52 Assessment and Management of Patients with Endocrine Disorders

A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? adrenal disorder thyroid disorder parathyroid disorder pituitary disorder

pituitary disorder Explanation: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? Monitor vital signs every 4 hours. Observe stool color. Observe urine output. Monitor bowel patterns.

Observe stool color. Explanation: The nurse should observe the color of each stool and test the stool for occult blood.

Which glands regulate calcium and phosphorous metabolism? Parathyroid Thyroid Adrenal Pituitary

Parathyroid Explanation: Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.

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 blood glucose levels A decrease in urine output A decrease in blood pressure A decrease in appetite

A decrease in urine output Explanation: 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.

Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? Perform capillary blood glucose monitoring four times daily. Continue to take his usual dose of hydrocortisone. Drink 8 oz of fluids. Administer hydrocortisone I.M.

Administer hydrocortisone I.M. Explanation: Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.

Which of the following hormones controls secretion of adrenal androgens? Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH) Calcitonin Parathormone

Adrenocorticotropic hormone (ACTH) Explanation: ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.

The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?

Correct response: Potassium of 6.0 mEq/L Explanation: Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L.

Which of the following would the nurse expect to find in a client with severe hyperthyroidism? Exophthalmos Striae Tetany Buffalo hump

Exophthalmos Explanation: 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.

The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? Dwarfism Simmonds' disease Acromegaly Gigantism

Gigantism Explanation: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

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 Testosterone Mineralocorticoids Estrogen

Glucocorticoids Explanation: 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 of the following would the nurse expect the physician to order for a client with hypothyroidism? Methimazole Propylthiouracil Levothyroxine sodium Propranolol

Levothyroxine sodium Explanation: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? Hypotension Moon face Weight loss Pale thick skin

Moon face Explanation: Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? Thyroid storm Myxedemic coma Acromegaly Addison's disease

Myxedemic coma Explanation: Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? Serum sodium level of 134 mEq/L Serum potassium level of 5.8 mEq/L Blood glucose level of 90 mg/dl Blood urea nitrogen (BUN) level of 12 mg/dl

Serum potassium level of 5.8 mEq/L Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels? Positive Babinski's sign Positive Chvostek's sign Positive Trousseau's sign Positive paresthesias

Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. A positive Trousseau's sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski's sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? Positive Chvostek's sign Hyperactive deep tendon reflex Positive Trousseau's sign Tetany

Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? Restricting fluids Administering glucose-containing I.V. fluids as ordered Encouraging increased oral intake Infusing IV fluids rapidly as ordered

Restricting fluids Explanation: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. Signs of dehydration Neurologic function Liver function tests Urine and blood chemistry Strict intake and output

Strict intake and output Neurologic function Urine and blood chemistry Explanation: Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? Diabetes insipidus (DI) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Hyperthyroidism Hypothyroidism

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: 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 Reference:

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? Hemorrhage Tetany Thyroid storm Laryngeal nerve damage

Tetany Explanation: 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 The concentration of a substance in plasma Details about the size of the organ and its location The client's blood sugar level

The functioning of endocrine glands Explanation: 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.

For a client with hyperthyroidism, treatment is most likely to include: emollient lotions. a synthetic thyroid hormone. a thyroid hormone antagonist. thyroid extract.

a thyroid hormone antagonist. Explanation: 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 group of clients should not receive potassium iodide? Those who are allergic to seafood Those taking medications such as cough medicines Those who are allergic to corticosteroids Those who are pregnant

Those who are allergic to seafood Explanation: Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.

Which of the following hormones would the nurse identify as being secreted by the thyroid gland? Parathormone Thyroxine Somatotropin Thymosin

Thyroxine Explanation: 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 nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? thymus function thyroid function adrenal function parathyroid function

adrenal function Explanation: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands?

four Explanation: The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? increase in hormonal levels hormonal underproduction hormonal overproduction decrease in hormonal levels

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

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: hypotension. thick, coarse skin. weight gain in arms and legs. deposits of adipose tissue in the trunk and dorsocervical area.

deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

A nurse explains the role of the ovaries. Which hormones would be included in that discussion? estrogen and progestin testosterone and progesterone estrogen and testosterone estrogen and progesterone

estrogen and progesterone Explanation: The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.

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 disorder should the nurse expect the physician to diagnose? Cushing's syndrome Diabetes mellitus Diabetes insipidus Goiter

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 this malfunction 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. Reference:

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: hypercalcemia. hyperkalemia. hypocalcemia. hypokalemia.

hypocalcemia Explanation: 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.

A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: potassium. vitamin D. folic acid. iron

vitamin D. Explanation: Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.