REVIEW for TEST #2

1. REVIEW for TEST #2 PN 142 ENDOCRINE SYSTEM

2. Disorders of the Adrenal Gland

3. Multiple Choice • ACTH stands for: • A. Antidiuretictropic Hormone • B. Anticorticotropic Hormone • C. Adrenocalcicotropic Hormone • D. Adrenocorticotropic Hormone

4. Multiple Choice • Another name for Adrenal Hyperfunction is: • A. Addison’s disease • B. Graves’ disease • C. Cushing’s Syndrome • D. SIADH syndrome

5. Multiple Response • Adrenal Hyperfunction (Cushing’s Syndrome) may be caused by which of the following? • A. Drinking too much sugar • B. a tumor of the adrenal cortex • C. Hyperplasia of adrenal tissue resulting from overstimulation of the adrenal glands by ACTH • D. Prolonged or overuse of corticosteroid drugs

6. Multiple Response • The overabundance of glucocorticoids, minoralocorticoids, and sex hormones leads to what clinical manifestations of Cushing’s? • A. weight loss and wasting syndrome • B. moonface • C. buffalo hump • D. thing arms and legs

7. Multiple Response • Lab results (blood and urine) for Cushing’s Syndrome include which of the following? • A. ↓ K+ • B. proteinuria • C. hyperglycemia • D. renal calculi

8. Multiple Choice • Upon interview of an adult with Cushing’s syndrome, the patient c/o feeling very discouraged, has difficulty concentrating, and has thought of harming herself. What would be the appropriate response on the part of the nurse? • A. “ Would you like me to call the doctor for some medication that will help you feel better.” • B. “ Can you share with me more of your concerns?” • C. “I really hope you are not going to do something harmful to yourself. Your family would feel really bad.” • D. “ I think that you should rest and think this over while you are here.”

9. Multiple Response • Some key features of Cushing’s syndrome include which of the following objective data? • A. fragile skin; slow wound healing • B. weight gain; abdominal enlargement with straie • C. Hirsuitism in women • D. high pitched voice

10. Other • Diagnostically, blood and urine checks will confirm or rule out the medical diagnosis of adrenal hyperfunction (Cushing’s). • Place an “↑” in front of the lab test if the results are expected to be elevated • Place a ↓ in front of the lab test if the results are expected to be lower than the normal range ___ Plasma Cortisol ___ Plasma ACTH ___ 17-ketosteroids ___ 17-hydroxysteroids

11. Other • List 3 diagnostic tests other than blood and urine for evaluating a patient with Cushing’s Syndrome.

12. Multiple Choice • The goal of medical management of adrenal hyperfunction is: • A. relieve fluid excess • B. treat the causative factor • C. administer Mitodane therapy • D. surgery

13. Multiple Response • Medical treatment of the causative factor for adrenal hyperfunction includes: • A. Adrenalectomy for adrenal tumors • B. Radiation of pituitary gland/tumor(s) • C. Surgical removal of pituitary tumors • C. Medication – Mitodane therapy

14. Other - Process • Mitodane Therapy _________ the peripheral metabolism of _________ causing a decreasing ________ and ___________ level; __________ cortisol production. • This therapy is also known as: ______________ _______________.

15. Multiple Response • Dietary management for people with Cushing’s syndrome is an important part of medical treatment. Which of the following would be included in adjusting the diet of a person with Cushing’s? • A. Low Na+ • B. High K+ • C. Low calorie and CHO • D. High calcium

16. Multiple Response • Nursing interventions include patient and family education in preparation for discharge. Which of the following nursing interventions would be included in the pt/family discharge preparation? • A. Importance of compliance with medication regimen • B. Medic-alert bracelet • C. Avoid being around people with infections • D. Instruct s/sx Addison’s disease and report occurrence of these to their MD.

17. Multiple Choice • Adrenocortical insufficiency refers to which disease process? • A. Cushing’s Syndrome • B. SIADH • C. Adrenal Hypofunction (Addison’s Disease) • D. Diabetes Insipidus

18. Multiple Choice • Adrenal Insufficiency occurs when the adrenal glands do not secrete adequate amounts of glucocorticoids, mineralocorticoids, and androgens. The most common cause of this problem is: • A. antibodies destroy adrenal cortex tissue (autoimmune) • B. adrenalectomy • C. primary Addison’s disease • D. adrenal tumor

19. Other - Process • Deficiencies in __________ and _________ lead to disturbance in _______, _____, and ________ metabolism and ___________ and ______________ imbalance, dehydration, water loss, and _____________.

20. Multiple Response • Clinical manifestations of Addison’s disease are related to imbalance of adrenal hormones, nutrients, and electrolytes. Which of the following would be included: • A. Craving for salt • B. progressive weakness and fatigue • C. postural hypotension • D. diarrhea

21. Multiple Choice • Identify the significance of the following lab results as they relate to Adrenal Hypofunction:hyponatremia, hyperkalemia • A. impending adrenal crisis • B. impending thyroid storm • C. impending SIADH • D. nonspecific dehydration

22. Multiple Response • Identify the goals of medical management for the person with Addison’s disease: • A. restore fluid and electrolyte balance • B. replacement of deficient adrenal hormones • C. diet high in Na+ and low in K+ • D. Rapid response to s/sx Adrenal Crisis

23. Other • List 4 relevant nursing interventions for the person with Addison’s disease.

24. Multiple Response • When preparing the patient with Addison’s disease for discharge home, the nurse instructs the patient and/or family member in which of the following: • A. Use and carry IM hydrocortisone • B. Adhere to medication regimen • C. Report ALL illness to MD • D. frequent bedrest

25. Other • List 4 clinical manifestations, s/sx., of Addisonian (adrenal) crisis. • Describe the treatment for Addisonian Crisis

26. Multiple Choice • A rare tumor of the Adrenal Medulla is called: • A. Catecholease mass • B. pheochromocytoma • C. Adrenal Medullatoma • D. Corticocytoma Medullary

27. Other – Process • A _____________ causes ___________ secretion of _____________ and ____________ which, in turn, causes ____________ ________.

28. Multiple Response • Clinical manifestations of pheochromocytoma include which of the following: • A. Severe HTN (300/175) • B. severe headache • C. abdominal or chest pain • D. excessive urinary output

29. Other • Describe subjective information that a patient with pheochromocytoma may complain of:

30. Multiple Response • Objectively, the nurse may notice any or all of the following with a patient with pheochromocytoma: • A. ↑ BP, PULSE, RESPIRATORY RATE • B. Presence of tremors, diaphoresis • C. glycosuria, hyperglycemia • D. dilated pupils

31. Other • List 3 diagnostic tests for pheochromocytoma.

32. Other • Pre-operatively, the patient will be given medications r/t the cardiovascular system. • List 1 calcium channel blocker and 1 beta-blocker medication and the purpose of each.

33. Multiple Choice • Post op adrenalectomy, the patient needs to monitored closely by the nursing staff for the following. Which of the following would be a priority nursing intervention? • A. monitor for BP changes and s/sx of cardiovascular collapse • B. Adequate rest and avoidance of stress • C. IV fluid administration and medication administration • D. Intake and Output

34. DIABETES MELLITUS

35. True/False • Diabetes Mellitus is a systemic metabolic disorder that involves the improper metabolism of CHO, fats and proteins.

36. Multiple Response • Diabetes Mellitus, a multisystem disease is related to which of the following problems: • A. a decrease or absolute lack of insulin production • B. impaired insulin utilization • C. none of the above • D. a and b

37. True or False • Though the exact cause of DM is unknown, there is an autoimmune component to this disease.

38. Other • List 3 contributing factors, not mentioned above, that are r/t the cause of DM.

39. Fill-in • There are __ main types of DM. Type __ was formerly called: ____________ ___________ ____________ ____________. Type __ was called: ___-________ ______________ __________ _____________.

40. Compare – Fill in • Type 1 – main problem • Process • Type 2 – main problem • Process

41. Compare • Type 1 Signs/symptoms • Type 2 Signs/symptoms

42. Complete • Metabolic Syndrome is a name for a group of risk factors that occur together and increase the risk for _________, ________, __________.

43. True/False • All of the risk for metabolic syndrome are related to obesity.

44. Multiple Response • The 2 most important risk factors for metabolic syndrome are: • A. extra weight around the middle and upper parts of the body • B. Absence of insulin due to destruction of beta-cells of the pancreas • C. Insulin resistance – body uses insulin less effectively than normal • D. Excess blood clotting

45. True/False • Hormone changes and lack of exercise are also considered risk factors for metabolic syndrome.

46. Multiple Response • Which of the following clinical manifestations are associated with metabolic syndrome? • A. BP =/> 130/85 mm/Hg • B. FBS =/> 100 mg/dL • C. Waist circumference of 35+ inches or greater for men and women • D. Low HDL cholesterol • E. Low triglycerides

47. Multiple Choice • The goal of treatment for metabolic syndrome is: • A. lifestyle changes • B. daily exercise • C. reduce your risk of heart disease and diabetes • D. help you feel young again

48. Multiple Response • People with metabolic syndrome have an increased long-term risk for: • A. developing heart disease • B. type 2 diabetes • C. stroke • D. rheumatoid arthritis

49. Other - Process • In normal metabolism, the end products of digestion are absorbed into the ________ circulation and carried to the __________ where they can be _______ ______________ or __________ for later use.

50. Other - Process • The liver can change ___________ and _______ _______ into ____________ which serves as fuel for muscles and as an energy source for the brain. • __________ must be present for muscles and other body cells to utilize glucose.