Thyroid/Endocrine

Question 1

Thyroid Binding Globulin (TGB)

Answer 1

1. Binds to T3 and T4
2. T4 is 99.96% bound
3. T3 is 99.7% bound
4. Measure the free t3 and t4 to test for hypothyroidism or hypothyroidism

Question 2

Calcitonin

Answer 2

1. Secreted by the thyroid
2. Responds to high circulating calcium levels
3. Increases calcium storage in the bone
4. Increases renal excretion of calcium and phosphorus

Question 3

Calcitonin

-used for

Answer 3

Medication used for osteoporosis

Question 4

Thyroid Replacing Medications

-Indication

Answer 4

1. Hypothyroidim
2. Myxedema coma & goiters
3. Well tolerated w/ very little adverse reactions

Question 5

Thyroid Replacement Medications

-Contraindication

Answer 5

1. During acute MI or angina

Question 6

Thyroid Replacement Medications

-Drug Interactions

Answer 6

1. Cholestyamine (binding)
2. Oral anticoagulants (potency)
3. Digitalis (decrease effectiveness)
4. Theophylline (decreased clearance)

Question 7

Thyroid Replacement Medications

-Adverse Effects

Answer 7

Well tolerated w/ correct dosing

Question 8

Hypothydoidism

Answer 8

1. Slowing of mind and body
2. Weak heartbeat
3. constipation
4. HIGH LDL
5. dry skin / hair thinning
6. Depression “schizophrenia” irritability

Question 9

Thyroid Storm

Answer 9

1. Life threatening
2. Easily treatable
3. Symptoms:
   - Severe tachycardia / HF & shock / Hyperthermia / seizures /
   - N/V/D

Question 10

Thyroid Storm

-Treatment

Answer 10

1. Hydration
2. Temp reduction
3. Reducing thyroid levels
4. Elimination of stressor

Question 11

Antithyroid Medication

Answer 11

1. Used when there is too much circulating thyroid hormone
2. Decreases T4 and T3 hormone
3. Propylthiouracil (PTU)

Question 12

Hyperthyroidism

-S/S

Answer 12

1. Graves
2. Sweating
3. Neurotic anxiety
4. Fine tremor (paper test)
5. brisk reflexes

Question 13

Antithyroid Medication

-Contraindications

Answer 13

Pt’s w/ pulmonary edema & TB (iodine preparations)

Question 14

Antithyroid Medication

-Drug Interactions

Answer 14

1. hyperkalemia w/ SSKI and K+ replacements

Question 15

Antithyroid Medication

-Adverse Effects

Answer 15

1. Hypothyroidism S/S
2. GI disturbance w/ PTU
3. Iodine solutions can:
   - stain teen
   - cause oral discomfort
   - give a metallic taste

Question 16

Antithyroid Medication

-Nursing Implications/Teaching

Answer 16

1. Divide doses for even dosing around the clock for PTU
2. Watch for S/S of “iodism”
3. Take iodine solution through a straw
4. Watch for S/S of hypothyroidism
5. Withdrawal gradually, NEVER ABRUPTLY

Question 17

Parathyroid Glands

Answer 17

1. Parathyroid increases PTH release when calcium falls
   - PTH is controlled by feedback loop
   - PTH rises when calcium falls, and increases calcium
   - PTH falls when calcium rises, and decreases calcium

Question 18

Hypercalcemic Medication

Answer 18

1. Works to lower serum calcium
2. Decreases bone reabsorption
3. Helps prevent complications from hypercalcemia
   - cardiac dysfunction
   - GI disturbances

Question 19

Hypercalcemic Medication

-Medications

Answer 19

1. Calcitonin
2. Bisphosphonate-etidronate (Didronel)
3. Alendronate (Fosamax)

Question 20

Hypercalcemic Medication

-Contraindication

Answer 20

1. Bisphosphonate and gallium w/ renal dysfunction
2. Bisphosphonate w/ acidosis & Heart Block
3. Calcitonins and salmon and fish allergies

Question 21

Hypercalcemic Medication

-Drug Interactions

Answer 21

1. Multiple vitamins, iron and antacids

2. Nephrotoxic antibiotics

Question 22

Hypercalcemic Medication

-Adverse Effects

Answer 22

1. Facial flushing
2. Nausea
3. Renal failure

Question 23

Hypercalcemic Medication

-Nursing Implications/Teaching

Answer 23

1. Given Orally, IV or nasal spray
2. Encourage fluid intake
3. Watch for EKG changes
4. Watch for signs of hypocalcemia and teach pt to report these signs immediately

Question 24

Hypercalcemia

-S/S

Answer 24

1. Fatigue
2. Depression
3. Confusion
4. N/V/C
5. Renal stones, increased urination
6. Cardiac arrhythmias

Question 25

Hypocalcemia | -S/S

Answer 25

1. Tetany / increased neural excitability 2. Check for Trousseau's sign -development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes 3. Check for Chvostek's sign (twitching facial muscles when the facial nerve is tapped anterior to the ear)

Question 26

Hypocalcemia | -Trousseau's Sign

Answer 26

1. Development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes

Question 27

Hypocalcemia | -Chvostek's Sign

Answer 27

1. Twitching facial muscles when the facial nerve is tapped anterior to the ear

Question 28

Glucocorticoid Therapy

Answer 28

1. Any disease that increases inflammation or where inflammation goes out of control

Question 29

Glucocorticoid Therapy | -Used for

Answer 29

1. Simple: Poison Oak 2. Complex and deadly: Pulmonary Inflammation (Pneumonitis) 3. Painful: Neuritis