2. The Endocrine System

3. Direction Each group will have index cards with number 1- 8 Each card will have a number for questions on Endocrine disorder. When the wheel hits the number on the index card, one group member will chosen to read the question and collaborate with group members on the correct answer.

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6. Question 1 1. A 57 year old with diabetes insipidus is hospitalized for care. Which finding should the nurse report to the physician? a. Urine output of 350 in 8 hours b. Urine specific gravity of 1.001 c. Potassium of 4.0 d. Weight gain

7. Answer B Diabetes Insipid is caused by a deficiency of antidiuretic hormone, which results in excretion of a large volume of dilute urine. Therefore, the urine specific gravity of less than 1.005 should be reported. Urine output should be 30-50ml so 350 is normal output over 8 hours. The potassium level is normal. Weight loss not weight gain is monitored for signs of dehydration

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9. Question 2 2. A client with diabetes mellitus asks the nurse to recommend something to remove corns from his toes. The nurse should advise him to a. Apply a high quality corn plaster to the area b. Consult his physician or podiatrist about removing the corns c. Apply iodine to the corns before peeling them off d. Soak his feet in borax solution to peel off the corns

10. Answer A The client with DM are prone to serious foot injuries secondary to peripheral neuropathy and decreased circulation. The client is taught to avoid going barefoot. Shoes that don’t fit should not be worn because they could cause blister that could become non-healing. Toe nails should be cut straight across. Heating pad should not be used for risk for injury due to insensitivity to temperature

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12. Question 3 3. Angiotensin-Converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of a. Chronic obstructive pulmonary disease b. Pancreatic Cancer c. Renal Failure d. Cerebral vascular accident (CVA)

13. Answer C Renal failure frequently results from vascular changes associated with DM. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic nephropathy. COPD is not a complication of DM. Pancreatic cancer is neither prevented with ACE nor considered a complication of diabetes. CVA is not directly prevented by ACE although management of HTN will decrease vascular disease

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15. Question 4 4. Which of the following is a priority outcome for a client with Addison’s disease? a. Maintenance of medication compliance b.Avoidance of normal activities with stress c.Adherence to a g sodium diet d.Prevention of hypertensive episodes

16. Answer A Medication compliance is an essential part of Addison’s disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stress of daily living. The nurse should instruct the client to never stop taking drugs to avoid Addisonian crisis. No need to restrict sodium. Client is at risk for hyponatremia. Hypotension not hypertension is common with Addison’s disease

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18. Question 5 5. When teaching a client newly diagnosis with primary Addison's disease, the nurse should explain that the disease results from a. Insufficient secretion of growth hormone b. Dysfunction of the hypothalamic pituitary c. Idiopathic atrophy of the adrenal gland d. Over secretion of the Adrenal Medulla

19. Answer C Primary Addison’s disease refer to problem in the gland itself that results from idiopathic atrophy of the glands, the process is believed to be autoimmune.

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21. Question 6 6. Initial treatment for a cerebralspinal fluid (CSF) leak after transphenoidal hypophysectomy would most likely involve: a.Repacking the nose b.Returning the client back to surgery c.Enforcing bed rest with the head of the bed elevated d.Administering high dose corticosteroid therapy

22. Answer C If CSF leakage is suspected or confirmed, the client is treated initially with bed rest with the head of bed elevated to decrease pressure on the graft site. Most leaks heal spontaneously, but occasionally surgical repair of the site is needed. Repacking the nose will not heal the leak at the graft site.

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24. Question 7 7. A 42 year old female client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. When examining this client, the nurse would expect to find a. Orthostatic Hypotension b. Muscle hypertrophy in the extremities c. Bruised areas on the skin d. Decreased body hair

25. Answer C Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing’s disease. Hyperpigmentasion and bruising are caused by the hyper secretion of glucocorticoids. Fluid retention causes hypertension not hypotension. Muscle wasting occurs in the extremities. Hair on the head thins, while body hair increases

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27. Question 8 Cushing's disease is manifested by the excessive secretion of corticosteroids. The hormones involved are: a.Glucocorticoids and aldesterone b.Adrenocorticotropic hormone (ACTH) c.Glucocorticoids, aldesterone and Androgens d.Catecholamines

28. Answer C Excessive levels of Glucocorticoids, Aldesterone an Androgens secreted from the adrenal cortex result in the constellation of symptoms known as Cushing's disease.

29. Reference Billings, D. (2005). Lippincott’s Q & A for NCLEX-RN. Lippincott: Williams & Wilkins