361 HESI endocrine system.

A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. Which response by the nurse is accurate? Rationale: Client with Cushing syndrome or those receiving cortical hormones must limit their intake of sodium and increase their intake of potassium because the kidneys are retaining sodium and excreting potassium.

"Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium"

Which question would the nurse ask to determine if a client who reports frequent urination may be experiencing diabetes insipidus? Rationale: Lithium carbonate is known to interfere with normal kidney response to antidiuretic hormone. Enquiring lithium carbonate therapy can help assess for diabetes insipidus, which ha a clinical manifestation of frequent urination. has

"Are you in lithium carbonate therapy"?

Which manifestation would the nurse expect to find when assessing a client with hyperthyroidism? SATA Rationale: Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate, Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema.

* Weight loss *Tachycardia *Restlessness *Exophthalmos

Which hormone is responsible for altered serum calcium concentrations? SATA Rationale: Produced by the thyroid gland, calcitonin decreases the serum calcium concentration if it increases above the normal level. Parathyroid hormones increase and stimulates bones to promote osteoclastic activity and release calcium into the blood in response to low serum calcium levels. stimulate

*Calcitonin *Parathyroid hormone

Which clinical manifestation would the nurse anticipate when assessing a client with hypothyroidism? SATA Rationale: Dry skin results from a decrease in the metabolic rate, which is associated with hypothyroidism. Dry, brittle hair results from a decrease in the metabolic rate, which is associated with hypothyroidism.

*Dry skin *brittle hair

Which effect does increased parathyroid hormone have on bones and electrolytes? SATA Rationale: Parathyroid hormone increases bone breakdown, which increases serum calcium levels. Parathyroid hormone increases the net release of calcium and phosphorus from bone into the extracellular fluid. It increases sodium and phosphorus excretion by the kidneys, not in the bone, and increases absorption of calcium and phosphorus in the gastrointestinal tract by using vitamin D. However this increase absorption of calcium and phosphorus is not related to the bone.

*Increased bone breakdown *Increased serum calcium levels *increased net release of calcium and phosphorus.

Which finding would be expected in a client with a history of hypothyroidism? SATA Rationale: A client with hypothyroidism would report feeling cold all the time, lethargy, and fatigue. These symptoms occur as a result of decreased metabolic form and low thyroid hormone levels. Clients with hypothyroidism may also be anemic (evidenced by a hemoglobin of 11.2 g/dL) report weight gain, and have bradycardia (heart rate of 59 b/m.

*Lethargy and fatigue *Hemoglobin 11.2 mg/dL *15- pound weight gain *heart rate 59 beats/min*

Which intervention would the nurse implement when caring for a client with the syndrome of inappropriate antidiuretic hormones (SIADH)? SATA Rationale: The excess production of antidiuretics hormone associated with SIADH leads to increased water reabsorption by the kidneys. Increases in water reabsorption result in decreased urinary output, increased intravascular fluid volume, serum hyperosmolality, and dilutional hyponatremia. Because treatment includes restricting fluid, frequent oral care is provided to increase client comfort. Fall risk precautions are instituted to protect the client from injury that might [occur as a result of neurological changes associated with declining serum sodium. The nurse monitors for and reports changes in neurological status resulting from cerebral edema and hyponatremia. Immediate treatment goals are to restore normal fluid balance and normal serum osmolality. Fluids are restricted

*Provide frequent oral care *Institute fall risk precautions *Monitor for a report of neurological changes

Which manifestation exhibited by a client taking levothyroxine for hypothyroidism for 3 months would cause a nurse to suspect that a decrease in dosage is needed? SATA Rationale: Excessive levothyroxine produces adaptation similar to hyperthyroidism, including tremors, heat intolerance, tachycardia, hypertension, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and an need to increase the dose of levothyroxine's.

*Tremors *heat intolerance

Which clinical manifestation/Signs and symptoms would the nurse expect to find upon assessment of a client with Cushing syndrome? SATA. Rationale: Truncal obesity is a key feature of Cushing syndrome. Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Truncal obesity is caused by the overproduction of the adrenal cortisol hormone associated with Cushing syndrome.

*Truncal obesity *Sleep disturbance *Then arms and legs

Which clinical findings would the nurse expect to see when assessing a client with a primary brain tumor who has developed a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) SATA? Rationale: Water retention and decreased urinary output occur because of excess secretion of antidiuretic hormone (ADH). Early manifestations are related to water retention and may include gastrointestinal (GI) disturbances such as loss of appetite, nausea, and vomiting. Weight gain occurs because of the water retention. Serum sodium levels are decreased because of fluid retention and sodium loss. Central nervous system changes include headache, lethargy, and decreased level of consciousness, progressing to coma and seizures. Hypothermia also occurs because of central nervous system disturbance. The pulse is full and bounding because of the increased fluid volume.

*Vomiting *Increased weight *Decreased serum sodium *Decreased level of consciousness

A client is diagnosed with hyperthyroidism and is treated with I-131. Before discharge, the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms would be included in the teaching? SATA Rationale: Fatigue is caused by a decreases metabolic rate associated with hypothyroidism. Dry skin most likely is caused by decreased glandular function associated with hypothyroidism. Progressive weight gain is associated with hypothyroidism in response to a decrease in the metabolic rate because of insufficient thyroid hormone. metabolic

*fatigue *Dry skin *Progressive weight gain

A client is diagnosed with parathyroid dysfunction. Which serum calcium concentration supports the diagnosis? Rationale: The normal serum calcium concentration ranges form 8.6 to 10.2 mg/dL. A serum calcium concentration above 10.2 mg/dL indicates hypercalcemia. Parathyroid hormones maintain calcium balance in the body. Hypocalcemia reflects hypothyroidism and hypercalcemia suggests hyperthyroidism. The serum calcium concentration of 7.8 mg/dL is below the normal range and indicates hypocalcemia. Therefore, the client may have hypothyroidism, which is a parathyroid dysfunction. Serum calcium concentration of 8.9 mg/dL, 9.7 mg/dL. and 10.2 mg/dL are all normal findings.

7.8 mg/dL

Which total serum calcium level stimulates the release of parathyroid hormone in a client? Rationale: Hypocalcemia stimulates the release of parathyroid hormone. The normal level of total serum calcium ranges between 9.0 and 10.5 mg/dL. A serum concentration of 8.5 mg/dL suggests hypocalcemia and stimulates parathyroid hormone release.

8.5 mg/dL

Which instruction would be included in the discharge plan for a client status post-total thyroidectomy? Rationale: Long-term thyroid replacement is prescribes after surgery to replace the thyroid's natural function. is prescribed

Take thyroid replacement medication as prescribed.

The nurse is caring for a client with Addison's disease. Which dietary instruction would the nurse provide? Rationale: Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to developing hyponatremia. The addition of salt to the diet is advised. Clients with Addison's disease are prone to hyperkalemia. High potassium food can be RESTRICTED. Protein is not omitted from the diet.

Add extra salt to food

The nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone can be impaired in its production because of this disease? Rationale: Aldosterone can be impaired in its production because of Addison's disease, although Addison's disease itself is caused by a cortisol deficiency. Aldosterone causes the kidneys to retain sodium ions. Increasing sodium promotes water retention, which elevates blood pressure. The absence of aldosterone causes hypotension.

Aldosterone

Which manifestation in a client who has a syndrome of inappropriate antidiuretic hormone (SIADH) would the nurse expect to find upon assessment? Rationale: SIADH is manifested in the form of retention of free water. This is because of excessive secretion of vasopressin causing reabsorption of water in renal tubules. There is hyponatremia and dilution of serum sodium in SIADH.

Retention of water

A client reports unexplained weight gain and back pain from a compression fracture of the vertebrae. On assessment, the nurse notes truncal obesity with excessive then extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. Which disease process would the nurse anticipate incorporating into the plan of care? Rationale: Common symptoms of Cushing disease are weight gain, truncal obesity, buffalo hump, and moon face because of deposit of adipose tissue. The condition is caused by excess cortisol secretion caused by hypersecretion of adrenocorticotropic hormone (ACTH). Other characteristics are diabetes mellitus, muscle wasting, osteoporosis, ecchymosis, and slow healing of wounds. Addison's disease is adrenal insufficiency. Symptoms of Addison's disease include hypotension, dehydration, hypoglycemia, and hyperpigmentation of the skin.

Cushing syndrome

Which clinical findings would the nurse expect when caring for a client with hyperthyroidism? SATA Rationale: tachycardia is associated with hyperthyroidism and is caused by increases in the basal metabolic rate. Exophthalmos is associated with hyperthyroidism and results from the accumulation of fluid behind the eyeball.

Tachycardia Exophthalmos

Which disorder is caused by the deficiency of antidiuretic hormone? Rationale: Diabetes insipidus is caused by the deficiency of antidiuretic hormone. Acromegaly and Cushing syndrome is not associated with antidiuretic hormone; excessive production of growth hormone results in acromegaly and excessive production of the adrenocorticotropic hormone causes Cushing syndrome.

Diabetes insipidus

When assessing a client with Graves disease, which clinical data would the nurse expect to find in the client's history? Rationale: Increased basal metabolic rate, increased circulation, and vasodilation result in warm, moist skin. Menorrhagia, sensitivity to cold, and dry, brittle hair are associated with hypothyroidism.

Diaphoresis

Which clinical findings would the nurse expect to identify when assessing a female client with Cushing syndrome? SATA Rationale: Cushing syndrome results from the excess adrenocortical activity causing excessive hairiness, especially a male pattern of hair distribution on a female (hirsutism) because of androgen excess. Hypercortisolism also causes a fat distribution, resulting in "buffalo hump" It also contributes to slow wound healing, hirsutism, weight gain, hypertension, acne, then arms and legs, and behavioral changes.

Hirsutism Buffalo hump

Which statement is correct regarding the effects of parathyroid hormone on bones for the maintenance of calcium balance? Rationale: Parathyroid hormone affects target tissues such as bone, kidney, and the gastrointestinal tract. The effects of parathyroid hormone on bones will be associated with the increase in the net release of calcium into extracellular fluid. Kidneys are responsible for increasing the bicarbonate and sodium excretion from the body. The action of parathyroid hormone on the gastrointestinal tract would show effects such as enhanced absorption of calcium and phosphorous. Kidneys are responsible for increased reabsorption of calcium and magnesium.

Increase net release of calcium into extracellular fluid.

Which symptom would a client exhibit if having a thyrotoxic crisis? Rationale: The thyrotoxic crisis is severe hypothyroidism; an excessive amount of thyroxine increases the metabolic rate, thereby raising the pulse and temperature. During crisis there usually is no increase in the difference between the apical and peripheral pulse rates (pulse deficit). The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during a crisis. Because of the uncreased metabolic rate, the pulse and respiratory rates increase to meet the body's oxygen needs.

Increased temperature and pulse rate

Which metabolic manifestations are likely to be observed in a client with hypothyroidism? SATA Rationale: Cold intolerance and decreased body temperature are the metabolic manifestations observed in a client with hypothyroidism. Impaired memory is the neurological manifestation of hypothyroidism. Difficulty in breathing is the pulmonary manifestation observed in a client with hypothyroidism. Decreased blood pressure is the cardiovascular manifestation observed in a client with hypothyroidism.

Intolerance to cold decreased body temperature

A client who has a subtotal thyroidectomy asks how hypothyroidism developed when the problem was hyperthyroidism. Which would the nurse consider when formulating a response? Rationale: After thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate.

Less thyroid tissue is available to supply thyroid hormone after surgery.

Which clinical findings correspond with the secretion of antidiuretic hormone (ADH)? SATA Rationale: Muscle cramps occur when the sodium level is less than 125 mEq/L and are caused by osmotic fluid shift. ADH causes water retention, which dilutes serum electrolytes such as sodium, with a resultant hyponatremia.

Muscle cramps Hyponatremia