303 Hinkle PrepU Chapter 52: Assessment and Management of Patients With Endocrine Disorders

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?

a decrease in urine output Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.)

Acetaminophen Iodine Propylthiouracil Dexamethasone (Decadron) Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.

A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies?

Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. The client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.

A nurse is collecting data from a client who is suspected of having an endocrine disorder and is scheduled for diagnostic testing that involves the use of a contrast medium. The nurse would inform the physician if the client stated which of the following?

"I have an allergy to shrimp and shellfish" The statement about an allergy to shrimp and shellfish would alert the nurse to the possibility of an allergy to iodine, a component of contrast media. This information needs to be reported to the physician. Although information about a family history of diabetes would be important, it would have no effect on the diagnostic testing. Certain drugs can affect diagnostic testing, but a multivitamin probably would not be a problem. Use of steroids within the past 3 months, rather than several years ago, could impact the results of thyroid testing.

A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns?

"I'll stay here with you while the technician draws your blood" The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear.

A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor?

"It regulates the function of other endocrine glands" The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?

"You must avoid hyperextending your neck after surgery" To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask?

"has your shoe size increased recently?" Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.

A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla?

450 pg/ml Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.

The nurse is aware that the best time of day for the total large corticosteroid dose is between:

7:00 and 8:00 AM The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

Cushing's syndrome The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected. the adrenal cortex?

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?

D The actions of PTH are increased by the presence of vitamin D.

A client with a 20-year history of hypothyroidism who has not been compliant with taking thyroid replacement therapy is brought into the ED with a diagnosis of myxedema coma. What client symptoms are consistent with this life-threatening event? Select all that apply.

Hypothermia Hypotension Hypoventilation The client will experience signs of hypothermia, hypotension, and hypoventilation with myxedema. Clients with myxedema will have bradycardia, not tachycardia, and will have lethargy, not hyperactivity.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism?

Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:

a corticotropin-secreting pituitary adenoma. A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.

Which of the following is a clinical manifestation of hypothyroidism?

a pulse rate below 60 beats/minute Bradycardia, a heart rate below 60 bpm, is associated with hypothyroidism because metabolism is subnormal and the tissues require little oxygen. This is initially tolerated without overt symptoms.

The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level?

a rise in serum calcium stimulates the release of calcitonin from the thyroid gland Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.

A nurse understands that for the parathyroid hormone to exert its effect, what must be present?

adequate vitamin D level Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate?

administer calcium gluconate as ordered When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.

Trousseau sign is elicited

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.

Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis?

glucagon Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.

A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress?

glucocorticoids Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?

have regular follow up care The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.

A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease?

helps the body adjust to stress Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?

hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hypophosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate:

hypocalcemia A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following?

hypotension The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside:

in 1 to 2 weeks Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol (Inderal).

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone?

increase serum calcium level The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.

Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells?

kidneys The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.

Which intervention is the most critical for a client with myxedema coma?

maintaining a patent airway Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function?

metabolic rate The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.

The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?

milk Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.

The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to

monitor for symptoms of hypoparathyroidism Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).

A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate?

myxedema coma Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome?

observe the color of stool The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:

phosphorus PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

ADH is secreted by which gland?

posterior pituitary Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in:

serum glucose level Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

Parathyroid hormone (PTH) has which effects on the kidney?

stimulation of calcium reabsorption and phosphorus excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms?

the moon face and acne will resolve when the medication is tapered off Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).

Which hormone is secreted by the posterior pituitary?

vasopressin Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?

weight loss, nervousness, and tachycardia Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.

A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?

acromegaly Acromegaly, which is caused by a *pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain*. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted?

decrease in hormone levels Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:

decreased body temperature and cold intolerance Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss?

consume adequate amounts of fluid The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces:

T3, thyroxine (T4), and calcitonin. The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?

"I may stop taking this medication when I feel better" The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.

When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate?

TH may increase the effects of digitalis preparation Thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.

A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do?

Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.

A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response?

adrenal medulla The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.

When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:

calcitonin Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?

decreased cardiac output An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?

desmopressin (DDVAP) DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration. Other medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.

A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose?

goiter A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of goiter include an *enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress*. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood?

pineal gland, melatonin The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.

A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly?

pituitary tumor When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:

sodium and potassium abnormalities In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

For a client with hyperthyroidism, treatment is most likely to include:

a thyroid hormone antagonist Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor?

handle body fluids carefully The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI.

Because there is no one cause for Graves' disease, treatment is relegated to the management of symptoms, or in severe cases, surgery to remove the thyroid gland. Which is not a symptom of Graves' disease?

constipation Clients with Graves' disease commonly experience diarrhea, increased appetite, weight loss, visual changes such as blurred or double vision, and fine tremors of the hands, causing unusual clumsiness.

Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following?

cretinism During fetal and neonatal development, undersecretion of thyroid hormone may cause cretinism (stunted growth and mental development). In adults, hyposecretion of thyroid hormone causes myxedema or hypothyroidism. Diabetes insipidus is caused by undersecretion of antidiuretic hormone (ADH/vasopressin).

A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of:

profound neuromuscular irritability Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following?

detecting evidence of hormone hypersecretion The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.

A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for?

diabetes insipidus Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not a pituitary tumor. The thyroid gland does not exhibit these symptoms.

A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following?

dysfunction of the thyroid gland itself Thyroidal hypothyroidism results from thyroid gland dysfunction. The other causes result in central, secondary, or tertiary causes if there is inadequate secretion of TSH.

Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines?

hypoglycemia Hypotension and hypoglycemia may occur in the postoperative period because of the sudden withdrawal of excessive amounts of catecholamines. Hypertension and hyporeflexia are not related to the sudden withdraw of excessive amounts of catecholamines.

A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for:

indicators of dehydration A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration. No glucose is lost in the urine. Hypernatremia occurs with dehydration.

For a client with Graves' disease, which nursing intervention promotes comfort?

maintaining room temperature in low normal range Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland?

posterior pituitary Antidiuretic hormone is secreted by the posterior pituitary gland.

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find?

reports of increased appetite Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability?

stimulate more hormones using the negative feedback system Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

A postpartum client is receiving intravenous oxytocin (Pitocin) after birth. Why will this medication be used for this client after the birth of her child?

stimulates the contraction of the uterus and prevent bleeding Oxytocin (Pitocin) is released from the pituitary gland and stimulates contraction of pregnant uterus and release of breast milk after childbirth. It will not prevent lactation or help treat nausea. It will increase lactation.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

thyroid crisis Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?

syndrome of inappropriate antidiuretic hormone secretion (SIADH) Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

tetany Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?

the functioning of endocrine glands Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.

The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland?

the lower neck anterior to the trachea The thyroid gland is located in the lower neck anterior to the trachea. It is divided into two lateral lobes joined by a band of tissue called the isthmus.

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking the prescribed antithyroid medication?

thyrotoxic crisis Antithyroid medication is given to treat hyperthyroidism. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Therefore, this client is at risk for thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism. Myxedema coma results from severe hypothyroidism. Diabetes insipidus (DI) and SIADH do not correlate with hyperthyroidism or the medication taken for hyperthyroidism.

Which of the following hormones would the nurse identify as being secreted by the thyroid gland?

thyroxine The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.

A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find?

deficient production of vasopressin The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.

Which of the following would the nurse expect to find in a client with severe hyperthyroidism?

exophthalmos Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.

A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?

glucose tolerance test in combination with GH measurement A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.

A nurse should expect a client with hypothyroidism to report:

puffiness of the face and hands Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?

related to one demineralization resulting in pathological fractures Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This increase, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?

sympathetic Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.

When caring for a client with diabetes insipidus, the nurse expects to administer:

vasopressin Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.