Identifying Endocrine Conditions - NCLEX-PN
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Most pituitary adenomas are non functional (incidentalomas). Of the functional adenomas, which are the most common?
Most pituitary adenomas are non functional (incidentalomas). Of the functional adenomas, which are the most common?
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Prolactinomas (prolactin-secreting) make up 30% of functional pituitary adenomas. The second most common type are somatotrophic (growth hormone-secreting) adenomas, which make up 15%, followed by gonadotrophic (gonadotrophin-releasing) adenomas, which make up 10% of reported cases. Null cell adenomas are non functional (they do not secrete hormones).
Prolactinomas (prolactin-secreting) make up 30% of functional pituitary adenomas. The second most common type are somatotrophic (growth hormone-secreting) adenomas, which make up 15%, followed by gonadotrophic (gonadotrophin-releasing) adenomas, which make up 10% of reported cases. Null cell adenomas are non functional (they do not secrete hormones).
Which of the following are common cardiac signs with hyperthyroidism?
Which of the following are common cardiac signs with hyperthyroidism?
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A cardiac workup on a patient with hyperthyroidism will often reveal high cardiac output, tachycardia, atrial fibrillation, a prominent (fourth heart sound) S4, and flow murmurs. This condition is not associated with low cardiac output and while it may be seen with murmurs it is not specifically associated with atrial stenosis.
A cardiac workup on a patient with hyperthyroidism will often reveal high cardiac output, tachycardia, atrial fibrillation, a prominent (fourth heart sound) S4, and flow murmurs. This condition is not associated with low cardiac output and while it may be seen with murmurs it is not specifically associated with atrial stenosis.
What is the most common sign of primary hyperparathyroidism?
What is the most common sign of primary hyperparathyroidism?
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The most common manifestation of primary hyperparathyroidism is elevated serum calcium. Parathyroid hormone (PTH) activates osteoclasts, which mobilize calcium and phosphate from bone. PTH also increases renal tubular absorption of calcium and inhibits the reabsorption of phosphate, resulting in elevated blood calcium levels while maintaining normal phosphate levels. High PTH has no significant direct effect on potassium levels.
The most common manifestation of primary hyperparathyroidism is elevated serum calcium. Parathyroid hormone (PTH) activates osteoclasts, which mobilize calcium and phosphate from bone. PTH also increases renal tubular absorption of calcium and inhibits the reabsorption of phosphate, resulting in elevated blood calcium levels while maintaining normal phosphate levels. High PTH has no significant direct effect on potassium levels.
What HbA1c level is diagnostic for type II diabetes?
What HbA1c level is diagnostic for type II diabetes?
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A hemoglobin A1c level of 6.5% or greater is considered diagnostic of type II diabetes. A HgA1c level of less than 6.5% does not exclude a diagnosis of diabetes, however, and should be looked at alongside fasting blood glucose and oral glucose tolerance testing.
A hemoglobin A1c level of 6.5% or greater is considered diagnostic of type II diabetes. A HgA1c level of less than 6.5% does not exclude a diagnosis of diabetes, however, and should be looked at alongside fasting blood glucose and oral glucose tolerance testing.
What is the most common cause of hyperthyroidism?
What is the most common cause of hyperthyroidism?
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Graves' disease is the most common cause of hyperthyroidism. Graves disease is an autoimmune condition in which antibody is produced against the thyroid-stimulating hormone (TSH) receptor, which binds to receptors, resulting in continuous stimulation of the gland to synthesize and secrete excess quantities of the thyroid hormones T4 and T3. Thyroid storm and toxic nodular goiter are less common causes of elevated thyroid hormone levels. Hashimoto's thyroiditis is the most common cause of hypothyroidism.
Graves' disease is the most common cause of hyperthyroidism. Graves disease is an autoimmune condition in which antibody is produced against the thyroid-stimulating hormone (TSH) receptor, which binds to receptors, resulting in continuous stimulation of the gland to synthesize and secrete excess quantities of the thyroid hormones T4 and T3. Thyroid storm and toxic nodular goiter are less common causes of elevated thyroid hormone levels. Hashimoto's thyroiditis is the most common cause of hypothyroidism.
A male client presents to the outpatient clinic for care for recently diagnosed hyperparathyroidism. He has been undergoing care for this condition. The nurse recognizes this patient will be at risk for several clinical manifestations.
All of the following are signs and symptoms associated with hyperparathyroidism except .
A male client presents to the outpatient clinic for care for recently diagnosed hyperparathyroidism. He has been undergoing care for this condition. The nurse recognizes this patient will be at risk for several clinical manifestations.
All of the following are signs and symptoms associated with hyperparathyroidism except .
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Painful muscle cramps and tremors are associated with low calcium levels which is indicative of hypoparathyroidism. All the other choices are associated with high calcium levels and therefore are symptoms associated with hyperparathyroidism.
Painful muscle cramps and tremors are associated with low calcium levels which is indicative of hypoparathyroidism. All the other choices are associated with high calcium levels and therefore are symptoms associated with hyperparathyroidism.
A 35-year-old male client presents to the emergency department after wife found him unresponsive at home. The wife informs the nurse her husband is a diabetic, and had not taken his insulin for the past two days. The client appears flushed, breathing is rapid and deep, and has a fruity smell on the breath.
The nurse suspects this presentation is diabetic ketoacidosis, which diagnostic finding would confirm this pathology?
A 35-year-old male client presents to the emergency department after wife found him unresponsive at home. The wife informs the nurse her husband is a diabetic, and had not taken his insulin for the past two days. The client appears flushed, breathing is rapid and deep, and has a fruity smell on the breath.
The nurse suspects this presentation is diabetic ketoacidosis, which diagnostic finding would confirm this pathology?
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The acidic pH is what is most consistent with the diagnosis of diabetic ketoacidosis (DKA). A pH of less than 7.30 is what is seen in DKA. The blood glucose will be elevated but the nurse may also see a similar elevation in hyperosmolar hyperglycemic syndrome as well. The serum bicarbonte will be low and the serum osmolality would be elevated, yet both findings are not specific for DKA. Elevated BUN (blood urea nitrogen) is not specific for DKA as well.
The acidic pH is what is most consistent with the diagnosis of diabetic ketoacidosis (DKA). A pH of less than 7.30 is what is seen in DKA. The blood glucose will be elevated but the nurse may also see a similar elevation in hyperosmolar hyperglycemic syndrome as well. The serum bicarbonte will be low and the serum osmolality would be elevated, yet both findings are not specific for DKA. Elevated BUN (blood urea nitrogen) is not specific for DKA as well.
The nurse cares for a patient with a history of diabetes mellitus after a cholecystectomy. He has reported nausea and cannot have solid foods. Upon assessment, the patient appears disoriented and confused. Based on these observations, which of the following is the most likely explanation for the patient’s condition?
The nurse cares for a patient with a history of diabetes mellitus after a cholecystectomy. He has reported nausea and cannot have solid foods. Upon assessment, the patient appears disoriented and confused. Based on these observations, which of the following is the most likely explanation for the patient’s condition?
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A patient status-post surgery is often unable to eat due to nausea. A diabetic patient is likely to be suffering from hypoglycemia because of this; confusion, disorientation, and shakiness are common manifestations of hypoglycemia as well. Hyperglycemia may present with blurry vision, frequent urination, headaches, and fatigue. Diabetic ketoacidosis can manifest with thirst, frequent urination, weakness, and fruity-scented breath and occurs in patients with diabetes mellitus (DM) type 1. Diabetic hyperglycemic hyperosmolar syndrome may also present with the same symptoms of diabetic ketoacidosis but occurs in patients with DM type 2. Insulin resistance syndrome (also known as metabolic syndrome or prediabetes) usually does not present with manifestations, but people with severe insulin resistance syndrome may present with dark patches of skin on the back of the neck, elbows, knees, and/or armpits.
A patient status-post surgery is often unable to eat due to nausea. A diabetic patient is likely to be suffering from hypoglycemia because of this; confusion, disorientation, and shakiness are common manifestations of hypoglycemia as well. Hyperglycemia may present with blurry vision, frequent urination, headaches, and fatigue. Diabetic ketoacidosis can manifest with thirst, frequent urination, weakness, and fruity-scented breath and occurs in patients with diabetes mellitus (DM) type 1. Diabetic hyperglycemic hyperosmolar syndrome may also present with the same symptoms of diabetic ketoacidosis but occurs in patients with DM type 2. Insulin resistance syndrome (also known as metabolic syndrome or prediabetes) usually does not present with manifestations, but people with severe insulin resistance syndrome may present with dark patches of skin on the back of the neck, elbows, knees, and/or armpits.
You are taking care of a 66-year old female who complains of weight gain, lethargy, dry skin, hair loss, constipation, and increased cold sensitivity. Based upon this assessment, you feel that the most likely diagnosis is which of the following?
You are taking care of a 66-year old female who complains of weight gain, lethargy, dry skin, hair loss, constipation, and increased cold sensitivity. Based upon this assessment, you feel that the most likely diagnosis is which of the following?
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This patient's constellation of symptoms is most consistent with hypothyroidism.
In hypothyroidism, which may occur for a handful of reasons, the patient typically does not produce significant levels of thyroid hormone (T3/T4), and therefore, a variety of functions that are modulated by thyroid hormone are impaired. Common symptoms associated with hypothyroidism are weight gain, lethargy, hair loss/brittle hair, dry skin, constipation, depression, cold sensitivity, bradycardia, and brittle nails, among other symptoms. On exam, the patient's thyroid may feel enlarged. Characteristic lab findings would be an elevated TSH level with low or low/normal T3/T4 levels.
The other choices are incorrect for the following reasons:
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Hyperthyroidism would be characterized by opposite symptoms from those seen in this patients. Patients with hyperthyroidism would be tachycardic, anxious, have poor heat tolerance, diaphoretic, may have diarrhea, and weight loss among, other symptoms.
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Thyroid storm is a severe, life-threatening condition that is essentially an acute, severe manifestation of excess levels of thyroid hormone (also known as thyrotoxicosis), and presents with very pronounced, severe signs of hyperthyroidism.
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Diabetic ketoacidosis is almost exclusively seen in patients with diabetes (which is not noted in this patient) and often presents with diffuse abdominal pain, rapid shallow breathing, altered mental status, and a fruity odor on the breath.
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Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities.
This patient's constellation of symptoms is most consistent with hypothyroidism.
In hypothyroidism, which may occur for a handful of reasons, the patient typically does not produce significant levels of thyroid hormone (T3/T4), and therefore, a variety of functions that are modulated by thyroid hormone are impaired. Common symptoms associated with hypothyroidism are weight gain, lethargy, hair loss/brittle hair, dry skin, constipation, depression, cold sensitivity, bradycardia, and brittle nails, among other symptoms. On exam, the patient's thyroid may feel enlarged. Characteristic lab findings would be an elevated TSH level with low or low/normal T3/T4 levels.
The other choices are incorrect for the following reasons:
-
Hyperthyroidism would be characterized by opposite symptoms from those seen in this patients. Patients with hyperthyroidism would be tachycardic, anxious, have poor heat tolerance, diaphoretic, may have diarrhea, and weight loss among, other symptoms.
-
Thyroid storm is a severe, life-threatening condition that is essentially an acute, severe manifestation of excess levels of thyroid hormone (also known as thyrotoxicosis), and presents with very pronounced, severe signs of hyperthyroidism.
-
Diabetic ketoacidosis is almost exclusively seen in patients with diabetes (which is not noted in this patient) and often presents with diffuse abdominal pain, rapid shallow breathing, altered mental status, and a fruity odor on the breath.
-
Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities.
You are the nurse taking care of a 23-year old patient who complains of anxiety, diaphoresis, palpitations, diarrhea, weight loss, and tremors. When examining them you notice exophthalmos and eyelid lag. The most likely diagnosis in your patient is which of the following?
You are the nurse taking care of a 23-year old patient who complains of anxiety, diaphoresis, palpitations, diarrhea, weight loss, and tremors. When examining them you notice exophthalmos and eyelid lag. The most likely diagnosis in your patient is which of the following?
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The most likely diagnosis in this patient is Graves' Disease, which is a form of hyperthyroidism.
Graves' Disease is an autoimmune condition in which the patient produces autoantibodies to the thyrotropin receptor, which overstimulates the release of T4 and T3, resulting in hyperthyroidism and its associated clinical manifestations (anxiety, palpitations, weight loss, diaphoresis, diarrhea, tremors, etc...). Further, in Graves' Disease, patients may have exophthalmos and/or lid lag, which are findings that are more specific to Graves' Disease than other causes of hyperthyroidism. This patient's constellation of symptoms is highly consistent with Graves' Disease.
Hypothyroidism is not correct, as this patient is experiencing symptoms opposite those of hypothyroidism. In hypothyroidism, one would expect the patient to feel lethargic, weak, experience weight gain, dry skin, constipation, and potentially have depression.
Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities.
Diabetes mellitus would not likely present in this manner. Patients are often asymptomatic at the time of diagnosis, and it would be discovered by elevated glucose or HbA1c readings on routine laboratory work. Occasionally, increased urinary frequency and dehydration, or more severe manifestations like hyperglycemic hyperosmolar nonketotic coma (HHNK) or diabetic ketoacidosis (DKA) would be a presenting scenario.
A glucagonoma would present with necrolytic migratory erythema, most commonly, as well as severely elevated glucose concentrations.
The most likely diagnosis in this patient is Graves' Disease, which is a form of hyperthyroidism.
Graves' Disease is an autoimmune condition in which the patient produces autoantibodies to the thyrotropin receptor, which overstimulates the release of T4 and T3, resulting in hyperthyroidism and its associated clinical manifestations (anxiety, palpitations, weight loss, diaphoresis, diarrhea, tremors, etc...). Further, in Graves' Disease, patients may have exophthalmos and/or lid lag, which are findings that are more specific to Graves' Disease than other causes of hyperthyroidism. This patient's constellation of symptoms is highly consistent with Graves' Disease.
Hypothyroidism is not correct, as this patient is experiencing symptoms opposite those of hypothyroidism. In hypothyroidism, one would expect the patient to feel lethargic, weak, experience weight gain, dry skin, constipation, and potentially have depression.
Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities.
Diabetes mellitus would not likely present in this manner. Patients are often asymptomatic at the time of diagnosis, and it would be discovered by elevated glucose or HbA1c readings on routine laboratory work. Occasionally, increased urinary frequency and dehydration, or more severe manifestations like hyperglycemic hyperosmolar nonketotic coma (HHNK) or diabetic ketoacidosis (DKA) would be a presenting scenario.
A glucagonoma would present with necrolytic migratory erythema, most commonly, as well as severely elevated glucose concentrations.
You are the nurse taking care of a patient hospitalized for two months for sepsis. The patient had been receiving 40 mg of prednisone daily for the last two weeks for airway inflammation, and now, for the last three days, given symptomatic improvement, his physician lowers his prednisone dose to 5 mg daily. Today, you assess the patient and he is lethargic and hypotensive, with a serum glucose of 52 and serum sodium of 131. Which of the following is the most likely diagnosis?
You are the nurse taking care of a patient hospitalized for two months for sepsis. The patient had been receiving 40 mg of prednisone daily for the last two weeks for airway inflammation, and now, for the last three days, given symptomatic improvement, his physician lowers his prednisone dose to 5 mg daily. Today, you assess the patient and he is lethargic and hypotensive, with a serum glucose of 52 and serum sodium of 131. Which of the following is the most likely diagnosis?
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The correct answer is "Adrenal insufficiency." This answer is correct because in this patient's case, he had been on a prolonged course of a high dose of prednisone, a corticosteroid. When patients are on prolonged courses, and/or high doses of corticosteroids, this can cause a negative feedback cycle on the body's own intrinsic production of corticosteroids. As a result, high doses of exogenous corticosteroids, or prolonged courses of any dose of exogenous steroids should not be abruptly stopped, as the body's own intrinsic steroid production will not yet have recovered, and therefore, the patient will exhibit signs of adrenal insufficiency. In this patient's case, while the physician does not completely eliminate the patient's exogenous steroid dose, he tapers the dose way too abruptly, from 40 mg to 5 mg, which dose not allow the body's own corticosteroid production to recover in time to meet the body's needs. Thus, the patient exhibits signs of adrenal insufficiency including lethargy, hypotension, hypoglycemia, and hyponatremia.
Hyperaldosteronism and Conn's Syndrome (primary hyperaldosteronism) are incorrect as these are the opposite of what is observed in this patient. In a patient with hyperaldosteronism, the patient would likely be anxious and/or have high energy, would be hypertensive, and hypernatremic, as the sodium/potassium ATPase's activity would be upregulated in the setting of excess aldosterone.
Exogenous testosterone use would likely also cause increased anxiety/energy and hypertension, rather than lethargy and hypotension, as in this patient.
Surreptitious insulin use could explain lethargy, hypotension, and hypoglycemia, but would likely cause hypernatremia rather than hyponatremia, as insulin upregulates the activity of the sodium/potassium ATPase, which would increase rather than decrease serum sodium.
The correct answer is "Adrenal insufficiency." This answer is correct because in this patient's case, he had been on a prolonged course of a high dose of prednisone, a corticosteroid. When patients are on prolonged courses, and/or high doses of corticosteroids, this can cause a negative feedback cycle on the body's own intrinsic production of corticosteroids. As a result, high doses of exogenous corticosteroids, or prolonged courses of any dose of exogenous steroids should not be abruptly stopped, as the body's own intrinsic steroid production will not yet have recovered, and therefore, the patient will exhibit signs of adrenal insufficiency. In this patient's case, while the physician does not completely eliminate the patient's exogenous steroid dose, he tapers the dose way too abruptly, from 40 mg to 5 mg, which dose not allow the body's own corticosteroid production to recover in time to meet the body's needs. Thus, the patient exhibits signs of adrenal insufficiency including lethargy, hypotension, hypoglycemia, and hyponatremia.
Hyperaldosteronism and Conn's Syndrome (primary hyperaldosteronism) are incorrect as these are the opposite of what is observed in this patient. In a patient with hyperaldosteronism, the patient would likely be anxious and/or have high energy, would be hypertensive, and hypernatremic, as the sodium/potassium ATPase's activity would be upregulated in the setting of excess aldosterone.
Exogenous testosterone use would likely also cause increased anxiety/energy and hypertension, rather than lethargy and hypotension, as in this patient.
Surreptitious insulin use could explain lethargy, hypotension, and hypoglycemia, but would likely cause hypernatremia rather than hyponatremia, as insulin upregulates the activity of the sodium/potassium ATPase, which would increase rather than decrease serum sodium.
Most pituitary adenomas are non functional (incidentalomas). Of the functional adenomas, which are the most common?
Most pituitary adenomas are non functional (incidentalomas). Of the functional adenomas, which are the most common?
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Prolactinomas (prolactin-secreting) make up 30% of functional pituitary adenomas. The second most common type are somatotrophic (growth hormone-secreting) adenomas, which make up 15%, followed by gonadotrophic (gonadotrophin-releasing) adenomas, which make up 10% of reported cases. Null cell adenomas are non functional (they do not secrete hormones).
Prolactinomas (prolactin-secreting) make up 30% of functional pituitary adenomas. The second most common type are somatotrophic (growth hormone-secreting) adenomas, which make up 15%, followed by gonadotrophic (gonadotrophin-releasing) adenomas, which make up 10% of reported cases. Null cell adenomas are non functional (they do not secrete hormones).
Which of the following are common cardiac signs with hyperthyroidism?
Which of the following are common cardiac signs with hyperthyroidism?
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A cardiac workup on a patient with hyperthyroidism will often reveal high cardiac output, tachycardia, atrial fibrillation, a prominent (fourth heart sound) S4, and flow murmurs. This condition is not associated with low cardiac output and while it may be seen with murmurs it is not specifically associated with atrial stenosis.
A cardiac workup on a patient with hyperthyroidism will often reveal high cardiac output, tachycardia, atrial fibrillation, a prominent (fourth heart sound) S4, and flow murmurs. This condition is not associated with low cardiac output and while it may be seen with murmurs it is not specifically associated with atrial stenosis.
What is the most common sign of primary hyperparathyroidism?
What is the most common sign of primary hyperparathyroidism?
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The most common manifestation of primary hyperparathyroidism is elevated serum calcium. Parathyroid hormone (PTH) activates osteoclasts, which mobilize calcium and phosphate from bone. PTH also increases renal tubular absorption of calcium and inhibits the reabsorption of phosphate, resulting in elevated blood calcium levels while maintaining normal phosphate levels. High PTH has no significant direct effect on potassium levels.
The most common manifestation of primary hyperparathyroidism is elevated serum calcium. Parathyroid hormone (PTH) activates osteoclasts, which mobilize calcium and phosphate from bone. PTH also increases renal tubular absorption of calcium and inhibits the reabsorption of phosphate, resulting in elevated blood calcium levels while maintaining normal phosphate levels. High PTH has no significant direct effect on potassium levels.
What HbA1c level is diagnostic for type II diabetes?
What HbA1c level is diagnostic for type II diabetes?
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A hemoglobin A1c level of 6.5% or greater is considered diagnostic of type II diabetes. A HgA1c level of less than 6.5% does not exclude a diagnosis of diabetes, however, and should be looked at alongside fasting blood glucose and oral glucose tolerance testing.
A hemoglobin A1c level of 6.5% or greater is considered diagnostic of type II diabetes. A HgA1c level of less than 6.5% does not exclude a diagnosis of diabetes, however, and should be looked at alongside fasting blood glucose and oral glucose tolerance testing.
What is the most common cause of hyperthyroidism?
What is the most common cause of hyperthyroidism?
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Graves' disease is the most common cause of hyperthyroidism. Graves disease is an autoimmune condition in which antibody is produced against the thyroid-stimulating hormone (TSH) receptor, which binds to receptors, resulting in continuous stimulation of the gland to synthesize and secrete excess quantities of the thyroid hormones T4 and T3. Thyroid storm and toxic nodular goiter are less common causes of elevated thyroid hormone levels. Hashimoto's thyroiditis is the most common cause of hypothyroidism.
Graves' disease is the most common cause of hyperthyroidism. Graves disease is an autoimmune condition in which antibody is produced against the thyroid-stimulating hormone (TSH) receptor, which binds to receptors, resulting in continuous stimulation of the gland to synthesize and secrete excess quantities of the thyroid hormones T4 and T3. Thyroid storm and toxic nodular goiter are less common causes of elevated thyroid hormone levels. Hashimoto's thyroiditis is the most common cause of hypothyroidism.
A male client presents to the outpatient clinic for care for recently diagnosed hyperparathyroidism. He has been undergoing care for this condition. The nurse recognizes this patient will be at risk for several clinical manifestations.
All of the following are signs and symptoms associated with hyperparathyroidism except .
A male client presents to the outpatient clinic for care for recently diagnosed hyperparathyroidism. He has been undergoing care for this condition. The nurse recognizes this patient will be at risk for several clinical manifestations.
All of the following are signs and symptoms associated with hyperparathyroidism except .
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Painful muscle cramps and tremors are associated with low calcium levels which is indicative of hypoparathyroidism. All the other choices are associated with high calcium levels and therefore are symptoms associated with hyperparathyroidism.
Painful muscle cramps and tremors are associated with low calcium levels which is indicative of hypoparathyroidism. All the other choices are associated with high calcium levels and therefore are symptoms associated with hyperparathyroidism.
A 35-year-old male client presents to the emergency department after wife found him unresponsive at home. The wife informs the nurse her husband is a diabetic, and had not taken his insulin for the past two days. The client appears flushed, breathing is rapid and deep, and has a fruity smell on the breath.
The nurse suspects this presentation is diabetic ketoacidosis, which diagnostic finding would confirm this pathology?
A 35-year-old male client presents to the emergency department after wife found him unresponsive at home. The wife informs the nurse her husband is a diabetic, and had not taken his insulin for the past two days. The client appears flushed, breathing is rapid and deep, and has a fruity smell on the breath.
The nurse suspects this presentation is diabetic ketoacidosis, which diagnostic finding would confirm this pathology?
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The acidic pH is what is most consistent with the diagnosis of diabetic ketoacidosis (DKA). A pH of less than 7.30 is what is seen in DKA. The blood glucose will be elevated but the nurse may also see a similar elevation in hyperosmolar hyperglycemic syndrome as well. The serum bicarbonte will be low and the serum osmolality would be elevated, yet both findings are not specific for DKA. Elevated BUN (blood urea nitrogen) is not specific for DKA as well.
The acidic pH is what is most consistent with the diagnosis of diabetic ketoacidosis (DKA). A pH of less than 7.30 is what is seen in DKA. The blood glucose will be elevated but the nurse may also see a similar elevation in hyperosmolar hyperglycemic syndrome as well. The serum bicarbonte will be low and the serum osmolality would be elevated, yet both findings are not specific for DKA. Elevated BUN (blood urea nitrogen) is not specific for DKA as well.
The nurse cares for a patient with a history of diabetes mellitus after a cholecystectomy. He has reported nausea and cannot have solid foods. Upon assessment, the patient appears disoriented and confused. Based on these observations, which of the following is the most likely explanation for the patient’s condition?
The nurse cares for a patient with a history of diabetes mellitus after a cholecystectomy. He has reported nausea and cannot have solid foods. Upon assessment, the patient appears disoriented and confused. Based on these observations, which of the following is the most likely explanation for the patient’s condition?
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A patient status-post surgery is often unable to eat due to nausea. A diabetic patient is likely to be suffering from hypoglycemia because of this; confusion, disorientation, and shakiness are common manifestations of hypoglycemia as well. Hyperglycemia may present with blurry vision, frequent urination, headaches, and fatigue. Diabetic ketoacidosis can manifest with thirst, frequent urination, weakness, and fruity-scented breath and occurs in patients with diabetes mellitus (DM) type 1. Diabetic hyperglycemic hyperosmolar syndrome may also present with the same symptoms of diabetic ketoacidosis but occurs in patients with DM type 2. Insulin resistance syndrome (also known as metabolic syndrome or prediabetes) usually does not present with manifestations, but people with severe insulin resistance syndrome may present with dark patches of skin on the back of the neck, elbows, knees, and/or armpits.
A patient status-post surgery is often unable to eat due to nausea. A diabetic patient is likely to be suffering from hypoglycemia because of this; confusion, disorientation, and shakiness are common manifestations of hypoglycemia as well. Hyperglycemia may present with blurry vision, frequent urination, headaches, and fatigue. Diabetic ketoacidosis can manifest with thirst, frequent urination, weakness, and fruity-scented breath and occurs in patients with diabetes mellitus (DM) type 1. Diabetic hyperglycemic hyperosmolar syndrome may also present with the same symptoms of diabetic ketoacidosis but occurs in patients with DM type 2. Insulin resistance syndrome (also known as metabolic syndrome or prediabetes) usually does not present with manifestations, but people with severe insulin resistance syndrome may present with dark patches of skin on the back of the neck, elbows, knees, and/or armpits.
You are taking care of a 66-year old female who complains of weight gain, lethargy, dry skin, hair loss, constipation, and increased cold sensitivity. Based upon this assessment, you feel that the most likely diagnosis is which of the following?
You are taking care of a 66-year old female who complains of weight gain, lethargy, dry skin, hair loss, constipation, and increased cold sensitivity. Based upon this assessment, you feel that the most likely diagnosis is which of the following?
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This patient's constellation of symptoms is most consistent with hypothyroidism.
In hypothyroidism, which may occur for a handful of reasons, the patient typically does not produce significant levels of thyroid hormone (T3/T4), and therefore, a variety of functions that are modulated by thyroid hormone are impaired. Common symptoms associated with hypothyroidism are weight gain, lethargy, hair loss/brittle hair, dry skin, constipation, depression, cold sensitivity, bradycardia, and brittle nails, among other symptoms. On exam, the patient's thyroid may feel enlarged. Characteristic lab findings would be an elevated TSH level with low or low/normal T3/T4 levels.
The other choices are incorrect for the following reasons:
-
Hyperthyroidism would be characterized by opposite symptoms from those seen in this patients. Patients with hyperthyroidism would be tachycardic, anxious, have poor heat tolerance, diaphoretic, may have diarrhea, and weight loss among, other symptoms.
-
Thyroid storm is a severe, life-threatening condition that is essentially an acute, severe manifestation of excess levels of thyroid hormone (also known as thyrotoxicosis), and presents with very pronounced, severe signs of hyperthyroidism.
-
Diabetic ketoacidosis is almost exclusively seen in patients with diabetes (which is not noted in this patient) and often presents with diffuse abdominal pain, rapid shallow breathing, altered mental status, and a fruity odor on the breath.
-
Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities.
This patient's constellation of symptoms is most consistent with hypothyroidism.
In hypothyroidism, which may occur for a handful of reasons, the patient typically does not produce significant levels of thyroid hormone (T3/T4), and therefore, a variety of functions that are modulated by thyroid hormone are impaired. Common symptoms associated with hypothyroidism are weight gain, lethargy, hair loss/brittle hair, dry skin, constipation, depression, cold sensitivity, bradycardia, and brittle nails, among other symptoms. On exam, the patient's thyroid may feel enlarged. Characteristic lab findings would be an elevated TSH level with low or low/normal T3/T4 levels.
The other choices are incorrect for the following reasons:
-
Hyperthyroidism would be characterized by opposite symptoms from those seen in this patients. Patients with hyperthyroidism would be tachycardic, anxious, have poor heat tolerance, diaphoretic, may have diarrhea, and weight loss among, other symptoms.
-
Thyroid storm is a severe, life-threatening condition that is essentially an acute, severe manifestation of excess levels of thyroid hormone (also known as thyrotoxicosis), and presents with very pronounced, severe signs of hyperthyroidism.
-
Diabetic ketoacidosis is almost exclusively seen in patients with diabetes (which is not noted in this patient) and often presents with diffuse abdominal pain, rapid shallow breathing, altered mental status, and a fruity odor on the breath.
-
Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities.