Acromegaly is associated with excessive:

A. LH

B. TSH

C. GRH

D. GH

D. GH, growth hormone

-overproduction of GH is usually caused by a benign pituitary tumor

-acromegaly is excessive growth, thickening of bones and soft tissues

-usually affecting middle-aged adults the gradual progression of symptoms may cause a 7-9 year span from onset to diagnosis

Changes associated with acromegaly include:

Select all that apply

A. enlargement of the nose, lips

B. speech difficulties

C. deepening of the voice

D. enlargement of the hands and feet

E. sleep apnea

F. muscle weakness

ALL

-speech difficulties caused by an enlarged tongue

-voice deepens due to hypertrophy of vocal cords

-enlargement of hands and feet can be mild or crippling

-sleep apnea develops due to upper airway narrowing and obsruction

Diagnosing acromegaly is done by CT, MRI, and oral glucose tolerance test.  Why is the oral glucose tolerance test used?

A. acromegaly is always associated with diabetes

B. it measures enlargement of the pancreas

C. GH secretion is inhibited by glucose

D. glucose is a tumor suppressant

C. GH secretion is inhibited by glucose

-two baseline levels of GH are taken before ingestion of 75-100g of glucose

-additional GH measures are taken q 30mins X4 following ingestion of glucose

-normally GH levels fall, in acromegaly GH levels will not fall below 3 ng/mL

The treatment of choice for acromegaly is surgery to remove the pituitary gland.  This procedure is called:

A. hyperphysectomy

B. salpingectomy

C. transsphenoidectomy

D. hypophysectomy

D. hypophysectomy

-the transsphenoidal approach is used

-glucocorticoids, throid hormone, and sex hormone replacement will be given orally and will have to be continued throughout life

The most common drug used in the treatment of acromegaly is:

A. Sandostatin

B. Spycel

C. Bexxar

D. Torisel

A. Sandostatin

-is a somatostatin analog that reduces GH levels to within normal limits

-drug therapy is normally reserved for patients that have had an inadequate response to surgery or radiation

You are the RN on a unit and your patient has just returned from a hypophysectomy, removal of his pituitary gland, what interventions can you expect to perform?

Select all that apply

A. keep patient on strict bed rest in the supine postition

B. monitor neurological status

C. brush the patients teach for him

D. instruct the patient to avoid vigorous coughing

B,D

-HOB should be kept at 30^o to relieve pressure on the sella turcica and avoid headaches

-patient's teeth shouldn't be brushed for at least 10 days to avoid irritating the suture line, perform mouth care

-vigorous coughing, sneezing, or straining at BMs can cause enough pressure to cause a CSF leak

-any clear drainage from the nose should be sent to the lab for glucose testing to see if it is CSF

-a CSF leak usually resolves within 72 hrs and daily spinal taps can be used to relieve pressure, if a CSF leak does occur the patient is at an increased risk for meningitis

SIADH occurs when _____ is released despite normal or low plasma osmolarity.

A. GH

B. ACTH

C. TSH

D. ADH

D. ADH (antidiurectic hormone) AKA vasopressin

-SIADH is an overproduction of ADH

-SIADH occurs more commonly in older adults

-the most common cause of SIADH is malignancy, especially small cell lung cancer

Which major F&E imbalance is associated with SIADH?

A. hyperkalemia

B. hypomagnesemia

C. hypercalcemia

D. hyponatremia

D. hyponatremia

-extracellular volume increases diluting the sodium levels

What initial signs will a patient with SIADH exhibit?

Select all that apply

A. dyspnea

B. thirst

C. muscle cramps

D. vomiting

E. confusion

A,B,C

-vomiting and confusion are seen as hyponatremia worsens

The patient with SIADH will experience low UOP and weight gain.  What signs indicate that hyponatremia is worsening?

Select all that apply

A. thirst

B. muscle cramps

C. vomiting

D. abdonminal cramps

E. muscle twitching

F. seizures

C,D,E,F

-thirst and muscle craps are seen with early hyponatremia

Diagnosis of SIADH is made by simultaneous measures of urine and serum osmoality.  What indicates SIADH?

A. serum osmolality much lower than urine osmolality

B. urine osmolality much lower than serum osmolality

C. serum and urine osmolality both being high

D. serum and urine osmolality both being low

B. urine osmolality much lower than serum osmolality

-this indicates that sodium concentration is high in the urine while low in the extracellular space, when serum sodium concentration is low the body should low the excretion of sodium in urine, with SIADH this doesn't happen

Treatments for SIADH include: Select all that apply

A. fluid restrictions

B. high Fowler's position

C. seizure precautions

D. .45% saline

E. Vaprisol

A,C,E

-fluid restriction is the main treatment, it causes  a gradual reduction in weight and progressive rise in serum sodium concentration

-fluid restrictions are 800-1000mL/day for mild cases and 500mL/day for severe cases

-HOB should be flat to promote venous return and increase left atrial filling

-in severe cases 3% or 5% saline may be administered via pump and a very slow infusion rate

-Vaprisol is a vasopressin (ADH) receptor antagonist and must be used with close monitoring so the serum concentration doesn't return to normal too quickly

Diabetes insipidus is associated with a deficiency of production or secretion of:

A. vasopressin

B. FSH

C. TSH

D. ACTH

A. vasopressin (ADH)

-central DI is caused by tumor, head injury, or brain surgery

-nephrogenic DI is results from inadequate renal response to ADH

-primary DI is caused by excessive water intake

Diabetes insipidus will show what results when a serum osmolality and urine osmolality are taken?

A. high concentration of urine and low serum concentration

B. low urine concentration and high serum concentration

C. both concentrations will be high

D. both concentrations will be low

B. low urine concentration and high serum concentration

-hypernatremia will cause elvated serum osmolality and since ADH is lacking or not affecting the kidneys urine will be mostly water

-hypernatremia will lead to polydipsia and polyuria

-fluid and hormone replacement are the main treatment for central DI

-hormones have little effect on nephrogenic DI so limiting sodium intake and thiazide diuretics are used

75% of hyperthyroid cases are Grave's disease

-Obvious signs are a goiter and the "exploding eyeballs"

A patient in the early stages of hyperthyroidism may exhibit which two of these:

A. weight loss

B. lethargy

C. anemia

D. nervousness

-an acute, rare condition in which all hyperthyroid manifestations are heightened

-manifestations include severe tachycardia, heart failure, shock, hyperthermia (up to 105.3^oF, restlessness, agitation, seizures, abd pain, nausea, vomiting, diarrhea, delirium, and coma

-thought to be brought on by some stressor such as infection, trauma, or surgery in a patient with preexisting hyperthyroidism

1. antithyroid meds
2. radioactive iodine therapy (treatment of choice)
3. subtotal thyroidectomy

What makes iodine an effective treatment for hyperthyroidism?

A. it inhibits TSH

B. blocks release of T₃ & T₄

C. neutralizes the effects of TH on target organs

D. is a TH cell receptor antagonist

B. blocks release of T₃ & T₄

-also decreases the vascularity of the thyroid gland making surgery safer

Radioactive Iodine Therapy is the treatment of choice for hyperthyroidism.  How does it work?

A. damaging thyroid tissue

B. suppressing release of TH

C. mutating TH release sites

D. inhibiting cell receptor attachment

A. damaging or destroying thyroid tissue

-this limits thyroid hormone secretion

-RAI won't show maximum effect for 2-3 months so the patient will be put on antithyroid meds until then

-there is a high occurence of post treatment hypothyroidism, so patients need to know the signs

Which of these is NOT a sign of iodine toxicity?

A. swelling of buccal mucosa

B. inadequate saliva production

C. nausea/vomiting

D. skin reactions

B. inadequate saliva production

-patients exhibit excessive salivation

What are expected interventions following a throidectomy?

Select all that apply

A. assess q 2hrs for 24 hrs

B. place patient in Trendelenburg

C. monitor for hyperparathyroid reaction

D. administer analgesics

A, D

-assess for signs of hemorrhage or tracheal compression suh as: irregular breathing, neck swelling, frequent swallowing, sensations of fullness at incision site, choking, and blood on the dressing

-patient needs to be in semi-Fowler's with pillow support for the head and avoiding flexion of the neck

-assess for signs of hypoparathyroidism as they may be accidently removed (tingling of the fingers/toes/or mouth, muscle twitching, or apprehension)

Hypothyroidism is characterized by the systemic _______ of body processes.

A. failing

B. heightening

C. slowing

D. reversing

C. slowing

-manifestations include: fatigue, impaired memory, slowed speech, depression, decreased cardiac contractility/output, anemia, lower metabolic rate, decreased GI motility, hair loss, coarse dry skin, swelling

-myxedema can arise from severe long-standing hypothyroidism (puffiness, periorbital edema, and a masklike effect

Myxedema coma is the progression of hypothroidism's sluggishness and lethargy to a gradual or sudden coma.  It is characterized by all of the following except:

A. hypothermia

B. hyponatremia

C. hypotension

D. hypoventilation

B. hypotension

-during myxedema coma the patient's vital functions must be supported while IV thyroid hormone replacement can be administered

Synthyroid is the drug of choice for hypothyroidism.  Why is a lower starting dose recommended?

A. irreversible damage to the thyroid can be done

B. overload can cause respiratory failure

C. rapid change may cause muscle wasting

D. may cause angina or cardiac disrhythmias

D. may cause angina or cardiac disrhythmias

-esp in the elderly or cardiac patients, because an initial dose may increase myocardial oxygen demand

-any chest pain should be reported immediately and an ECG and serum cardiac enzyme test performed

used to increase T₃ & T₄ back to normal levels

-restores the metabolic rate of a hypothyroid patient

-CONTRAINDICATED: severe cardiac conditions

-pregnancy category A

-administered PO, IM, IV for hormone replacement, increased dose every 4-6 weeks to reach therpeutic level

-IV 200-500mcg/day for myxedema coma

-Peak 3-4 weeks

-Duration 1-3 weeks

-Half-life 6-7 days

-Monitor HR and BP

Cushing syndrome is caused by an excess of:

A. oxalic acid

B. H₂CO₃

C. corticosteroids

D. thyroid hormone

C. corticosteroids

-esp glucocorticoids

-corticosteroids are the steroid hormones released by the adrenal cortex

-85% of Cushing's cases are the result of an ACTH (adrenocorticotropic hormone) secreting pituitary tumor

Which of the following are clinical indications of Cushing's syndrome?  Select all that apply

A. generalized obesity

B. "moon face"

C. purple striae on the abd, breasts, or buttocks

D. hirsutism in women

E. menstrual disorders

F. hypertension

G. unexplained hypokalemia

Cushing syndrome is diagnosed by a 24 hour urine collection to check for free __________.

A. cortisol

B. aldosterone

C. ADH

D. ketones

A. cortisol

-if the cortisol level is elevated (normal 80-120 mcg) indicates Cushing

-CT and MRI of the pituitary and adrenal glands may be done

Addison's disease is caused by ___________ insufficiency.

A. pituitary

B. thyroid

C. parathyroid

D. adrenalcortical

D. adrenalcortical

-the most common cause is autoimmune response

-causes are infarction, fungal infections, AIDS, metastatic cancer

Manifestations are generally not noticed with Addison's disease until ______ of the adrenal cortex is destroyed.

A. 45%

B. 60%

C. 80%

D. 90%

D. 90%

-onset is slow including progressive weakness, fatigue, weight loss, and anorxia

-skin hyperpigmentation is a major sign esp on sun exposed areas, pressure points, joints, and palmar creases

-other signs are: orthostatic hypotension, hyponatremia, salt craving, hyperkalemia, nausea, vomiting, and diarrhea

Addisonian crisis is caused by a(n) _________ of adrenocortical hormones.

A. drastic rise

B. steady rise

C. steady flow

D. drastic drop

D. drastic drop

-caused by stress (infection, surgery, trauma), sudden withdrawal of corticosteroid replacement, after adrenal surgery, or following sudden pituitary gland destruction

Addisonian crisis is manifested by all of these except:

A. postural hypotension

B. tachycardia

C. dehydration

D. hyponatremia

E. hypokalemia

F. hypoglycemia

E. hypokalemia

-a patient in addisonian crisis will experience hyperkalemia

-also fever, weakness, and confusion

-hypotension may lead to shock

Addison's disease is diagnosed by low ________ levels.

A. aldosterone

B. ADH

C. thyroid hormone

D. cortisol

Treatment of Addisonian crisis is focused on management of the underlying cause.  Management includes a high dose _________ and large volume of normal saline or D5W to reverse hypotension and electrolyte imbalances.

A. aldosterone

B. radiation

C. hydrocortisone

D. prednisone