is reviewing the history of a patient suspected of having hyperthyroidism. Which
manifestation(s) would be supportive of the diagnosis?
a. Emotional instability
b. Increased appetite
c. Increased heart rate
d. Hyperactivity with increasing sense of fatigue
10. The patient presents to the emergency department with symptoms of syndrome of inappropriate antidiuretic
hormone (SIADH). The nurse knows to educate the patient about which test(s) or procedure(s) that will be
performed before a diagnosis can be made?
a. Serum osmolality
b. Urine osmolality
Ch. 36 SG Questions
A patient is admitted for a minor elective surgery. He also has a diagnosis of Cushing's syndrome. Which
physical assessment findings are associated with Cushing's and are likely not in the patients record?
o Buffalo hump and moon face
A patient is diagnosed with diabetes insipidus. Which finding is characteristic of this disorder?
o Excessive dilute urine
The nurse is caring for a patient who has SIADH, which of the following nursing interventions is
appropriate for the care of this patient.
o Restricting fluids to 500-100mL/day as ordered
The nurse is caring for a patient who is receiving large doses of radioactive iodine. The care plan should
include what precaution?
o Isolation of the patient for 8 days (half-life of the drug)
The patient is diagnosed with a rare tumor of the adrenal gland (pheocytochroma). The nurse recognizes
that the priority vital sign to monitor frequently is
o Blood pressure
The nurse is caring for a postoperative patient who has had a hypophysectomy. What are some nursing
interventions that would be appropriate in the care of this patient?
o Note and report change in mental status, Change nasal drip pad as needed, Assist the patient with
mouth rinses
The nurse is caring for a patient with a simple goiter. What is the first sign usually noticed in this
condition?
o Enlargement in the front of the neck
The nurse is administering an iodine preparation to a patient. What is a nursing implication in administering
this drug?
o Diluting and administering through a straw to prevent staining to the teeth
What statement by a patient indicates a need for additional teaching about the treatment plan for
hyperthyroidism?
o "I will have a thyroidectomy and then begin ablation therapy treatments."
The nurse is carefully assessing a postoperative patient who had a thyroidectomy. Which assessment
finding is most likely to be associated with one of the potential complications of this surgery
o Tetany
Thyroid cancer is often not diagnosed in the early stages. The primary reason for this is:
o Signs and symptoms are common to other disorders
Which therapies and medication is the health care provider likely to order for a patient who is experiencing
an Addisonian crisis?
o Fluid bolus and IV hydrocortisone Solu-Cortef
When planning care for a patient with hypothyroidism, what would the nurse do?
o Provide extra time to avoid rushing the patient
7.
-
Which endocrine disorder is most likely to mimic the symptoms of a cardiac disease?
o Hyperthyroidism
The nurse is caring for a patient with hyperparathyroidism. Which set of laboratory values is the primary
concern?
o Calcium and phosphorus
A patient has recently had a thyroidectomy. The nurse notes that the patient demonstrates sudden onset of
muscular twitching and spasms. What is the priority intervention?
o Check the patency of the IV site
Which patient has the greatest risk for developing cushing syndrome?
o Patient on long term steroid therapy
The nurse is caring for a patient with diabetes insipidus. Which pattern of urinary output would be the most
typical of this disorder?
o Usually more than 2.5 l/day
The nurse is caring for several patients with endocrine disorders. Which is most likely to have
desmopressing acetate (DDAVP) ordered as part of the therapy?
o Patient with diabetes insipidus
What are signs and symptoms of hypothyroidism?
o decreased appetite but increase weight
o Muscle weakness, muscle pain
o Orthostatic hypotension and vulnerability to cardiac dysrhythmias
o Anorexia, nausea and vomiting, flatulence, and diarrhea.
o Anxiety, depression, and loss of mental acuity
Chapter 37 NCLEX Book
1. A 30-year-old woman is admitted for urinary tract infection with sepsis. A urinalysis reveals presence of
ketones, glucose, and nitrates. Which question would the nurse ask to further assess possible diabetes
mellitus?
a. "Have you been thirstier than usual? Do you find you urinate more now?"
2. Which teaching technique(s) would be most useful for an older adult patient with diabetes?
a. Set a time for the teaching session that is agreeable to the patient
b. Allow time for the patient to jot down important points
c. Repeat key concepts frequently; if the patient does not understand, try rephrasing the concept
3. A patient newly diagnosed with diabetes is given diet instructions. What should the nurse do to effectively
motivate the patient to comply with dietary recommendations
a. Emphasize good food choices
b. Apply diet prescriptions to patient preferred foods
c. Focus on the benefits of diet compliance
d. Involve meal preparers in diet teaching
4. A 50-year-old woman was recently diagnosed with type 2 diabetes mellitus and desires to start a healthy
lifestyle to control her disease. What is the initial recommendation that the nurse should make
a. Maintain adequate glucose control
5. The nurse answers the call light for patient with diabetes. The patient states she feels shaky and weak. The
nurse notes pallor and moist skin. List in order of priority order the actions of the nurse
a. Assess LOC
b. Check fingerstick glucose
c. Give patient 6 oz juice
d. Document interventions
6. A patient who works as a personal trainer is diagnosed with insulin-dependent diabetes. What should the
nurse teach regarding self-administration of regular insulin
a. Use the abdomen as an insulin injection site
7. The home health nurse is visiting an older adult patient who has successfully managed her type 2 diabetes
for years. During the visit, the nurse notes that the patient has severe arthritis; poor vision; and several dry,
red areas on the lower extremities. What is the priority patient problem?
a. Potential for ineffective self-health management due to aging
8.
A nurse determines the fingerstick blood glucose reading for a patient with diabetes is 750 mg/dL. What is
the nurse's priority action?
a. Assess the patient’s vital signs
9. The nursing assistant tells you that a patient with diabetes has a blood glucose level of 60 mg/dL. What
symptoms would the nurse be most likely to observe with this glucose level?
a. Confusion, tremulousness, pallor, sweating, and weakness
10. During a routine checkup, the health care provider tells a patient with diabetes that the test results reveal
albuminuria. Which long-term complication is specific to this test result?
a. Nephropathy
Ch 37 Evolve
1. A patient who is undergoing surgery will have an intravenous solution to which insulin will be added.
Which type of insulin must be used?
a. regular
2. When teaching a patient with type 1 diabetes about home care, the LPN/LVN would be sure to include
which signs of diabetic ketoacidosis?
a. Abdominal pain, anorexia, and dry mucous membranes
3. A patient with type 1 diabetes mellitus (DM) plays tennis and asks if she will be able to continue with that
sport. The nurse should base his response on which information?
a. She can play tennis, but she will need to eat more before she plays.
4. In discussing DM with a patient, it is important to base the discussion on which information regarding the
disease?
a. It can often be controlled by diet and regular exercise.
5. A patient recently diagnosed as having hypoglycemia says, “Hypoglycemia! I can’t live with that. My
neighbor, Joseph, had that and he acted crazy!” Which response by the nurse is most appropriate?
a. “Hypoglycemia has been successfully treated by diet modifications.”
6. A patient newly diagnosed with diabetes is learning to administer his injections of NPH and regular insulin.
Which statement indicates that the patient understands the nurse’s teaching regarding proper insulin
administration?
a. “I will draw up the regular insulin before the NPH.”
7. A patient with diabetes is admitted to the emergency department with complaints of lack of feeling, yet
debilitating pain in his legs and feet, constipation, and sexual impotence. These symptoms most closely
correlate with which disorder?
a. Diabetic neuropathy
8. A patient with diabetes asks her nurse about foot care when she is discharged home. What is the nurse’s
best response?
a. “Inspect each foot daily for cuts, cracks, blisters, or abrasions.
9. The nurse is teaching a class on diabetes to a group of adults in the community. The nurse should be sure to
include information on which classic symptoms of diabetes?
a. Excessive thirst
b. Increased appetite
c. Frequent urination
10. The nurse is providing discharge teaching to a patient recently diagnosed with type 2 DM. The nurse
should include information on which long-term consequences of poor glycemic control?
a. Recurrent infections
b. Delayed wound healing
c. Peripheral vascular disease
ZZI Corticosteroids
1. The primary therapeutic outcome expected from fludrocortisone therapy is
a. Blood pressure control
2. Glucocorticoids are administered to relieve the symptoms of tissue inflammation in disorders such as
a. Rheumatoid arthritis
3. Patients receiving corticosteroid therapy should be asked about any previous treatment for an ulcer,
heartburn, or stomach pain because of the higher incidence of
a. Peptic ulcer disease
The patient taking a diuretic and a corticosteroid should be closely monitored for fluid and electrolyte
levels because corticosteroids may enhance the loss of
a. Potassium
5. Abrupt discontinuation of glucocorticoids after being administered for 1 week or longer may result in
a. Adrenal insufficiency
6. Corticosteroid therapy often masks symptoms of
a. Infection
7. Corticosteroids are hormones secreted by the cortex of the
a. Adrenal gland
8. Patients receiving corticosteroid therapy must be monitored especially during the early weeks of therapy
for
a. Hyperglycemia
9. The hormone which maintains fluid and electrolyte balance and is used to treat adrenal insufficiency caused
by hypopituitarism is
a. Mineralocorticoid
10. The major glucocorticoid of the adrenal cortex is
a. Cortisol
ZZI Endocrine System
1. An overgrowth of the thyroid gland (goiter) can occur from insufficient iodine intake. The major source of
iodine for most people in the United States is
a. Iodized salt
2. Which value is considered in the “good” range for glycosylated hemoglobin (HbA1c) in patients with
diabetes?
a. 7.6-8.5
3. Normal value for a fasting blood glucose level
a. 70-115
4. Without mineralocorticoids, a person would die within how many days as a result of lack of control of fluid
balance, blood volume, and all chemical processes and glandular functions in the body?
a. 3 to 7 days
5. Principal action of the thyroid gland
a. Increasing the metabolic rate
6. Pancreas is responsible for producing
a. Insulin and glucagon’s
7. Glycosylated hemoglobin (HbA1c) is a measurement of blood glucose over a period of
a. Several weeks
8. Pituitary gland is located in the
a. Head
9. Intake of protein and _________ are needed to synthesize both thyroid hormones
a. Iodine
10. What hormone is secreted by the adrenal cortex
a. Corticosteroids
11. Diabetes insipidus occurs because of
a. Decreased production of ADH
12. During a 24-hour period, expected urine output for the patient with diabetes insipidus is
a. 15 to 20 L
13. What percent of nodules found on the thyroid gland are cancerous?
a. 5 to 10%
14. A primary concern that may result from coughing following a hypophysectomy is a(n)
a. Cerebrospinal leak
15. Nursing assessment of a patient with Addison’s disease will likely reveal
a. Generalized malaise and muscle weakness
16. typical signs and symptoms of Cushing syndrome include
a. buffalo hump
17. The most common age range of women affected by hyperthyroidism is
a. 30 to 50 years
4.
18. The nurse would expect a patient with Graves’ disease to have which sign or symptoms
a. Exophthalmos
19. Cushing syndrome is often attributed to
a. Prolonged use of steroid therapy
20. Patient with a goiter would most likely present
a. Enlarged neck
ATI Med Surg Book
1. A client asks the nurse why the provider bases his medication regimen on his HbA1C instead of his log of
morning fasting blood glucose results. Which of the following is an appropriate response by the nurse?
a. HB A1 C indicates how well you have regulated your blood glucose over the past 120 days.
2. A nurse is reviewing the laboratory findings of the client has suspected hyperthyroidism. An elevation
of which of the following supports this diagnosis?
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
a. Triiodothyroxine
The nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following laboratory findings should the nurse anticipate?
a. Low sodium, increased urine osmolality, high urine sodium, increased urine specific gravity
A nurse is caring for a client who has a primary adrenal insufficiency and is preparing to undergo an ACTH
stimulation test. Which of the following findings should the nurse expect after an IV injection of
cosyntropin?
a. No change in plasma cortisol
A nurse is assessing a client during a water deprivation test. For which of the following complications
should the nurse monitor the client?
a. Orthostatic hypotension
A nurse is caring for a client who has SIADH. Which of the following findings should the nurse expect?
a. Decreased serum sodium, serum osmolarity of 230
A nurse is caring for a client who has DI. Which of the following urinalysis laboratory findings should the
nurse anticipate?
a. Decreased specific gravity
A nurse is caring for a client who has acromegaly and is postoperative following a transsphenoidal
hypophysectomy. Which of the following interventions should the nurse include in the plan?
a. Observe dressing drainage for the presence of glucose.
A nurse in a provider’s office is reviewing the health record of a client who is being evaluated for Graves'
disease. Which of the following is an expected laboratory finding for this client?
a. Decreased thyroid stimulating hormone
A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which of the following
findings should the nurse include? Select all that apply.
a. Heat intolerance, palpitations, weight loss
A nurse is providing instructions to client who has Graves' disease and has a new prescription for
propranolol (Inderal). Which of the following information should the nurse include?
a. Take your pulse before each dose
The nurse is preparing to receive a client from the PACU who is post-operative following a thyroidectomy.
The nurse should ensure that which of the following equipment is available?
a. Suction equipment, humidified O2, tracheostomy tray
A nurse in a provider’s office is planning care for a client who has a new diagnosis of Graves' disease and a
new prescription for methimazole (Tapazole). Which of the following should the nurse include in the plan
of care?
a. Monitor CBC, monitor triiodothyronine, advise to take medication same time every day
A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for
secondary hypothyroidism. Which of the following laboratory findings is expected for a client with this
condition?
a. Decreased T3
A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the
following findings are expected with this condition?
a. Menorrhagia, dry skin, hoarseness
16. The nurse is reinforcing teaching with a client who has been prescribed levothyroxine (Synthroid) to treat
hypothyroidism. Which of the following should the nurse include in the teaching?
a. Medication should not be discontinued without the advice of the provider.
b. Follow up serum TSH levels should be obtained
c. Take the medication on an empty stomach
17. A nurse in an intensive care unit is admitting a client who has myxedema coma. Which of the following
should the nurse anticipate in caring for this client?
a. Observe cardiac monitor for dysrhythmias
b. Observe for evidence of urinary tract infection
c. Initiate IV fluids using 0.9% sodium chloride
d. Administer a levothyroxine IV bolus
18. A nurse in a provider's office is assessing a client who has hypothyroidism and recently began treatment
with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse
that the client might need a decrease in the dosage of the medication?
a. Hand tremors
19. The nurse is planning care for a client who has Cushing's disease. In planning care, the nurse should
recognize that the clients with Cushing's disease are increased risk for which of the following?
a. Infection, gastric ulcer, bone fractures
20. The nurse is providing discharge instructions to a client who had a transsphenoidal hypophysectomy.
Which of the following instructions should the nurse include?
a. Avoid brushing teeth for two weeks post-operatively, expect to experience a diminished sense of
smell
21. A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following
findings are expected for this client?
a. Sodium 150 mEq/L
b. Potassium 3.3 mEq/L
c. Calcium 8.0 mg/dL
d. Fasting glucose 145 mg/dL
22. A nurse is admitting a client who has acute adrenal insufficiency to the intensive care unit. Which of the
following prescriptions should the nurse anticipate?
a. Regular insulin
b. Hydrocortisone sodium succinate (Solu-Cortef)
c. Sodium polyestyrene sulfonate (Kayexalate)
d. Furosemide (Lasix)
23. A nurse is planning to teach a client who is being evaluated for Addison's disease about the ACTH
stimulation test. The nurse should base her instructions to the client on which of the following?
a. ACTH is a hormone produced by the pituitary gland
24. A nurse is caring for a client who has blood glucose of 52 mg/dL. The client is lethargic but arousable.
Which of the following actions should the nurse perform first?
a. Provide 4 oz grape juice
25. A nurse is preparing to administer a morning dose of aspart insulin (NovoLog) to a client who has type 1
diabetes mellitus. Which of the following is an appropriate action by the nurse?
a. Administer insulin when breakfast arrives
26. A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information
should the nurse include in the teaching?
a. Trim toenails straight across, wear closed toe shoes
27. A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should
expect which of the following findings (Select all that apply)
a. Fruity odor of breath, abdominal pain, Kussmaul respirations, metabolic acidosis
28. A nurse is providing discharge teaching to a client who has experience diabetic ketoacidosis. Which of the
following information should the nurse include in the teaching?
a. Drink 2L fluids daily, monitor blood glucose every 4 hr when ill, administer insulin as prescribed
when ill, report ketones in the urine after 24 hr of illness
Remediation
Physical findings for Cushing
o Pg. 876
o
Hypo and hyper glycemia – insulin what it looks like
Why is it important to keep blood glucose level above 60, if a patient asks
Addisonian crisis, severe what
Why do we taper steroids
Remediation
Physical findings for Cushing
o Pg. 876
o Caused by excessive levels of cortisol, painful fatty swellings in the intrascapular space (buffalo
hump), an enlarged abdomen with thin extremities, bruising after even minor traumas, impotence,
amenorrhea, hypertension, and weakness from abnormal protein catabolism with loss of muscle
mass
o Unusual growth of body hair (hirsutism) in women, streaked purple markings in the abdominal
area because of collection of body fat
Hypo and hyper glycemia – insulin what it looks like
o Pg 883-885
o Adjusting insulin doses to match carbohydrate intake
o Meal planning
o Hypoglycemia is when blood sugar drops so glucagon, honey, juice, etc.
 Hypoglycemic agents pg 886
 Sulfonylureas (long acting) stimulate pancreas to create more insulin
o Hyperglycemia
 High blood sugar so providers use rapid acting, short acting, intermediate acting etc pg.
888
Why is it important to keep blood glucose level above 60, if a patient asks
o Pg 891, pg 893
o Hypoglycemic shock if your blood sugar gets to low
o Energy supplier, some people can function on 40 likes in book however this is dangerous
o Hunger headache pallor sweating palpitations, blurred vision and weakness, seizures
o Can result in loss of consciousness
o Risk of heart disease
Addisonian crisis, severe what
o Pg 872-876, g 876
o Acute adrenal crisis is a life-threatening state caused by insufficient levels of cortisol, which is a
hormone produced and released by the adrenal gland.
o An Addisonian crisis is a life-threatening situation that results in low blood pressure, low blood
levels of sugar and high blood levels of potassium. You will need immediate medical care. People
with Addison's disease commonly have associated autoimmune diseases.
o Sudden insufficiency of glucocorticoid cortisol can lead to shock
o Addison is decreased function of adrenal cortex, skinny with malaise and weakness , hypotension
Why do we taper steroids
o Pg 876
o Body becomes dependent on the outside source of cortisol, if stopped abruptly acute cortisol
insufficiency will occur