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NURS 405A Exam 4 Study Guide
1. What does the thyroid do?: Produces hormones
2. What are the primary hormones the thyroid is responsible for producing?-
: Thyroxine (T4) Triiodothyronine (T Calcitonin
3. What are the effects of the thyroid (NORMAL functions)?: - Increases meta- bolic rate
- Increases heart rate
- Increases respiratory rate
- Increases cardiac output
- Potentiates (makes it better) effects of catecholamines (epinephrine, norepineph- rine (fight or
flight))
- Potentiates brain development
4. How are thyroid hormone levels regulated?: - Hypothalamus releases thyroid releasing
hormone (TRH)
- The pituitary releases thyroid stimulating hormone (TSH)
- The thyroid releases T4 and T
5. Where are the adrenal glands located?: Above each kidney (adrenal glands "sit like a hat on top
of the kidneys")
6. What is the adrenal medulla?: Center/inner layer of the adrenal gland
7. What does the adrenal medulla secrete?: Catecholamines (epinephrine & norepinephrine)
8. What is the adrenal cortex?: Outer layer of the adrenal gland
9. What does the adrenal cortex secrete?: Cortisol, aldosterone, androgens
10. What does cortisol do?: - Cortisol is a glucocorticoid
- Helps us with stress response, regulates metabolism
11. What does aldosterone do?: Mineral glucocorticoid that is responsible for potassium
regulation and sodium regulation
12. What do androgens do?: Sex hormones, growth and development
13. What are the kinds of catecholamines?: Epinephrine and norepinephrine
14. What do catecholamines (epinephrine and norepinephrine) do?: Stimula- tion of sympathetic
nervous system:
- Increases cardiac output
- Diverts blood to vital organs and muscles
- Raises glucose
- Increase metabolic rate
15. What is hydrocortisone (cortisol)/what does it do?: - A glucocorticoid
- Allows the body to cope with stress
- Stimulate glucocorticoid receptors in multiple tissues
16. What are the physiologic effects of hydrocortisone (Cortisol)?: - Release of glucose from the
liver
- Release of amino acids
- Decreased uptake of glucose in muscle
- Release of free fatty acids from adipose tissue
- Suppression of inflammatory and immune responses
17. What does the hypothalamic-Pituitary-Adrenal Axis do?: - Stress causes hypothalamus to
release corticotropin releasing hormone (CRH)
- CRH stimulates pituitary to release adrenocorticotropic hormone (ACTH)
- ACTH stimulates adrenal cortex to secrete cortisol
- Negative feedback loop inhibits CRH & ACTH
18. What are the adrenal gland hormones?: SSS
- Sugar (glucocorticoids)
- Salt (mineralcorticoids)
- High blood cortisol
- Buffalo hump & back pain
- Cardiac hypertrophy/hypertension
- Catabolism
- Pendulous abdomen & breasts
- Poor wound healing
24. What is the assessment mnemonic (STRESSED) for Cushing's Syndrome stand for?: S - Skin
fragility T - Truncal obesity with small arms R - Round face E - Elevated BP S - Striae on abdomen and extremities S - Sugar extremely high E - Excessive body hair & electrolyte imbalance (low K) D - Depression and Dorsocervical fat pad (buffalo hump)
25. What does a pituitary tumor do and cause (exogenous cause of cush- ing's)?: Secreting
ACTH
Causes headache, vision changes, galactorrhea (milky discharge from nipples in non-lactating person)
26. What are the diagnostics used for Cushing's syndrome?: 24 hour urine for free cortisol
Dexamethasone Suppression Test Measure ACTH if + for cushing's Imaging studies (can be helpful, but can't be relied on alone)
27. What do you do for the 24 hour urine for free cortisol?: Keep it cool, discard first void and
collect for 24 hours from that point
28. What is the dexamethasone suppression test?: - 1 mg of dexamethasone at 11 PM
- Measure serum cortisol at 8 AM
- Serum cortisol should be <2-3 mcg/dL for the diagnosis of cushing's (Taking antidepressants, Dilantin, or rifampin can give us a false positive in the dexamethasone suppression test)
29. What does LOW ACTH mean if the patient is positive for Cushing's Syn- drome?: Primary
adrenal problem
30. What does HIGH ACTH mean if the patient is positive for Cushing's?: Pitu- itary problem
31. What imaging studies can be helpful (but can't be relied on alone) when diagnosing Cushing's
syndrome?: Abdominal CT for adrenal tumor MRI for pituitary tumor
32. How is Cushing's syndrome treated when the cause is a pituitary tumor?: -
Transsphenoidal Hypophysectomy (removal of the tumor, goes in through the nose)
33. How is Cushing's syndrome treated when the cause is an adrenal tumor?-
: Adrenalectomy (removal of adrenal gland, can be done laparoscopically or open)
34. What should be done during the perioperative period before treating Cush- ing's disease?:
Administer cortisol
- We need to be ready to give corticosteroids ahead of time or we could flip the patient into Addison's disease or Addisonian crisis (extreme, life-threatening hypotension)
35. What are some nursing diagnoses for Cushing's Syndrome?: - Impaired skin integrity (skin
issues, ecchymosis, poor wound healing)
- Risk for infection (the more hyperglycemic, the greater the risk of infection (bacteria loves sugar))
- Fluid volume overload (holding onto sodium which leads to overload)
- Disturbed body image (moon face, chicken legs, distended abdomen)
- Disturbed thought processes
36. The nurse is performing an assessment of a patient with Cushing's syn- drome. Which of the
following findings would the nurse expect?: Hypertension, Moon face, Abdominal striae
37. The nurse is planning care for a patient with Cushing's Syndrome. Which complication should
the nurse monitor for?: Dysrhythmia (because of low potassium)
38. What is Addison's Disease?: Insufficiency of the adrenal cortex function (adrenal
- Draw blood before and 30 minutes after ACTH administration
- Primary adrenal insufficiency: Plasma cortisol levels will NOT rise
- Secondary adrenal insufficiency: Plasma cortisol levels WILL increase
- ACTH test cannot be performed if the patient is experiencing an acute crisis
44. What would you expect the ACTH levels to be in a patient with Addison's Disease?: High
45. What would you expect the cortisol levels to be in a patient with Addison's Disease?: Low
46. What would you expect the aldosterone levels to be in a patient with Addison's Disease?:
Low
47. What would you expect the sodium levels to be in a patient with Addison's Disease?: Low
48. What would you expect the potassium levels to be in a patient with Addi- son's Disease?: High
49. How is Addison's Disease medically managed?: - IV administration of Hydro- cortisone if they
are in Addisonian Crisis
- IV fluids D5 Normal Saline (D5 NS is given: D5 to combat hypoglycemia, NS helps hydrate, helps with hypotension)
- Lifelong replacement of glucocorticoids and mineralocorticoids (Prednisone or Hydrocortisone (Cortef); Fludrocortisone (Florinef))
- Increase hormone replacement in times of stress
- Increase salt intake
50. What are the glucocorticoids and mineralocorticoids used lifelong to man- age Addison's
Disease?: Prednisone or Hydrocortisone (Cortef) Fludrocortisone (Florinef)
51. What is the nursing care done for Addison's Disease?: - Monitor V/S and orthostatic V/S
(Look up orthostatic BP/Vitals??)
- Monitor glucose
- Limit activity during crisis
- Monitor fluid and electrolyte balance
- Assess and treat nausea (Meds/Interventions to treat nausea: antiemetics - Zofran, Reglan, Compazine, Phenergan, increased IV fluid volume, insert NG tube & put it to suction and suck out whatever is making them nauseous)
- Administer medications and fluids
- Patient education
52. What are the nursing diagnoses for Addison's Disease?: - Fluid volume deficit
- Decreased cardiac output
- Activity intolerance
- Risk of injury
- Disturbed body image
- Knowledge deficit
53. What is some patient education that needs to be done for Addison's Disease?: - Need for
lifelong hormone replacement (Bad side effects of long term prednisone/steroid use: osteoporosis/bone demineralization, blood sugar problems (elevated), too much cortisol, weight gain/moon face)
- Try to limit stress
- S/S of inadequate or excessive hormone replacement
- Increase dosages with stress
usually malignant or benign?: 10% are malignant (they are usually benign)
62. What do pheochromocytomas (endocrine tumors) release and why can this be dangerous for the
patient?: Catecholamines (produces extra epinephrine and norepinephrine)
- Can be dangerous for a patient because it can cause extreme/excessive HTN
63. What are the physiologic effects of a pheochromocytoma?: - Paroxysmal Symptoms
(Symptoms come and go)
- Hypertension (can be severe)
- Headache
- Tachycardia
- Diaphoresis
- Anxiety
- Tremors
- Hyperglycemia
- "5 H's": Hypertension, Headache, Hyperhidrosis (excessive sweating), Heart con- sciousness, Hypermetabolism
64. What are the 5 H's of Pheochromocytoma symptoms?: Hypertension Headache
Hyperhydrosis (excessive sweating) Heart consciousness Hypermetabolism
65. What are the diagnostics used for pheochromocytoma?: - 24 hour urine for free
catecholamines, catecholamine metabolites (MN), and vanillylmandelic acid (VMA)
- Clonidine Suppression Test
- CT or MRI to locate tumor
66. What should you remember when performing a 24 hour urine for free catecholamines,
catecholamine metabolites (MN), and vanillylmandelic acid (VMA) to diagnose pheochromocytoma?:
- No caffeine, tobacco, or stimulants during the test
- Try to limit stress
- When collecting 24 hour urine collection: discard the first void (it has been sitting in the bladder and will not be an accurate 24 hour urine collection), collect for 24 hours after first void
67. If there is an elevation in free catecholamines from 24 hour urine, what are the chances that the
patient has pheochromocytoma?: There is a 95% chance they have pheochromocytoma if there is an elevation in free catecholamines from the 24 hour urine
68. Why would the Clonidine Suppression Test be used to help with the diag- nosis of
pheochromocytoma?: Done if the patient tests negative in 24 hour urine and further testing is requested
69. What is done for the clonidine suppression test?: - No smoking, no caffeine)
- Draw baseline lab values (baseline catecholamines)
- Give clonidine 0.3 mg and come back and draw labs after 2 hours and 3 hours after administration of clonidine
70. What do we want to happen during the clonidine suppression test for pheochromocytoma?:
Want plasma levels of catecholamines to drop (want blood pressure drop) from the baseline after administration of clonidine (no pheochromo- cytoma if they drop), if they fail to drop/there is no effect on the blood pressure after giving clonidine then they have a positive result for pheochromocytoma (yes pheochromocytoma if they do not drop)
71. Why is a CT or MRI done for pheochromocytoma?: Done to locate the tumor
- CT or MRI will show the tumor but will not tell you what type of tumor it is
- (use 24 hour urine and clonidine suppression test to diagnose pheochromocytoma)
72. How is pheochromocytoma medically managed?: - Control BP with phenoxy- benzamine (long
acting alpha blocker)
- Can add beta blocker for tachycardia
- Surgical resection is usually curative
- Increase volume with normal saline (done preoperatively to prevent BP from dropping too low/changing too rapidly after tumor is removed)
- May require post-op steroids temporarily for unilateral adrenalectomy
73. What nursing care should be performed for pheochromocytoma?: Care for them like any
and hypoglycemia may occur
- Fluid and electrolyte balance (watch for potassium to go up and sodium to go down (changing to be more like addison's disease))
80. What medications and fluids should be given post-operatively for an adrenalectomy?: Fluids:
D5 0.9% NS (combats and all in one swoop)
81. What is important to educate the patient on after an adrenalectomy?: Will require 3-6 months of
corticosteroids
- Gradually wean them off/taper the dose
- Do NOT stop these medications abruptly because BP will crash!
82. What is primary hyperaldosteronism?: Direct result of excessive aldosterone production
(this is different from Cushing's! (in Cushing's there is excess aldosterone, cortisol, and androgens and with primary aldosteronism there is just excessive aldosterone production)
83. What is the clinical presentation of primary hyperaldosteronism?: Hyper- tension
Edema Hypokalemia Metabolic acidosis
84. What is the etiology of primary hyperaldosteronism?: Adrenal tumor
85. How is primary hyperaldosteronism managed?: Adrenalectomy
86. A patient has primary hyperaldosteronism. Which of the following medica- tions would the nurse
anticipate being ordered?: Spironolactone (Aldactone) (spares potassium and is a diuretic)
87. When is the therapeutic use of corticosteroids indicated?: To suppress inflammation or
suppress the immune system:
- Acute allergic reactions
- Asthma/COPD exacerbations
- Autoimmune diseases: Rheumatoid arthritis, Multiple sclerosis, Systemic lupus erythematosus
88. Why should corticosteroids be tapered off?: Gradually wean them off/taper the dose, do NOT
abruptly stop the medications because the BP will crash
89. What is important to remember about long term corticosteroid use?: - GI prophylaxis is needed
with long term steroid use ’ PPI
- Calcium supplementation if on corticosteroids long term ’ tums (calcium carbonate)
- Prophylactic antibiotics (Bactrim every Monday, Wednesday, and Friday for exam- ple) for infection prevention
90. What is the most common cause of hypothyroidism?: Iodine deficiency
91. What does iodine deficiency cause?: - Results in Hypothyroidism (most com- mon cause of
hypothyroidism)
- Increases TSH (thyroid stimulating hormone)
- Causes goiter (bulging, can be one sided or bilateral presentation (tell patient before you are going behind them that you are going to put your hands on their neck, have them swallow))
92. What are some sources of iodine?: Seafood Iodine
fortified salt
93. Is iodine deficiency common in the US?: Rare in the US
94. What is the etiology of hypothyroidism?: - Autoimmune (Hashimoto's)
- Treatment of hyperthyroidism
- Drug toxicity
- Radiation
- Iodine deficiency
95. What happens with the autoimmune cause of hypothyroidism?: Destruction of thyroid tissue by
its own antibodies
96. How can Hashimoto's be detected in a patient with hypothyroidism?: An- tithyroid antibodies
labs will show this if a patient has Hashimoto's
97. What are people with Hashimoto's also at increased risk for?: Other en- docrine disorders
such as Addison's disease
104. What are the diagnostics used for hypothyroidism?: TSH value Free T
Anti-thyroid antibodies
105. How can you tell if a patient has Hashimoto's?: Anti-thyroid antibodies Check
antithyroid antibodies for Hashimoto's:
- If the patient HAS hashimoto's, then antithyroid hormones will be PRESENT
- If the patient does NOT have hashimoto's, then antithyroid hormones will be ABSENT
106. Would the TSH and T4 values be elevated or decreased in HYPOthy- roidism?: - TSH
would be elevated because it is trying to overcompensate
107. How is hypothyroidism treated?: Levothyroxine (Synthroid)
108. How should patients with hypothyroidism take Levothyroxine (Syn- throid)?: Synthroid is
very sensitive: Take it in the morning on an empty stomach (Give it far away from other drugs and before eating) (bare minimum of 30 minutes between taking the med and eating)
109. When a patient has hypothyroidism, what should be monitored?: TSH levels
110. What are we hoping will happen to the TSH levels when a patient is started on Synthroid
for hypothyroidism?: TSH will go down
111. What can happen if we are overdosing someone on Synthroid for hy- pothyroidism?:
TSH levels will be extremely low and the patient will end up pre- senting with signs of hyperthyroidism
112. What are the adverse effects of excessive thyroid supplements?: Osteo- porosis
Atrial fibrillation Myocardial ischemia
113. For what type of patients would you start with lower doses of Synthroid for initial
treatment of hypothyroidism?: - Elderly
- Patients with A-Fib or history of A-Fib
- Heart failure/significant cardiac history
114. What patient education should be given for hypothyroidism?: - Take Syn- throid on an
EMPTY STOMACH
- Continue to take medication EVEN IF FEELING BETTER
- Get FOLLOW-UP lab work (TSH levels)
115. What are the nursing diagnoses for hypothyroidism?: - Activity intolerance
- Risk for imbalance body temperature
- Constipation
- Knowledge deficit
116. What interventions would you implement for a nursing diagnosis of ac- tivity
intolerance?: Cluster care, do the most physically taxing activities first thing in the morning (most energy when you first get up), might need frequent breaks
117. What interventions would you implement for a nursing diagnosis of risk for imbalanced
body temperature?: - Dress in layers, always have a sweater, put an extra blanket in your car
- If you have a wild change from always cold to always hot then contact your provider to do some bloodwork and see if your dose needs to be adjusted!
118. What interventions would you implement for a nursing diagnosis of con- stipation?:
Fluids, high fiber, ambulation
119. A 70 year old male is started on Levothyroxine (Synthroid) for treatment of
hypothyroidism. What symptom is most important for the nurse to monitor for?: Chest pain
120. How many cases of thyroid cancer occur annually?: 37,000 cases annually
121. What is a significant risk for thyroid cancer?: Prior radiation therapy
122. What is are the malignant nodules that occur in thyroid cancer like?: - Hard and fixed
(more concerning for malignancy)
- "Cold" (would not reabsorb/uptake iodine in radioactive iodine uptake)
- Lymphadenopathy
123. How is thyroid cancer diagnosed?: Needle biopsy (usually under fluo- roscopy;
tells us if it is malignant or not)
124. How is thyroid cancer treated?: Surgery (surgical removal)
129. A patient is admitted in thyroid storm. Which of the following signs and symptoms would
the nurse anticipate?: Fever and heart failure
130. What are parathyroid glands and where are they located?: Tiny glands (multiple)
that exist on the thyroid (posterior to thyroid)
131. What does the parathyroid function to do?: - Maintain ionized Ca++
- Increase Ca++ absorption from kidney, intestine, bone (help us maintain calcium)
- Responsible for decreasing phosphorus levels
132. What happens in primary hyperparathyroidism?: An overactive gland (can rarely be
malignant)
- Increased secretion of PTH (parathyroid hormone)
133. Is primary hyperparathyroidism more common in men or women?: -
Women
134. What are the symptoms of primary hyperparathyroidism?: Can be asymp- tomatic
Fatigue Irritability Weakness Nausea Constipation Kidney stones Bone pain Osteoporosis Psychosis Dysrhythmias (symptoms related to calcium issues: kidney stones, bone pain, osteoporosis, dys- rhythmias)
135. What are the diagnostics used for primary hyperparathyroidism?: - Serum calcium
- Elevated PTH level (high)
- Vitamin D level
- Sestamibi scan
136. What is one of the first things we look at when we are suspecting primary
hyperparathyroidism?: Serum calcium (High: >10)
- Calcium level is one of the first things we look at (usually relatively high: Over 10)
137. Will vitamin D levels usually be high or low in primary hyperparathy- roidism?:
Usually low
138. What is done during a Sestamibi Scan (done for primary hyperparathy- roidism)?: Mild
radioactive agent is injected into the patient
- If we HAVE hyperparathyroid it WILL absorb/uptake the radioactive dye
- If it is NORMAL it will NOT absorb the radioactive material
139. How is hypercalcemia managed?: - Maintain adequate hydration
- Weight bearing
- Stool softener (get rid of extra calcium through stools)
- Bisphosphonates
- Calcitonin
140. What is a parathyroidectomy?: Standard neck exploration or minimally inva- sive (can
take parathyroids and leave thyroid intact) (can be done laparoscopically or open)
141. What are the potential complications of parathyroidectomy?: - Airway compromise
- Bleeding
- Infection
- Recurrent laryngeal nerve damage
- Post op: monitor for hypocalcemia (complications are the same as with thyroidec- tomy)
142. What is secondary hyperparathyroidism?: Results from something that causes
chronic hypocalcemia
- In response to hypocalcemia, increased PTH is secreted
143. What can cause secondary hyperparathyroidism?: Chronic kidney disease
Malabsorption
144. What does secondary hyperparathyroidism result in?: Osteoporosis/Bone issues
