Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)

A 65-year-old woman is brought to the ED by ambulance after fainting. Physical examination reveals central-type obesity with a fatty buffalo hump in the neck, hirsutism, thin and fragile extremities with ecchymotic areas, hypertension, and mild congestive heart failure. She informs the nurse that she has experienced extreme weakness and fatigue during the past month and that her sleep patterns have become altered. The nurse realizes that the patient’s signs and symptoms are characteristic of:

A friend brings a 25-year-old man to the ED. The patient had been complaining of blurred vision, headache, slurred speech, and weakness. He is now comatose. Earlier in the morning, he had been playing tennis. Immediate laboratory studies indicate a serum glucose level of 34 mg/dL. The nurse suspects that this patient’s symptoms resulted from:

A 47-year-old man is brought to the ED. His family reports that he had become confused over the past 72 hours and suffered a seizure while on the way to the hospital. Upon arrival, the patient is minimally responsive. His respiratory rate is 32 breaths/minute, pulse rate 110 beats/minute, and blood pressure 120/90 mmHg. Immediate laboratory work reveals an abnormal sodium level of 117 mEq/L. The patient’s chest X-ray reveals a mass in the right mid-lung field. The nurse suspects that the underlying factor responsible for this patient’s change in mental status is related to:

The nurse knows that emergency management of a comatose patient with hypoglycemia includes:

A 65-year-old woman is brought to the ED by ambulance after fainting. Physical examination reveals central-type obesity with a fatty buffalo hump in the neck, hirsutism, thin and fragile extremities with ecchymotic areas, hypertension, and mild congestive heart failure. She informs the nurse that she has experienced extreme weakness and fatigue during the past month and that her sleep patterns have become altered. The nurse realizes that the patient’s signs and symptoms are characteristic of:

Paramedics bring a 66-year-old woman to the ED. Her blood pressure is 104/58 mmHg, pulse rate 44 beats/minute, respiratory rate 14 breaths/minute, and temperature 92.4o F (33.6oC). No medical history is available, except for the patient’s statement of not feeling well for the past month. Physical examination reveals a lethargic, thin woman with dry skin and periorbital and facial edema. Bilateral pulmonary congestion is noted. EKG monitoring shows sinus bradycardia. The physician diagnoses impending myxedema coma. The patient remains hypothermic, with a temperature of 95o F (35oC). An appropriate nursing intervention would be to:

Nursing care of a patient with adrenal crisis should focus on the prevention of which life-threatening aspect of adrenal crisis:

A 58-year-old man arrives at the ED, diaphoretic and complaining of severe pain in the right side. He informs the nurse that he had been walking his dog when he suddenly felt a horrible pain. Assessment findings reveal that his blood pressure is 160/70 mmHg, pulse 124 beats/minute and regular, temperature 98.6o F (37oC), and respiratory rate 24 breaths/minute. His abdomen, when palpated, reveals tenderness in the right flank. Urinalysis indicates RBCs in the urine. The patient has a history of hypertension and no known allergies. The physician diagnoses renal calculi and requests a consultation with the urologist. The nurse would expect the history of a patient with renal calculi to reveal a previous diagnosis of:

A 55-year-old woman is admitted to the ED with a temperature of 105o F (40.5oC), blood pressure 180/110 mmHg, pulse rate 120 beats/minute, and respiratory rate 36 breaths/minute. She shows signs of dehydration and states that she has been experiencing muscle weakness and bone pain for the past week. She has a history of Grave’s disease. The physician diagnoses thyroid crisis. Which nursing measure would be inappropriate in controlling a patient’s pyrexia that is in thyroid crisis?

The nurse learns that a patient is iodine-sensitive and is in thyroid crisis. Based on this information, which drug would the nurse expect to be included in the treatment plan?