Download Endocrinology Exam: Growth Hormone, Puberty, Hypothyroidism and more Exams Nursing in PDF only on Docsity!
NSG 502 Final Exam Questions With
Verified Answers
Define Growth Hormone Deficiency - ANSWER - inadequate production or secretion of GH What does inadequate production or secretion of GH cause? - ANSWER - poor growth
- short stature Growth Hormone Deficiency Etiology (3) - ANSWER Associated with underlying cause
- hypopituitarism
- brain tumor
- cranial irradiation 7 Growth Hormone Deficiency Manifestations - ANSWER 1. Short height
- Growth rate less than 2 SD from mean for age
- Immature face
- Delayed puberty
- Hypoglycemia
- Diminished Muscle mass
- Deficiencies in other hormones 3 Growth Hormone Deficiency Diagnostic Studies Components - ANSWER - Serial growth measurements using consistent equipment
- bone age evaluation
- complete metabolic lab analysis What indicates GH deficiency? - ANSWER 2 positive GH levels GH Deficiency Therapeutic Management - ANSWER Biosynthetic replacement GH
- SQ injection: usually specialty pen
- Best administered at bedtime
When does Precocious Puberty occur in females & males? - ANSWER Females: puberty before the age of 8 Males: puberty before the age of 9 Precocious Puberty in Caucasian & African American girls - ANSWER Caucasian: under 7 African American: under 6 5 Precocious Puberty Etiology - ANSWER - more frequent in females -idiopathic
- CNS lesions or trauma
- adrenal, ovarian, testicular tumors
- Partial effects with some meds 4 Precocious Puberty Manifestations - ANSWER 1. Secondary sexual characteristics before the age of 7 or 8 depending on gender & race
- Rapid bone growth
- Early growth plate fusion: short stature
- Psychological effects Precocious puberty therapeutic management - ANSWER Administration of GbRH agonist (Lupron) injection
- every 4 to 12 weeks 2 Precocious Puberty Therapeutic Management Goals - ANSWER 1. Stop the development of secondary sexual characteristics
- Maximize adult height (may require GH) 3 Precocious Puberty Nursing Considerations - ANSWER 1. Medication education
- Psychosocial interventions
- mental age vs. age of appearance
- Dress, peer relationship education 3 Neonates & Infants Congenital Hypothyroidism Etiology - ANSWER Live births secondary to:
- thyroid dysgenesis
pituitary TSH receptor sites resulting in decreased thyroid hormone production
- common cause: hashimoto's thyroiditis
Who is hypothyroidism more common in? - ANSWER women > men
10 Acquired Hypothyroidism Manifestations - ANSWER 1. Goiter
- Dry, thick skin
- Coarse, dull hair
- Fatigue
- Cold intolerance
- Constipation
- Weight gain
- Edema of face, eyes & hands
- Delayed or irregular menses
- Confusion, lethargy, depression (older adults)
How is primary hypothyroidism diagnosed? - ANSWER - elevated TSH
How is thyroiditis diagnosed? - ANSWER - circulating antibodies
- Elevated TSH
- normal T4 that decreases over time
How is secondary or tertiary hypothyroidism diagnosed? - ANSWER - TSH not elevated
- Low T
- TRH stimulation test required for diagnosis
Which gland measures TSH & TRH? - ANSWER TSH: pituitary
TRH: hypothalamus
Hypothyroidism Treatment - ANSWER Thyroid hormone replacement
- levothyroxine
- may require frequent lab tests & dose adjustments
2 Hypothyroidism Nursing Considerations - ANSWER 1. Monitor growth & development
- Monitor:
- Constipation
- Activity Intolerance
- Cardiac output
Who has Hyperthyroidism Graves' Disease more? - ANSWER females 5X more likely to be affected
What is the pediatric peak age for acquiring hyperthyroidism Graves Disease? - ANSWER 11 to 15 years old
What age group has the highest frequency of Hyperthyroidism Graves Disease? - ANSWER 20 to 40 years old
Hyperthyroidism Graves' Disease Pathophysiology - ANSWER - Circulating antibodies thyroid stimulating immunoglobulins (TSIs) bind to pituitary TSH receptor sites resulting in excessive T3 & T4 production
- Radioactive iodine
- Surgery
What is the chance of developing hypothyroidism r/t treatment of hyperthyroidism Graves Disease? - ANSWER Treatment = 60 to 80% chance of causing hypothyroidism
2 medications used for Antithyroid therapy - ANSWER 1. Propylthiouracil (PTU)
- Methimazole
PTU or Methimazole MOA - ANSWER - blocking thyroid hormone production by the thyroid gland
PTU or Methimazole Adverse Effects - ANSWER 1. Arthralgia
- skin rash
- pruitus
- Gastric intolerance
- Leukopenia
- Hepatotoxicity
- Hypothyroidism
How is PTU administered? - ANSWER 3x Daily
- lowers thyroid hormones in several weeks
PTU or Methimazole success rate - ANSWER 20 to 40%
3 Antithyroid Therapy: PTU or Methimazole Nursing Considerations - ANSWER 1. Activity restriction despite high energy
- children may be limited to school work only
- Emotional lability
- Nutrition -High metabolic needs
- small, frequent, high calorie, high protein meals
What is the worse PTU or Methimazole side effect? - ANSWER Agranulocytosis
2 Early s/s of agranulocytosis - ANSWER 1. fever
- sore throat
How is radioactive iodine given? - ANSWER - oral solution
Radioactive Iodine r/t Hyperthyroidism MOA - ANSWER - destroys thyroid tissue in 6 to 8 weeks
2 Radioactive Iodine Nursing Considerations - ANSWER 1. Dryness & irritation of mouth/throat
- Teach precautions to minimize radiation exposure to others
Surgery r/t Hyperthyroidism - ANSWER subtotal or partial thyroidectomy
- iodine administered 10 to 14 days before surgery to decrease vascularity
Surgery r/t Hyperthyroidism Nursing Considerations - ANSWER 1. Address fear of "having neck cut" and scarring
T2DM: may go undiagnosed for years
What is the % prevalence for T1DM & T2DM? - ANSWER T1DM: 5-10%
T2DM: 90-95%
What are 2 environmental factors that can cause T1DM & T2DM? - ANSWER T1DM: Virus & toxins
T2DM: Obesity & lack of exercise
What is the nutritional status for T1DM & T2DM? - ANSWER T1DM: thin, normal or obese
T2DM: Frequency overweight or obese
5 T1DM s/s - ANSWER 1. polyuria
- polydipsia: extreme thirst
- polyphagia: eats alot
- fatigue
- weight loss without trying
5 s/s of T2DM - ANSWER Frequently none
- fatigue
- recurrent infections
may also experience:
- Polyuria
- polydipsia: extreme thirst
- polyphagia: eats alot
Is insulin required for T1DM & T2DM? - ANSWER required for all
How are prediabetes characterized by? (2) - ANSWER 1. Impaired fasting glucose (IFG)
- Impaired glucose tolerance (IGT)
What are the prediabetes s/s? - ANSWER Typically asymptomatic
3 Ways to diagnose T2DM - ANSWER 1. Hemoglobin A1C: greater than 6.5%
- Fasting glucose level: >126 mg/dl
- Random glucose measurement >299 mg/dl with s/s
What should you monitor in T1DM when blood glucose >240 mg/dl? - ANSWER Monitor urine or blood ketones
5 T1DM & T2DM Treatment Goals - ANSWER 1. Informed decision making
- Experience few or no episodes of acute hyperglycemic or hypoglycemic emergencies
- Maintain blood glucose levels between 70-100 mg/dl
- Prevent, minimize or delay complications
- Adjust lifestyle to accomodate diabetes regimen with minimum stress
Aspart Insulin
Duration: 18-24 hours
When do you dose insulin for long acting insulin? - ANSWER Evening or bedtime snack
When do you dose insulin for rapid acting insulin? - ANSWER - meals & snacks
What is the correction factor? - ANSWER dose needed to correct current blood sugar to normal
What is the Carb ratio? - ANSWER dose needed to metabolize number of carbs in meal
What is basal rate? - ANSWER continuous secretion of insulin dose that can vary over 24 hours (set by the provider)
5 Complications of Insulin Therapy - ANSWER 1. Hypoglycemia: try different site difference
- Allergic rxn
- Lipodystrophy
- Somogyi effect
- Dawn Phenomenon
What is lipodystrophy? - ANSWER atrophy of subcutaneous tissue
What is Somogyi effect? (2) - ANSWER - rebound hyperglycemia from counter regulatory hormones after undetected hypoglycemia from overdose of insulin
- can occur at any time (typically with sleep): headache & nightmares
What is Dawn Phenomenon? (2) - ANSWER - Hyperglycemia from normal circadian
rhythm of predawn counter regulatory hormones
- Most severe when growth hormone peaks in adolescence and young adulthood
What are 2 Non insulin Injectable agents? - ANSWER 1. Glucagon-like peptide-1 (GLP-1) agonist
- Amylin analogs
Glucagon-like peptide-1 (GLP-1) agonists: 4 MOA - ANSWER -stimulate release of insulin -suppress glucagon -slow gastric emptying -increase satiety
Amylin analogs: 4 MOA - ANSWER -slows gastric emptying
- suppresses glucagon
- hepatic glucose production
- increases satiety
What are 2 questions to ask patient with diabetes mellitus? - ANSWER 1. Is patient or caregiver physically able to prepare and administer accurate doses of the medication?
- What emotions and attitudes are patient and caregiver displaying in regard to diagnosis of diabetes and insulin or oral agent treatment?
3 Adjustments to insulin - ANSWER 1. Clarification of diabetes medications for NPO status
- Hold metformin day of and for 48 hours post surgery/radiologic procedures requiring contrast medium
How do you prevent hypoglycemia while exercising? (3) - ANSWER - Monitor blood glucose levels before, during and after exercise
- small carbohydrate snacks ever 30 minutes
- exercise after meals
When should exercise plans be started when treating T1DM & T2DM? (3) - ANSWER - After medical clearance
- slowly with gradual progression
- should be individualized
3 Health Promotions for T2DM - ANSWER - identify & screen at risk individuals
- screen all adults over 45
- weight management/physical activity
How does stress & illness impact glycemic control? - ANSWER Increase risk of delayed surgical recovery
- target blood glucose less than 180 mg/dl
7 Hyperglycemia s/s - ANSWER 1. dry mouth
- extreme thirst
- frequent urge to urinate 4.drowsiness
- frequent bed wetting
- stomach pain
- blurred vision
7 Hypoglycemia s/s - ANSWER 1. sweating
- trembling
- double vision
- mood changes
- palpitations
- seizure
- numbness
2 Acute Complications r/t Hyperglycemia due to T2DM - ANSWER 1. Hyperosmolar Hyperglycemic NonKetoacidosis (HHNK)
- Nonketotic Hyperglycemia Hyperosmolar Syndrome (NHHS)
Acute Complication r/t Hyperglycemia due to T1DM - ANSWER Diabetic Ketoacidosis (DKA)
Is hypoglycemia a manifestation of diabetes? - ANSWER NO!!! NOT a manifestation of diabetes
- side effect of insulin therapy
2 Early signs of Diabetic Ketoacidosis - ANSWER 1. Lethargy
- weakness
What is associated with diabetic ketoacidosis? - ANSWER Dehydration!!!
- poor skin turgor
- tachycardia
- orthostatic hypotension
7 s/s of Diabetic Ketoacidosis as it progresses - ANSWER 1. dry loose skin; eyes soft & sunken
- ensure patent airway and O2 prn
- IV access for fluids and to correct electrolyte imbalance (especially K+)
- more fluid replacement needed r/t more profoundly dehydrated
- correct cause
What is the most common cause of the hypoglycemia with T1DM? - ANSWER Mismatch in timing of food and medication
What is mild and moderate hypoglycemia levels? - ANSWER Mild: 40 - 70 mg/dl
Moderate: 20 - 40 mg/dl
What are s/s of moderate hypoglycemia? - ANSWER - deprives brain cells of fuel & impairs CNS
- cold, clammy skin, pale, rapid pulse, rapid shallow respirations, change in mood
What are s/s of mild hypoglycemia? - ANSWER - sweating, tremor, tachycardia, palpations, nervousness, hunger, headache, shaky, headache, fully conscious
How should you treat mild hypoglycemia? What are examples? - ANSWER Treat with 10-15g of carb
- glucose tablets/gel fruit juice
- regular soft drink
- skim milk
- hard candies
- saltines
- graham crackers
How should you treat moderate hypoglycemia? What are examples? - ANSWER Treat with 15 - 30g of rapidly absorbed carb
- take additional food such as low fat milk or cheese after 10-15 min
At what glucose level should you investigate further/monitor? - ANSWER >70 mg/dl
- check if the glucose is trending down
At what glucose level should you begin treatment? - ANSWER <70 mg/dl
5 Hypoglycemia Nursing Consideration: if able to swallow - ANSWER 1. initiate carb treatment
- recheck blood glucose in 15 minutes
- repeat until blood sugar >70 mg/dl
- patient should eat regularly scheduled meal/snack to prevent rebound
- check blood sugar again 45 minutes
Hypoglycemia Nursing considerations: if unable to swallow or having a seizure - ANSWER - IM/intranasal dose of glucagon
2 Hypoglycemia Nursing considerations: in acute care settings - ANSWER 1. 20 to 50 ml of 50% dextrose (D50) IV push
- have patient ingest a complex carbohydrate after recovery
2 Microvascular Complications r/t hypoglycemia - ANSWER 1. retinopathy
- nephropathy
2 macrovascular complications r/t hypoglycemia - ANSWER 1. stoke
