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Adult Health 1 Exam 3 Study Guide

Optimized for Learning & Retention

ENDOCRINE SYSTEM (22 Questions)

HYPOTHYROIDISM (6 Questions) - HIGH YIELD

Remember: "Everything SLOWS DOWN"

Core Concept

Low thyroid hormone → Decreased metabolism → Body functions slow down

Key Signs (Think "SLOW")

  • Sluggish: Fatigue, slow reflexes, bradycardia
  • Large: Weight gain, edema, enlarged tongue
  • Off: Depression, memory problems, constipation
  • Winter: Cold intolerance, dry skin, hair loss

Must-Know Labs

  • TSH ↑ (primary) - "TSH is Trying So Hard"
  • Free T4 ↓ - "T4 is Too low"
  • Total T3 ↓ - Often decreased but less specific than Free T4

Note: In secondary hypothyroidism, TSH will also be ↓

Treatment Memory Aid

"Take Levothyroxine Like This"

  • Take on empty stomach (30-60 min before food)
  • Life-long therapy required
  • Titrate slowly, monitor TSH every 6-8 weeks

Danger: Myxedema Coma

"Cold, Slow, Low" - Hypothermia, bradycardia, hypotension

HYPERTHYROIDISM (3 Questions)

Remember: "Everything SPEEDS UP"

Core Concept

High thyroid hormone → Increased metabolism → Body functions accelerate

Key Signs (Think "FAST")

  • Fever: Heat intolerance, warm skin, hyperthermia
  • Anxious: Anxiety, irritability, tremor, insomnia
  • Skinny: Weight loss despite increased appetite
  • Tachycardia: Fast heart rate, palpitations, high BP

Special for Graves' Disease

"Graves' EYES" - Exophthalmos (bulging eyes), lid lag Autoimmune origin: Positive TSI (thyroid-stimulating immunoglobulin) confirms diagnosis

THYROID STORM (2 Questions) - EMERGENCY

Remember: "STORM"

Recognition

  • Severe hyperthermia (>104°F)
  • Tachycardia (>140 bpm)
  • Out of control: Agitation, delirium
  • Really sick: Nausea, vomiting, diarrhea
  • Mental status changes

Precipitated by: Stress, trauma, infection, surgery, childbirth, stopping meds abruptly

Treatment Order (Remember "ABIP")

  1. Anti-thyroid drugs FIRST (methimazole/PTU)
  2. Beta-blockers (propranolol)
  3. Iodine AFTER antithyroid drugs
  4. Prednisone (steroids)

DIABETES (7 Questions) - HIGH YIELD

Type 1 vs Type 2 (Simple)

  • Type 1: "Young, Thin, Insulin dependent"
  • Type 2: "Older, Overweight, Insulin resistant"

Classic Symptoms: "The 3 P's"

  • Polyuria (frequent urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)

Also include: Blurred vision and fatigue (classic presentations)

Key Numbers to Memorize

  • Normal glucose: <100 mg/dL fasting
  • Diabetes: ≥126 mg/dL fasting OR ≥200 mg/dL random
  • HbA1c goal: <7% for most adults
  • Hypoglycemia: <70 mg/dL

Hypoglycemia Treatment: "Rule of 15"

15 grams carbs → Wait 15 minutes → Recheck glucose

Complications Memory Aid

"Big vessels, Little vessels"

  • Big (Macro): Heart attack, stroke, leg problems
  • Little (Micro): Eyes, kidneys, nerves

Neuropathy: Burning, numbness, foot ulcers—daily foot inspection critical Nephropathy: Monitor microalbuminuria annually

DIABETES MEDICATIONS (3 Questions)

Metformin (Biguanide)

"Met the Kidneys" - Don't use if kidney problems (eGFR <30) Hold before contrast - 48 hours before/after

Sulfonylureas

"Sugar makers" - Force pancreas to make insulin Main problem: Hypoglycemia and weight gain Take: 30 minutes before meals

Key Teaching

"STOP metformin if sick" - Lactic acidosis risk

GLP-1 Agonists (e.g., exenatide, liraglutide)

"GLP helps" - Increase insulin, slow gastric emptying, weight loss benefit

METABOLIC SYNDROME (2 Questions)

Remember: "3 of 5 Rule"

The 5 Components (Memory: "WHEAT")

  • Waist >40" (men), >35" (women)
  • HDL <40 (men), <50 (women)
  • Elevated BP ≥130/85
  • Abnormal glucose ≥100 mg/dL
  • Triglycerides ≥150 mg/dL

Impact: "Double Trouble"

  • 2x risk of heart disease
  • 5x risk of diabetes

HEMATOLOGIC SYSTEM (10 Questions)

DVT (3 Questions) - HIGH YIELD

Virchow's Triad: "SHE"

  • Stasis: Not moving (surgery, long flights)
  • Hypercoagulable: Clotting disorders, cancer, pregnancy
  • Endothelial injury: Trauma, surgery, IV lines

Diagnosis

"D-dimer rules OUT" - If negative + low suspicion, no DVT "Ultrasound confirms" - Gold standard

Signs: "SPEC"

  • Swelling (unilateral leg)
  • Pain in calf/thigh
  • Erythema (redness)
  • Cord (palpable vein)

ANEMIA (3 Questions)

Three Types by Size

  • Small (Microcytic): "Iron deficiency" - Most common
  • Normal (Normocytic): "Chronic disease" - Inflammation
  • Large (Macrocytic): "B12/Folate deficiency" - Megaloblastic

Iron Deficiency Teaching

"Iron Facts"

  • Take with vitamin C (enhances absorption)
  • Avoid calcium, coffee (blocks absorption)
  • Black stools are normal
  • Take on empty stomach (better absorption)

BLOOD TRANSFUSION (1 Question) - SAFETY

The "15-15-15 Rule"

  • 15 minutes: Stay with patient (reactions occur early)
  • 15 minutes: Check vitals every 15 minutes
  • 15 minutes: Start slowly first 15 minutes

Before Transfusion: "2-2-2"

  • 2 patient identifiers
  • 2 nurses verify blood and patient
  • 2 signatures on consent

Red Flag Reactions

  • Hemolytic: Stop immediately, wrong blood type
  • Febrile: Most common, premedicate with Tylenol
  • Allergic: Hives, give Benadryl

If Transfusion Reaction Occurs

  1. Stop transfusion
  2. Run normal saline
  3. Notify HCP and blood bank
  4. Save tubing and bag for analysis

SURGICAL NURSING (6 Questions)

PREOPERATIVE CARE (1 Question)

Safety Checklist: "MANIS"

  • Mark surgical site
  • Allergies documented
  • NPO status verified (8 hours food, 2 hours clear liquids)
  • Identify patient (2 identifiers)
  • Signed consent

POSTOPERATIVE CARE (4 Questions) - HIGH YIELD

Immediate Priorities: "ABCD"

  • Airway: Patent, oxygen
  • Breathing: Rate, depth, sounds
  • Circulation: Vitals, surgical site
  • Discomfort: Pain assessment

Preventing Complications

Respiratory Problems: "Deep and Move"

  • Deep breathing every 2 hours
  • Incentive spirometry
  • Early ambulation
  • If patient is sedated or immobile, reposition every 2 hours to promote lung expansion

Blood Clots: "Move or Lose"

  • Early ambulation (best prevention)
  • Sequential compression devices
  • Leg exercises if bed rest

Wound Problems: "RED"

  • Redness around incision
  • Edema or swelling
  • Drainage (purulent, increased)

Pain Management: "Multimodal"

  • Opioids for severe pain
  • Acetaminophen for mild pain
  • Ice for swelling
  • Positioning for comfort

INTRAOPERATIVE SAFETY (1 Question)

Universal Protocol: "VIP"

  • Verify patient identity
  • Identify correct procedure/site
  • Pause for final time-out

Key Safety: "FIRE"

  • Fire prevention (electrocautery safety)
  • Infection control (sterile technique)
  • Respiratory monitoring
  • Electrical safety (grounding)

Priority Questions: "ABC-M"

  • Airway first
  • Breathing second
  • Circulation third
  • Maslow's hierarchy (physiological → safety → psychosocial)

FINAL 24-HOUR CHECKLIST

Must Review

  • Hypothyroidism signs/treatment (6 questions)
  • Diabetes complications/education (7 questions)
  • Post-op nursing care (4 questions)
  • DVT risk factors/diagnosis (3 questions)
  • Thyroid storm treatment (2 questions)

Key Numbers

  • TSH normal: 0.4-4.0
  • TSI (Graves): Positive
  • HbA1c goal: <7%
  • Hypoglycemia: <70 mg/dL
  • Metabolic syndrome: 3 of 5 criteria
  • Microalbuminuria Goal: <30 mg/day
  • Normal Total Calcium: 8.5–10.5 mg/dL

Safety Priorities

  • Blood transfusion 15-15-15 rule
  • Surgical time-out procedure
  • Medication timing (levothyroxine, diabetes meds)

🎯 Success Tip: Focus on understanding WHY things happen, not just memorizing facts. Ask yourself: "What would I do as the nurse in this situation?"

You've got this! Trust your nursing judgment and clinical reasoning skills.

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    Adult Health 1 Exam 3 Study Guide | Claude