NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
1. Identify the pathophysiology, clinical manifestations, diagnostic criteria, complications,
interprofessional management, and nursing interventions for a patient with SIADH,
Diabetes Insipidus, hypothyroidism, hyperthyroidism, Cushing’s syndrome, and Addison’s
disease. SIADH
● Patho
○ Excess production and release of ADH despite low serum osmolality.
○ Causes - ADH-secreting tumor, cancer, CNS disorders, head injury,
medications (phenothiazides, tricyclic antidepressants, chemo, SSRIs, )
○ ADH promotes excessive water retention
○ Result: dilutional hyponatremia (too much water in the blood)
● Manifestations
○ Decreased urine output and concentrated urine
■ High urine specific gravity because less water and
more concentrates are coming out of pee, but
LOW blood serum osmolality).
○ Severity of symptoms dependent upon serum sodium levels.
CNS symptoms with low serum Na!!
■ Anorexia, nausea, vomiting, headache
■ Irritability, disorientation, weakness, acute confusion
■ Psychosis, seizures, coma
○ ***Manifestations of fluid volume overload
■ High blood pressure, trouble breathing, crackles etc
● Diagnostic criteria
○ Hyponatremia
■ May have severe neuro symptoms with Na <120
○ Blood chemistries- dilute!
■ DILUTE: Decreased serum osmolality (serum osmolality
<280 mOsm/kg)
○ Urine- concentrated!
■ with a high urine sodium content
■ increased urine osmolality,
■ high urine specific gravity.
● Normal is → 1.010 - 1.030
● Management
○ ***Fluid restriction - may be 500-1,000 ml/24 hrs.
■ Mouth care, limited ice chips, throat lozenges
while fluid restricted
■ Monitor VS. Monitor for fluid overload
■ Daily wts- When weighing, remember 1kg weight =1L fluid
○ Hypertonic IV fluid (3% NSS) Only if serum Na less than
120. Replacement CAREFULLY! Just used to get Na out
of danger zone
○ Pharmacologic treatment - diuretic: Lasix, vasopressin antagonist
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
,NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
■ (Vasopressin is synthetic ADH, so an antagonist would do the
opposite of ADH aka it would be a diuretic and make us
release water and help SIADH . Pt must be hospitalized when
receiving and watch for too rapid correction of Na.
■ Central pontine (CNS) demylinolysis; Caused by too
rapid Na correction.
● Results in “locked-in syndrome”
● Nursing interventions
○ Watch the patient with SIADH for S/S of fluid overload.
■ Dyspnea, crackles on auscultation
○ Provide a safe environment with hyponatremia
■ Watch for confusion, headaches, seizures, neuro changes
■ Seizure precautions
■ Fall precautions
■ If confused, may require bed alarm, sitter,
■ Hourly neuro checks.
● PERRLA, orientation x3, grip strength
DIABETES INSIPIDUS = “dry inside”
● Patho
○ Deficiency of ADH; inability to concentrate or retain water
■ So we lose a lot of water instead of retain it
● Manifestations
○ Urine is DILUTE
■ Polyuria - urine specific gravity < 1.005 (very
dilute and LOTS OF URINE!!!!)
○ Polydipsia- 2-20 L/day!!
○ Dehydration: thirst, weakness, H/A, tachycardia, Constipation
○ shock/death if left untreated
○ serum osmolality elevated ->285- blood serum is concentrated!
■ Because we now have too many solutes in relation to
fluid cuz fluid loss
○ Causes / risk factors
■ Neurogenic - head injury, brain tumor, brain surgery affecting pituitary
■ Nephrogenic-inherited
■ Drug induced- Lithium, demeclocycline
● Diagnostic criteria
○ Water deprivation test
■ (ADH stimulation test) to diagnose and
determine type (neurogenic, nephrogenic,
drug-induced)
■ Patient is given ADH sq and fluids are completely
restricted during the test.
■ Urine osmolality measured at specified intervals.
■ Nursing - monitor the pt for dehydration during the test!!
● Complications/Management/Nursing interventions
○ Treat cause
■ Hydration!!!!!!
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
,NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
■ Pharmacologic treatment
● IV vasopressin (acute postop)
● Desmopressin nasal spray (DDAVP)
HYPOTHYROIDISM
● Patho
○ Hypofunctioning of the thyroid gland is most
common.
■ Hashimoto’s disease- autoimmune thyroiditis
■ Less common- hypothyroidism due to
problem with pituitary or hypothalamus
○ Many potential causes such as autoimmunity, genetic
defects, (cretinism), injury to gland, iodine deficiency.
● Manifestations
○ Fatigue, weakness, lethargy
○ Bradycardia
○ Cold intolerance, decreased metabolic rate, decreased body
temp
○ Constipation
○ Dry skin, thin dry hair, thick, brittle nails
○ Weight gain
○ Cardiac enlargement, hypotension
○ Impaired reproduction
○ Impaired memory, slowing of intellectual functions,
change in emotional responses.
○ infiltration of the tissues by glycosaminoglycans giving it
a waxy or coarsened appearance. Tissue is edematous/
mucinous. (Cardiac infiltration)
○ May have a goiter- enlarged thyroid with/without hoarseness
or husky voice
● Diagnostic criteria
○ LABS: Elevated TSH, low T3, T4
● Complications
○ Myxedema coma - medical emergency- complication
of hypothyroidism. Can result in shock, organ
damage, death.
○ Precipitated by infection, cold, drugs,, trauma, poorly
controlled hypothyroidism.
○ S/S- subnormal temp, hypotension, decreased cardiac
output, hypoventilation, paralytic ileus
○ Treatment
■ Treatment- IV thyroid hormone (levothyroxine sodium)
■ IV .9 NSS
■ IV Corticosteroids
■ Check hourly temps, hourly Vital signs. May
require mechanical ventilation
■ Avoid hypnotic or sedative meds
● Management
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
, NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
○ Lifelong thyroid hormone replacement therapy
■ -Levothyroxine (Synthroid)- metabolized by the liver to
active T3. Assess
BP, HR prior to therapy, and periodically during therapy.
○ REVIEW PLAN OF CARE: pg 1616 chart 52-4
■ promote independence
■ provide extra layer of clothing or extra blanket (cold
intolerance
■ high fiber
■ adequate fluid but not more than reactricion
■ encourage mobility
■ use laxatives sparingly
■ monitor respiratory
■ encourage deep breathing
■ monitor for worsening condition
● hypotension, stupor, hypoventilation,
decreased cardiac output, paralytic lieu’s
● Nursing interventions
○ Importance of taking medication daily and need for follow
up blood work.
○ Med side effects.
○ Watch for S/S acute coronary syndrome esp with early
treatment
○ Signs and symptoms of myxedema coma
○ Develop bowel elimination plan to prevent
constipation (fluids, fiber, increase activity, minimize
any enemas or laxatives).
○ Avoid sedatives which can lead to respiratory difficulties.
HYPERTHYROIDISM
● Patho
○ Excessive activity of thyroid gland
○ Most common form is Graves Disease- stimulation of thyroid gland
by circulating immunoglobulins. Causes hypersecretion of thyroid
hormones
○ Other- thyroid cancer, iodine excess, toxic goiter
● Manifestations
○ Goiter (enlargement of thyroid gland)
○ Exophthalmos = bulging eyes
○ Excess metabolic rate
■ Weight loss, tremors
■ Agitation, palpitations, tachycardia, weakness
■ Heat intolerance, sweating
■ Diarrhea
■ Emotional lability, apprehension
■ Increased appetite
■ Insomnia
■ Increased BP, temp, heart rate,
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
WITH ANSWERS GRADED A+
1. Identify the pathophysiology, clinical manifestations, diagnostic criteria, complications,
interprofessional management, and nursing interventions for a patient with SIADH,
Diabetes Insipidus, hypothyroidism, hyperthyroidism, Cushing’s syndrome, and Addison’s
disease. SIADH
● Patho
○ Excess production and release of ADH despite low serum osmolality.
○ Causes - ADH-secreting tumor, cancer, CNS disorders, head injury,
medications (phenothiazides, tricyclic antidepressants, chemo, SSRIs, )
○ ADH promotes excessive water retention
○ Result: dilutional hyponatremia (too much water in the blood)
● Manifestations
○ Decreased urine output and concentrated urine
■ High urine specific gravity because less water and
more concentrates are coming out of pee, but
LOW blood serum osmolality).
○ Severity of symptoms dependent upon serum sodium levels.
CNS symptoms with low serum Na!!
■ Anorexia, nausea, vomiting, headache
■ Irritability, disorientation, weakness, acute confusion
■ Psychosis, seizures, coma
○ ***Manifestations of fluid volume overload
■ High blood pressure, trouble breathing, crackles etc
● Diagnostic criteria
○ Hyponatremia
■ May have severe neuro symptoms with Na <120
○ Blood chemistries- dilute!
■ DILUTE: Decreased serum osmolality (serum osmolality
<280 mOsm/kg)
○ Urine- concentrated!
■ with a high urine sodium content
■ increased urine osmolality,
■ high urine specific gravity.
● Normal is → 1.010 - 1.030
● Management
○ ***Fluid restriction - may be 500-1,000 ml/24 hrs.
■ Mouth care, limited ice chips, throat lozenges
while fluid restricted
■ Monitor VS. Monitor for fluid overload
■ Daily wts- When weighing, remember 1kg weight =1L fluid
○ Hypertonic IV fluid (3% NSS) Only if serum Na less than
120. Replacement CAREFULLY! Just used to get Na out
of danger zone
○ Pharmacologic treatment - diuretic: Lasix, vasopressin antagonist
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
,NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
■ (Vasopressin is synthetic ADH, so an antagonist would do the
opposite of ADH aka it would be a diuretic and make us
release water and help SIADH . Pt must be hospitalized when
receiving and watch for too rapid correction of Na.
■ Central pontine (CNS) demylinolysis; Caused by too
rapid Na correction.
● Results in “locked-in syndrome”
● Nursing interventions
○ Watch the patient with SIADH for S/S of fluid overload.
■ Dyspnea, crackles on auscultation
○ Provide a safe environment with hyponatremia
■ Watch for confusion, headaches, seizures, neuro changes
■ Seizure precautions
■ Fall precautions
■ If confused, may require bed alarm, sitter,
■ Hourly neuro checks.
● PERRLA, orientation x3, grip strength
DIABETES INSIPIDUS = “dry inside”
● Patho
○ Deficiency of ADH; inability to concentrate or retain water
■ So we lose a lot of water instead of retain it
● Manifestations
○ Urine is DILUTE
■ Polyuria - urine specific gravity < 1.005 (very
dilute and LOTS OF URINE!!!!)
○ Polydipsia- 2-20 L/day!!
○ Dehydration: thirst, weakness, H/A, tachycardia, Constipation
○ shock/death if left untreated
○ serum osmolality elevated ->285- blood serum is concentrated!
■ Because we now have too many solutes in relation to
fluid cuz fluid loss
○ Causes / risk factors
■ Neurogenic - head injury, brain tumor, brain surgery affecting pituitary
■ Nephrogenic-inherited
■ Drug induced- Lithium, demeclocycline
● Diagnostic criteria
○ Water deprivation test
■ (ADH stimulation test) to diagnose and
determine type (neurogenic, nephrogenic,
drug-induced)
■ Patient is given ADH sq and fluids are completely
restricted during the test.
■ Urine osmolality measured at specified intervals.
■ Nursing - monitor the pt for dehydration during the test!!
● Complications/Management/Nursing interventions
○ Treat cause
■ Hydration!!!!!!
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
,NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
■ Pharmacologic treatment
● IV vasopressin (acute postop)
● Desmopressin nasal spray (DDAVP)
HYPOTHYROIDISM
● Patho
○ Hypofunctioning of the thyroid gland is most
common.
■ Hashimoto’s disease- autoimmune thyroiditis
■ Less common- hypothyroidism due to
problem with pituitary or hypothalamus
○ Many potential causes such as autoimmunity, genetic
defects, (cretinism), injury to gland, iodine deficiency.
● Manifestations
○ Fatigue, weakness, lethargy
○ Bradycardia
○ Cold intolerance, decreased metabolic rate, decreased body
temp
○ Constipation
○ Dry skin, thin dry hair, thick, brittle nails
○ Weight gain
○ Cardiac enlargement, hypotension
○ Impaired reproduction
○ Impaired memory, slowing of intellectual functions,
change in emotional responses.
○ infiltration of the tissues by glycosaminoglycans giving it
a waxy or coarsened appearance. Tissue is edematous/
mucinous. (Cardiac infiltration)
○ May have a goiter- enlarged thyroid with/without hoarseness
or husky voice
● Diagnostic criteria
○ LABS: Elevated TSH, low T3, T4
● Complications
○ Myxedema coma - medical emergency- complication
of hypothyroidism. Can result in shock, organ
damage, death.
○ Precipitated by infection, cold, drugs,, trauma, poorly
controlled hypothyroidism.
○ S/S- subnormal temp, hypotension, decreased cardiac
output, hypoventilation, paralytic ileus
○ Treatment
■ Treatment- IV thyroid hormone (levothyroxine sodium)
■ IV .9 NSS
■ IV Corticosteroids
■ Check hourly temps, hourly Vital signs. May
require mechanical ventilation
■ Avoid hypnotic or sedative meds
● Management
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
, NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
○ Lifelong thyroid hormone replacement therapy
■ -Levothyroxine (Synthroid)- metabolized by the liver to
active T3. Assess
BP, HR prior to therapy, and periodically during therapy.
○ REVIEW PLAN OF CARE: pg 1616 chart 52-4
■ promote independence
■ provide extra layer of clothing or extra blanket (cold
intolerance
■ high fiber
■ adequate fluid but not more than reactricion
■ encourage mobility
■ use laxatives sparingly
■ monitor respiratory
■ encourage deep breathing
■ monitor for worsening condition
● hypotension, stupor, hypoventilation,
decreased cardiac output, paralytic lieu’s
● Nursing interventions
○ Importance of taking medication daily and need for follow
up blood work.
○ Med side effects.
○ Watch for S/S acute coronary syndrome esp with early
treatment
○ Signs and symptoms of myxedema coma
○ Develop bowel elimination plan to prevent
constipation (fluids, fiber, increase activity, minimize
any enemas or laxatives).
○ Avoid sedatives which can lead to respiratory difficulties.
HYPERTHYROIDISM
● Patho
○ Excessive activity of thyroid gland
○ Most common form is Graves Disease- stimulation of thyroid gland
by circulating immunoglobulins. Causes hypersecretion of thyroid
hormones
○ Other- thyroid cancer, iodine excess, toxic goiter
● Manifestations
○ Goiter (enlargement of thyroid gland)
○ Exophthalmos = bulging eyes
○ Excess metabolic rate
■ Weight loss, tremors
■ Agitation, palpitations, tachycardia, weakness
■ Heat intolerance, sweating
■ Diarrhea
■ Emotional lability, apprehension
■ Increased appetite
■ Insomnia
■ Increased BP, temp, heart rate,
NURSING EXAM -ENDOCRINE 13 QUESTIONS
WITH ANSWERS GRADED A+
