Hair loss is associated with?

A pt responds slowly to external stimulation and needs repeated stimulation to maintain attention/response, how would you describe their behavior?

Exophthalmos (bulging eyes), moon face, buffalo hump, and truncal obesity are associated with?

Measures proportion of iodine present in the thyroid gland; low uptake = hypothyroidism, high update = hyperthryoidism. Which diagnostic am I?

DI is a deficicency of ADH (vasopressin); polydipsia of dilute urine happens. There are too types. One happens d/t head trauma, craniotomy, brain tumors, surgical ablation of the pituatary, and CNS infections. The other happens when renal tubules fail to respond to ADH d/t increases in calcium, decreases in potassium, and medx like lithium, amphotericin B, or demeclocycline.

What would be the SP of a pts urine with DI?

For a pt with DI, how would you describe their serum NA levels?

Note: Their urine contains no glucose or albumin. They prefer cold water btw 2-20L daily. Restricting water could leave to severe dehydration and the right answer to this question.

Monitor DI pts for hypotension and tachycardia. You can conduct a fluid deprivation test - withholds fluids for 8-12 hrs. Be sure that you monitor pt HR and BP.

If the pts specific gravity doesn't improve, they may have DI. If pt develops tachycardia, excessive weight loss, or hypertension, what is your next step?

Pharm tx for DI, if neurogenic or central, would be?

Pharm tx for DI, if nephrogenic or renal, would be?

Too much ADH/vasopression is what?

Note: Hyponatremia, low serum osmolality <280, and high urine osmolality >100

Pts would be anorexic, NV (early), abdominal pain, lethargic, irritable, confused, delirius, seizing, coma, heart attack, and experience muscle weakness

Not enough ADH/vasopression is what?

Nephrons produce >250mL/hr = polyuria, dilute urine w/ SG of 1.001-1.005, pts crave coldwater.

Pts with this condition are hyponatremic. Causes include lung disorders like pneumonia, small cell lung cancer, and pneumothorax. CNS disorders like head injury, brain tumors or infection can also stimulate excessive amounts of ADH. Some medx like vincristine, phenothiazines, TCAs, thiazide diuretics, adn nicotine can cause this condition as well. What am I? (excessive ADH/vasopressin)

For pts w/ SIADH, aim to address the underlying cause, restrict fluids, 3% saline (hypertonic) to correct the hyponatremia (avoid neurologic issues), raise NA by 0.5-1 mEq/hr, monitor VS and serum NA, I&O frequently, neuro checks, blood/urine chemistricts, and provide support/teaching. What type of diuretics should the pt receive?

Parathyroid glands regulate which of the following? Select all that apply.

Excessive parathormone can lead to hypercalcemia = life-threatening.

Serum levels of CA lead to parathormone release. Increased serum levels of CA lead to a decrease in parathormone. Which type of feedback is this?

Note: Calcium and phosphorous have an inverted relationship; one up, the other down

A certain level of parathyroid hormone leads to softened bones and kidney stones. It happenes 2-4 times more often in women. A primary incidence is caused by enlargement of the glands or overproduction. A secondary incidence happens d/t renal failure and vitamin D deficiency. A pt may be asymptomatic or experience "stones, bones, abdominal groans, thrones (constipation/polyuria), or psychiatric overtones (delirium). Which condition could they be experiencing?

A radioimmunoassay for PTH uses antibodiesand antigens to dx hyperparathyroidism. A double antiboy parathyroid hormone test can distinguish btw primary or malignant cause.

If primary hyperparathyroidism is associated with oversecretion of PTH, what would be the cause of tertiary hyperparathyroidism?

Note: Calcium and a vitamin are bounded.

Normal serum CA would be 8.6-10.3. Hypercalcemic Crisis = Serum CA >13-14 and can be life threatening. Treatment includes isotonic saline fluids to increase UOP; calcitonin and corticosteroids increase CA deposition in bone; dialysis in emergent situations not responding to treatment. There are other tx options, which of the following should be avoided

Parathyroidectomy is recommended for _ with primary hyperparathyroidsim and who meet one or more of the following criteria:

- Younger than 50

- Unable to f/u

- Serum CA >1 above normal levels

- GFR <60

- Urinary CA >400 mg/day

- Bone density <-2.5 (osteoporosis)

- Nephrolithiasis or Nephrocalcinosis

Pts undergoing sx for parathyroidism are encouraged to drink >2L of water to prevent renal calculi, ambulate (reduces resorption of CA from bones), avoid excess CA, take antacids or protein if w/ peptic ulcer, improve appetite, drink prune juice, take stool softeners, and monitor serum CA levels. What type of position should they be in?

Surgery is usually the culprit. The outcome ends up being hyperphosphatemia and hypocalcemia (and vitamin D deficiency). Pts suffer from muscle tetany, anxiety, irritability, depression, delirum, dysrhytmias, and hypotension. Which represents contracture of facial muscle in response to tapping the facial nerve (insensitive test)?

The other is associated w/ carpal spasm > brachial artery and BP cuff 20 mm above systolic BP for 3-5 mins

The goals for tx of hypoparathyroidism is to increase CA levels to 9-10. Tx can include calcitriol, Ca, Mg, and VitD2 or D3, thiazide diuretic. Restrict foods high in Phosphate and avoid spinach b/c it contains oxalate, soft drinks, and meats. Encourage green leafy, fortified OJ, and breakfast cereals. Ca salts and Ca gluconate are supplements. Aluminum hydroxide or carbonate binds to phosphate and is excreted. In emergency situations, calcium gluconate is given _ for pts w/ cardiac conditions, disorders, or taking digoxin.

Post-parathyroidectomy, a hoarse voice is a cause for concern?

Which is secreted in response to high plasma Ca levels?

Serum TSH is the primary screening test for thyroid function. A pt has weight gain, cold intolerance, fatigue/lethargy, bradycardia, hypotension, dysrhythmias, and a slow though process or speech. Which are they showing s/s of?

Note: Monitor cardiovascular, weight, mental status, use stocking/elevate, low calorie/high bulk, encourage activity, cathartics, stool softeners, extra clothing/blankets for temp, and caution w/ meds d/t decreased metabolism.

Thyroid hormone replacement involves use of which medx?

Note: Increases effects of warfarin. Use caution w/ geriatric pts that have coronary artery disease; monitor for angine/dysrhythmia.

Dr. Wartofsky suggested that both work, but which is the active thyroid hormone that pts w/ myxedema coma (chronic hypothyroidism) need STAT?

S/S include: hypothermia, myxedema, slow HR, low BP, respiratory failure, hyponatremia, hypoglycemia, confusion, droswy

In response to myxedema coma, a pt received tx. The patient soon displayed the various s/s headache, leg cramps, tremors, feeling nervous or irritable, chest pain, shortness of breath, and fast or pounding heartbeats. Which of the following would the nurse be concerned about?

A pt experiences anxiety, hand tremor, heat sensitivity, weight loss, puffy eyes, and a goiter. They were diagnosed with hyperthyroidism secondary to which of the following?

Pts w/ hyperthyroidism are best when calm, comfortable, cool, and in a quiet environment. Obtain daily weights, monitor EKG and BP, and educate about meds like methimazole and Propylthiouracil (PTU). If a pt gets irritable/grumpy, systolic BP spikes and diastolic BP drows w/ an accelerated HR, NVD, what would a nurse be concerned about?

Pts may experience tachydysrhythmias >130 bpm

Radioactive iodine therapy (RIT) is appropriate for pregnant women, infants, and small children? Note: 4-6 weeks may be needed for effects to be met. Geriatric and CV pts are high-risk.

Prior to a thyroidectomy, reduce stress and anxiety to limit the potential for a thyroid storm. Pts are on anti-thyroids for 4-6 weeks; beta blockers as needed (-lols). Which of the following are recommended nursing interventions

Post-thyroidectomy, pt should be in semi-fowlers, assist w/ deep breathing, suction as necessary, monitor for bleeding, assess/respond to pain, anticipate hypocalcemia d/t procedure. How often should you monitor voice?

Use caution with anti-thyroid medx for pregnant or lactating women. Meds should be taken at regular intervals, report fever, sore throat, and bruising immediately, report signs of jaundice. When should you take your meds?

BBs treat tachycardia, palpations, and counters thyroid hormone effects. RNs should monitor BP, HR, and EKG, signs of hypoglycemia for DM pts. Dizziness is a SE. Monitor pulse prior to each dose.

Your pt HR<60, how would you handle the BB medication?

Iodine solutions are recommended 1 hr after anitthyroid meds, contraindicated in pregnant and breastfeeding women, can be mixed w/ juice w/ a straw, and the PCP should be notified if sore throat, fever, or mouth ulcers develop. How would you best describe use?

For pts experiencing a thyroid storm, maintain airway, monitor their heart, administer medx followed by sodium iodide, IVF for hydration, and monitor I&O strictly. Which of the following can they not give?

Which of the following are associated w/ hypothyroidism? Select all that apply.

Which of the following are associated w/ hyperthyroidism? Select all that apply.

Thanks to glucocorticoids, we have glucose, protein, and fat metabolism. Where are they produced?

Note: The chief glucocorticoid is cortisol - increases glucose levels in bloodstream.

When the adrenal cortex is damaged and you have a lack of mineralcorticoids/glucocorticoids, an individual develops _ disease.

Pts have low Na and sugar, are tired/weak, high levels of K and Ca, reproductive changes, low BP, increased pigmentation or bronze skin, diarrhea, nausea, and depression. Tx includes monitoring glucose & K, replacing hormone levels, wearing a medical alert bracelet, diet high in proteins/carbs and Na, and avoiding illness, stress, and strenuous exercise. What condition am I?

If a pt complained of sudden pain in the stomach, back, or legs, syncope, shock, super low BP, and severe vomiting, diarrhea, and headache. A nurse would be concerned about which diagnosis?

Note: Tx includes IV cortisol (solu-cortef) and IV fluids, monitoring for infection, frequent neuro status, and electrolyte levels. Increase intake of Na and glucocorticoids when anticipating stress.

Excessive adrenocortical activity due to pituatary tumor or corticosteroid meds (monitor for infection) can result in growth retardation, obesity, muscoskeletal changes, and glucose intolerance. Pts may experience muscle wasting and osteoporosis. Pts also retain Na and water, develop HTN, HF, and a moon face, and signs of hyperglycemia, diabetes, or delayed wound healing. Which condition are they showing s/s of?

S/S of cushing's syndrome include fragile skin, weakness, truncal obesity w/ small arms, moon face, ecchymosis w/ elevated BP, striae on extremities/abdomen, hyperglycemia, excessive body hair on women, hypokalemia, buffalo hump, and depression. A serum cortisol test can be done. Which suppression test is done to evaluate change in cortisol levels?

Given at night, cortisol measuremed the next morning.

For pts w/ Cushing's Syndrome, they take 3 types of meds. Adrenal enzyme inhibitors reduce hyperadrenalism, one controls glucose intolerance for pts w/ DM, and the last inhibits adrenal corticosteroid synthesis. Which inhibits corticosteroid synthesis?

Following an adrenalectomy, pts would be go ICU post-op. The site should be monitored for bleeding, abdomen for bowel sounds, administer pain and stool softeners, introduce foods slowly, and assess abdomen for tenderness/distention. How often should you check vital signs?

Following an adrenalectomy, GI ulcers require that pts avoid alcohol, caffeine, smoking, aspirin, and NSAIDs. Diet should be high in calcium and vitamin D.

Adrenal crisis treatment includes which of the following?

A pt requires immediate defribillation, CPR, vasopressors, and antiarrhythmics. Which type of rhythm may they be exhibiting?

Cardioversion: Abnormal heart rate to normal, synched to QRS

Defribillation: Stops a hear to allow for normal to begin, not synched/at random

A pt requires cardioversion, antiarrhythmics, vagal maneuvers, carotid massage, and anti-tachy pacing. Which condition may they be experiencing?

Cardioversion: Abnormal heart rate to normal, synched to QRS

Defribillation: Stops a hear to allow for normal to begin, not synched/at random

A pt requires pacing, atropine, epinephrine, and/or dopamine. Which condition may they be experiencing?

Cardioversion: Abnormal heart rate to normal, synched to QRS

Defribillation: Stops a hear to allow for normal to begin, not synched/at random

Which condition is the pt experiencing?

If pt is symptomatic, administer atropine 0.5 mg IV bolus, q 3-5 mins until max dose of 3 mg; if ineffective, administer dopamine or epinephrine. Which condition is the pt experiencing?

Address cause; if unstable use cardioversion, vagal maneuvers, carotid massage, gaggin, bearing down, coughing, facein water, adenosine @ 6 mg/2 mL, or catheter ablation (monitor for reoccurence). Which condition would the pt be experiencing?

Early beats are initiated by the atrium (not SA node), P wave found in T wave. Treat the cause, decrease caffeine, and correct the hypokalemia. Which condition would the pt be experiencing?

Digoxin toxicity, HF, CAD may cause it. PR interval <0.12, treatment includes eliminate cause, decrease caffeine, and correct hypokalemia. P wave is inverted or absent. Which condition might the pt be experiencing?

QRS complex >0.10 secs; irregular rhythms; absent P waves. Can be caused by fear, anxiety, high emotion, drugs like caffeine, alcohol, nicotine, hypoxia, acidosis, cardiac disease, electrolyte imbalances (K and Mg). Tx includes correcting cause. Pharm rarely needed - amiodarone, electrolyte replacement, and oxygen. Which condition might the pt be experiencing?

Lifevest or automatic cardioverter defibrillator vest should be worn at all times - even in the hospital. Do you take off when bathing/showering?

Note: For pts waitlisted for ICD, works like an AED, announces shock, download info daily

Inplantable cardioverter-defibrillator are for pts at _ for sudden cardiac death due to VTach/Fib. Which correctly fills in the blank?

Complete heartblockw/ slow ventricular rate; pacemaker may be needed. Withhold meds, identify cause, atropine can be given but ineffective. Which condition am I?

More severe, associated w/bundle branch block, occasional P not followed by QRS. Can lead to heart stopping or 3rd degree block. Atropine; implant if ineffective. Which condition am I?

Note: QRS falls

PR interval lengthens; QRS is still upright. I also may decrease CO. Which condition am I?

PR interval lengthens; QRS is still upright. I also may decrease CO. Which condition am I?

In response to asystole, which medx would you anticipate giving? Select all that apply.

For polymorphic V-Tach or Torsades de Pointes, the 1st line therapy is?

Signs of LQTS include syncope, seizures, and sudden death, QT>0.50 seconds and a common cause of cardiac arrest for young people. Genetic testing is available. Tx includes eliminating meds, implantable defibrillator, mexiletine, and BB. What type of supplements are given as tx?

V-Fib w/ no pulse; call a code blue. Pts also need immediate _?

Which increases HR and vasoconstricts?

In addition to regulating the renin-angiotension system, prostaglindins regulate renal hemodynamics - control _ and _? Fill in the blanks.

Pain, assessed using the CVA or costovertebral angle tenderness at the 12th rib and the spine, can identify issues with which organ?

Oliguria would be <400 mL of urine a day; which would suggest anuria?

Where should the bladder scan be placed in relation to the symphysis pubis?

BUN us well the kidneys are functioning - kidneys should filter urea from the blood. T/F?

Serum Creatinine should be filtered out.

Elevated BUN can be due to dehydration, urinary tract obstruction, CHF, recent MI, medications, shock, and high protein diet. High SeCr can be caused by renal infection, kidney stones, kidney failure, and other causes.

Best metric for kidney function?

Dialysis is required at 15 or less.

Which is noninvasive, can see fluid accumulations, masses, and abnormaliities, and obstructions?

Which can be done at the bedside, is less costly, and is often first diagnostic assessment?

Best for masses, stones, infections, trauma, metastasis, soft tissue abnormalities, and can be used with contrast agent. Use caution d/t allergic reacitons, sensitivities to dye. Which diagnostic tool am I?

A pt has a sulfur allergy. It is safe to give them IVF and N-acetylcysteine/mucomyst? T/F

A pt undergoing a cystocopy allows the provider to view the inside of the bladder and uretha. A kidney biopsy is anohtertool that collects a specimen from renal coretex. Pt must fast 6-8 hrs prior, take a local anesthetic, hold their breath, and inform of any use of anticoagulants. Which position should a pt be in for the kidney biopsy?

If an issues is associated w/ ciruclation, the cause of AKI would be?

Loss of deep tendon reflexes are associated with AKI & hypermagnesium

RIFLE stands for risk, injury, failure, loss, and EKD. Criteria for _ is a decrease in GFR >50%, increase in serum creatinine above baselines, and with/without change in urine volume. Which of the following goes in the blank?

Geriatric kidney injury or damage shows with which of the following?

Impaired kidney function can result in fluid overload, pulmonary edema, edema, and requires _ weighing?

AKI can lead to hyperkalemia, hypocalcemia, and hyperphosphatemia. ABG would show metabolic acidosis. Which of the following can lead to ventricular tachycardia or cardiac arrest?

N-Acetylcysteine is _ and should be given prior to receiving contrast dye.

If a pt is hyperkalemic, which medx would you anticipate giving?

With AKI, avoid more than 500-600 mL of fluid over previous days urinary output. Consult a dietician and limit which of the following?

Damage to the glomeruli and non-systemic would be which of the following? Cause can be idiopathic or auto-immune in origin.

Diabetes can cause damage to the glomeruli of the kidneys, how would you describe this process considering that it is systemic like lupus and sickle cell disease? A common cause is streptococcal infection.

Nephrosclerosis is hardening of the renal arties most likely casused by which of the following?

Nephrotic syndrome happens when damage to the glomerulus leads to proteinuria. Urine becomes dark yellow and frothy. Interventions include monitoring fluid status, corticosteroids, DVT, respiratory changes, Na intake, and infusion of what?

Acute glomerulonephritis happens due to exposure to a strep infection within _ days that inflames the glomeruli. This happens frequently with peds. HAD STREP; control BP, administer diuretics, strict I&O. monitor K, and limit K.

How long would you expect to see the strep infection cause acute glomerulonephritis?

Normal GFR would be?

Which causes dangerous dysrhythmias?

Renal osteodystrophy is d/t an imbalance in which electrolytes?

With dialysis, which represents toxin/waste removal w/ high concentration to low concentration?

With dialysis, which represents movement across a semipermeable membrane of lowsolute concentration to high solute concentration?

With dialysis, which represents movement from an area of high pressure to an area of lower pressure?

The membrane that allows passage of toxins, fluids, and electrolytes is called the _?

Which form of dialysis happens overnight and allows for a more active lifestyle?

For pts w/ HD, protect vascular access, don't check BP on same side extremity, monitor fluids/electrolytes, monitor VS, and hold antihypertensive meds. Which supplements should you avoid?

A dialysis pt complains of itching, what would be a tx or medx you anticipate?

Best time to give corticosteroids is?