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Dx/MGMT Endocrine
ANCC Board review
| Question | Answer |
|---|---|
| Your pt has complaints of excessive thirst and urination with unexpected weightless. You check a fasting glucose and it is 299. There is ketonemia, elevated BUN and Creatinine. As the acute care NP you suspect | DM I |
| The Acute care NP realized that good glycemic control is represented by | Hgb A1c of approx 6 |
| normal glucose finding is | 60-99 |
| Recurrent vaginitis is an associated S/S of | DM II |
| Chronic skin infections such as cellulitis and vanities may suggest your patient has | DM II |
| Your patient just had their prescription renewed however 4 months after they return complaining of blurred vision. you suspect | DM II |
| You male patient has a waist circumference of 49inches, has BP 140/90 and HDL of 39. As an acute care NP you recognizes that he meets criteria for ___ | |
| How does therapy for the type II DM who is obese begin? | Weight control |
| What medication is the standard of care for DM II | metformin |
| Potential SE's metformin | lactic acidosis Muscle pain |
| Sulfonylureas | G drugs end in -ide (Glipizide, Glimepride etc) stimulate pancreas to release more insulin |
| Alpha-glucosidase inhibitors | Bond to disaccharidases more readily than sucrose, less absorbed by guy |
| Normal BUN | 10-20 |
| Normal Creatinine | 0.5-1.5 |
| Your patient is profoundly hypoglycemic the early morning hours but then around 0700 she becomes hyperglycemic. The NP realizes this to be ______ and initiates the following treatment | Somogyi effect and will omit the PM/bedtime dose of insulin |
| The pt has progressively elevated glucose throughout the night which results in profound hyperglycemia at the 0700 hour the NP realizes this to be _________ and initiates the following intervention______ | Dawn Phenomenon and adds or increases the PM/bedtime insulin dose |
| Define DKA | State of intracellular dehydration resulting from elevated BG levels Can be presenting sign of TYPE I DM |
| MGMT DKA | Bolus 0.1 units/kg IV regular insulin no initial Tx for hyperkalemia Isotonic Fluidsx1 liter If glucose >500 1/2 NS change to D5 1/2 NS after glucose drops below 250 Bicarb used only in severe acidosis pH <7.1 |
| HHNK is | intracellular dehydration as a result of profound elevated BG Usually a TYPE II DM complication |
| HHNK labs | serum BG > or = 600 relatively normal pH NORMAL ANION GAP |
| TX HHNK | Fluid Resuscitaiton with NS then 1/2 Ns then D5 1/2 15U regular insulin IV followed by 10-15U SQ immediately |
| 50 y/o female who complains of anxiety, fatigue, mood swings, and feeling nervous. On exam you note hyperrelexia of DTRs, and tachycardia that is irregular. You obtain a 12 lead EKG and it shows the patient to be in a-fib. You are suspicious for | Hyperthyroidism |
| The acute care knows that _______ is most sensitive test for hyperhyroidism | TSH assay |
| The ______ is decreased and the T3 is ________ | TSH; elevated |
| What does does the thyroid radioactive iodine uptake and scan establish | etiology of hyperthyroidism |
| The serum ANA is elevated or decreased in hyperthyroidism | elevated w/o evidence of lupus |
| High Iodine uptake is most consistent with | Graves Dz |
| Low uptake of iodine is consistent with | subacute thyroiditis |
| Most common form of hypothyroidism | Hashimoto's thyroiditis |
| Pt presents with muscle cramping, weight gain, dr skin, cold intolerance, puffy eyes and edema of the hands with slowed DTRs. Lab data reveals hyponatremia and hypoglycemia. As the acute care NP you suspect | hypothyroidism |
| The TSH in hypo thyroids would be | Elevated |
| Serum T4 in hypothyroidism is | Decreased |
| Your patient has bee diagnosed with subacute thyroiditis. You know the best treatment for this disorder to be | symptomatic treatment with Propranolol |
| What must happen before a patient with hyperthyroidism can under go surgical intervention | They must be euthyroid |
| Treatment for Thyroid crisis | PTU 150-250 mg q6 IV OR Methimazole (Tapazole) 15-25mg q6 With the following in 1 hour LUgol's solution 10gtts TID or sodium iodide `1gm slow IV with Propranolol 0.5-2gm IV q4 or 20-120mg PO q6 with hydrocortisone 50mg q6h w/ rapid reduction w/improve |
| ASA is contraindicated in thyroid crisis because | It can exacerbate |
| TX for myxedema coma | Protect airway Fluids as needed IV Levothyroxine 400mcg x1 then 100mcg daily Support hypotension Slow rewarming Symptomatic care |
| Causes of Cushing's Syndrome | ACTH hyper secretion (pituitary) Adrenal tumors Chronic admin of glucocorticoids (transplant pt) |
| Your patient comes to your clinic with a wound that has been extremely slow to heal and complaints of being frequent urine and excessive thirsty, new onset of weakness, and no period in two months. BP is 150/90 BG 120 NA 148 and K+ 3.0. You suspect_____ | Cushing's syndrome |
| Your patient has hyperpigmentation of the nail beds and palmar creases with diffuse tanning and freckles. BP is 80/70; WBC 12000; BG is 55; NA 128 and K+ 5.9. Plasma cortisol at 0800 is 3mcg/dL. This is most consistent with | Addison's disease |
| What are the causes and etiology of additions Dz | Deficient cortisol, androgens and aldosterone Autoimmune destruction of adrenals Metastatic CA Pituitary failure resulting in decreased ACTH Bilateral adrenal hemorrhage (anti coat therapy) |
| Tx for addison's Dz | Outpatient MGMT is: referral coupled with gluco/mineralocorticoid replacement -hydrocortisone Fludrocortisone Inpatient MGMT Hydrocortisone (solu-cortef) 100-300 IV initially with NS; Volume replacemtent with D5NS at 500cc/hr x4 hours then taper |
| The patient complains of mild headache with NV. On exam you notice that there is =1 edema now and their DTRs are decreased. Serum Osmolality is 240, urine NA is 30mEq however, the patient is in a euvolemic state with normal kidney Function. You suspect | SIADH Pt with Decreased serum OSM <280 Increased urine osmolality >100 mOsm/kg Urine Na+ >20 |
| Your patient labs have come back as Serum Osmolality 300 mosm/kg; Urine Osmolality 60mosm/kg; BUN 30; Cr 2.0; Na+ 150 and specific gravity 1.000 You are suspicious of _____ | Diabetes insipidus Hyper Na+ Serum Osmo >290 Urine Osmo <100 Bun and Cr elevation Urine specific gravity <1.005 |
| The NP knows that the treatment for SIADH involves | Treating the underlying cause If serum NA >120 fluid restriction of 1L daily If serum NA 110-119 fluid restriction of 500mL daily and monitor If serum Na<110 or neuron symptoms present replace with isotonic or hypertonic |
| The NP knows the treatment for Diabetes insipidus with NA+ >150 to be | D5W IV and replacing half of the volume loss in 12-14 hours with careful attention to lowering Na levels to fast to avoid cerebral edema |
| The Acute care NP knows that ______ can e administered in the acute stages of Diabetes Insipidus. |
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EL92578
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