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Which is the major function of the hormones produced by the adrenal cortex? a. "Fight-or-flight" response b. Control of potassium, sodium, and water c. Regulation of cell growth d. Calcium and stress regulation

The assessment findings of a male patient with pituitary tumor include reports of changes in secondary sex characteristics, such as episodes of impotence and decrease libido. The nurse explains that these findings are a result of overproduction of which hormone? A) Gonadotropins inhibiting prolactin B) Thyroid hormone inhibiting prolactin C) Prolactin inhibiting secretions of gonadotropins D) Steroids inhibiting production of sex hormones

C) Prolactin inhibiting secretion of gonadotropins

14. The nurse is assessing a patient with Graves' disease and observes an abnormal protrusion of both eyeballs. How does the nurse document this assessment finding?

Exophthalmos

Preoperative care for hypophysectomy

Explain that, because nasal packing is present for 2-3 days after surgery, it will be necessary to breathe thru the mouth, and a "mustache" dressing ("drip" pad) will be placed under the nose. Instruct the patient NOT to brush teeth, cough, sneeze, blow the nose, or bend forward after surgery. These activities can increase ICP and delay healing.

A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with this disorder? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

Moon face Petechiae Muscle atrophy Clinical manifestations of Cushings disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

Which nursing intervention is a preventative measure for adrenalcortical insufficiency?

Reducing high dose glucocorticoid doses gradually

17. Following a hypophysectomy, the patient requires instruction on hormone replacement for which hormones? (Select all that apply.) a. Cortisol b. Thyroid c. Gonadal d. Vasopressin e. PRL

a, b, c, d

23. What is the disorder that results from a deficiency of vasopressin (ADH) from the posterior pituitary gland called? a. SIADH b. DI c. Cushing's syndrome d. Addison's disease

50. Which drug decreases cortisol production? a. Mitotane (Lysodren) b. Aminoglutethimide (Cytadren) c. Cyproheptadine (Periactin) d. Hydrocortisone (Cortef)

In addition to the pancreas that secretes insulin which gland secretes hormones that affect protein, carbohydrate, and fat metabolism? a. Posterior pituitary b. Thyroid c. Ovaries d. Parathyroid

Which mechanism is used to transport the substance produced by the endocrine glands to their target tissue? a. Lymph system b. Bloodstream c. Direct seeding d. Gastrointestinal system

8. The nurse is performing an assessment of an adult patient with new-onset acromegaly. What does the nurse expect to find? a. Extremely long arms and legs b. Thickened lips c. Changes in menses with infertility d. Rough, extremely dry skin

b Thickened lips

2. A client has a hypofunctioning anterior pituitary gland. Which hormones does the nurse expect to be affected by this? (Select all that apply.) a.Thyroid-stimulating hormone b.Vasopressin c.Follicle-stimulating hormone d.Calcitonin e.Growth hormone

ANS: A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.

2. An adult client has been diagnosed with a deficiency of gonadotropin and growth hormone. Which fact reported in the client's history could have contributed to this problem? a. Mother with adult-onset diabetes mellitus b. Experienced head trauma 5 years ago c. Severe allergy to shellfish and iodine d. Has used oral contraceptives for 5 years

ANS: B Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

34. Which type of IV fluid does the nurse use to treat a patient with SIADH when the serum sodium level is very low? a. D5 1/2 normal saline b. D5W c. 3% normal saline d. Normal saline

What is the name of the substance secreted by the endocrine glands? a. Vasoactive amines b. Chemotaxins c. Hormones d. Cytotoxins

36. The nurse assesses a patient post thyroidectomy for laryngeal nerve damage. Which findings indicate this complication? (Select all that apply.) a. Dyspnea b. Sore throat e. Dry cough

c. Hoarseness d. Weak voice

48. A patient with continuous spasms of the muscles is diagnosed with hypoparathyroidism. The muscle spasms are a clinical manifestation of which condition?

c. Tetany

35. After a thyroidectomy, a patient reports tingling around the mouth and muscle twitching. Which complication do these assessment findings indicate to the nurse?

d. Hypocalcemia

7. Which laboratory result is consistent with a diagnosis of hyperthyroidism?

d. Increased serum T3 and T4

Symptoms of SIADH

*Ø* Na: hyponatremia problems *Ø* Free water retention, not salt, so dependent edema is not present *Ø* GI: decreased appetite, N/V *Ø* Neuro: LOC. changes, lethargic, headache, hostile, irritable, seizure, coma, decreased deep tendon reflexes *Ø* Urine: decreased urine output, osmolarity increased (concentrated) *Ø* Blood: volume increased, osmolarity decreased (dilutional) *Ø* VS: bounding pulse, hypothermia

Adrenal gland hypofunction pathophysiology

-Adrenocortical steroid production may decrease as a result of inadequate secretion of adrenocorticotropic hormone (ACTH), dysfunction of the hypothalamic-pituitary control mechanism, or direct dysfunction of adrenal gland tissue. -Symptoms may develop gradually or occur quickly with stress. -In acute adrenocortical insufficiency (adrenal crisis), life-threatening symptoms may appear without warning. -Insufficiency of adrenocortical steroids causes problems thru the loss of aldosterone and cortisol action. Decreased cortisol levels result in hypoglycemia. Gastric acid production and glomerular filtration decrease. Decreased glomerular filtration leads to excessive BUN levels, which cause anorexia and weight loss. -Reduced aldosterone secretion causes disturbances of fluid and electrolyte balance. Potassium excretion is decreased, causing hyperkalemia. Sodium and water excretion are increased, causing hyponatremia and hypovolemia. Potassium retention also promotes reabsorption of hydrogen ions, which can lead to acidosis.

Laboratory and imaging assessment for hypercortisolism

-Blood, salivary, and urine cortisol levels will be high -Plasma ACTH levels vary depending on cause of the problem (high if it's due to pituitary Cushing's disease, low if due to adrenal Cushing's disease or due to steroid use) -CT scans, MRI. and arteriography can identify lesions of the adrenal or pituitary glands, lung, GI tract, or pancreas.

Deficiency in gonadotropins (FSH & LH)

-These are hormones that stimulate the gonads to produce sex hormones, so a deficiency changes sexual function in both men and women. -In men, gonadotropin deficiency results in testicular failure with decreased testosterone production that may cause sterility. -In women, gonadotropin deficiency results in ovarian failure, amenorrhea, and infertility.

nephrogenic diabetes insipidus

-This is a problem with the kidney's response to ADH rather than a problem with ADH production or release. Any severe kidney injury can reduce the ability of the kidney tubules to respond to ADH. In this situation, as long the kidney is able to continue to produce urine, DI results. In some cases, mutation in the gene responsible for producing the ADH receptor interferes with kidney response to ADH.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) pathophysiology

-Vasopressin secretes even when plasma osmolarity is low or normal -A decrease is plasma osmolarity normally inhibits ADH production and secretion. However in SIADH, Negative feedback mechanisms do not function properly (if plasma hypo/normo-osmo, it should inhibit ADH production/secretion) -Water is retained, leading to dilution hyponatremia -The blood volume increase inhibits kidney release of renin and aldosterone, which increases Na loss, leading to even greater hyponatremia (vicious cycle)

Growth hormone (GH) deficiency

-changes tissue growth by reducing liver production of *somatomedins*. These substances, especially somatomedin C, trigger growth and maintain bone, cartilage, and other tissues throughout life. -GH deficiency results from decreased GH production, failure of the liver to produce somatomedins, or a failure of tissues to respond to the somatomedins. -In adults, GH deficiency alters cellular regulation by increasing the rate of bone destructive activity, leading to thinner bones (osteoporosis, and increased risk for fractures.

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client? a. Atropine sulfate b. Levothyroxine sodium (Synthroid) c. Propranolol (Inderal) d. Epinephrine (Adrenalin)

ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.

7. A client has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurse's best action? a. Counsel the client on the health risks of alcoholism. b. Assess for jaundice of the skin and eyes. c. Document the finding and monitor the client. d. Draw blood for liver function studies.

ANS: C Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver. Other than documenting the finding and monitoring the client, these actions would be inappropriate because the finding is commonly associated with acromegaly.

While caring for a postoperative patient following a transshpenoidal hypophysectomy, the nurse observes nasal drainage that is clear with yellow color at the edge. The "halo sign" is indicative of which condition? A) Worsening neurologic status of the patient. B) Drainage of cerebrospinal fluid from the patient's nose. C) Onset of postoperative infection. D) An expected finding following this surgery.

B) Drainage of cerebral spinal fluid C S F from the patient's nose.

Postoperative care for a patient who has had a transsphenoidal hypophysectomy includes which intervention? A) Encouraging coughing and deep-breathing to decrease pulmonary complications. B) Testing nasal drainage for glucose to determine weather it contains cerebrospinal fluid. C) Keeping the bed flath to decrease central cerebrospinal fluid leakage. D) Assisting the patient with brushing the teeth to reduce risk of infection.

B) Testing nasal drainage for glucose to determine whether it contains cerebral spinal fluid cerebrospinal fluid.

The nurse is performing an assessment of an adult patient with new onset acromegaly. What does the nurse expect to find? A) Extremely long legs and arms. B) Thickened lips C) Changes in menses with infertility D) Rough, extremely dry skin

B)Thickened lips

Which are diagnostic methods to measure patient hormone levels? (SATA) a. Stimulation testing b. Suppression testing c. 24-hour urine testing d. Chromatographic assay e. Needle biopsy

abcd

Which assessment findings does the nurse monitor in response to catecholamines released by the adrenal medulla? (SATA) a. Increased heart rate related to vasoconstriction b. Increased blood pressure related to vasoconstriction c. Increased perspiration d. constriction of pupils e. Increased blood glucose in response to glycogenolysis

abce

Which statements about T₃ and T₄ hormones are correct? (SATA) a. The basal metabolic rate is affected b. Hypothalamus is stimulated by cold and stress to secrete thyrotropin-releasing hormone (TRH) c. These hormones need intake or protein and iodine for production d. Circulating hormone in the blood directly affects the production of TSH e. T₃ and T₄ increase oxygen use in tissues

abce

Which are the types of radiographic test that may be used for an endocrine assessment? (SATA) a. Ultrasonography b. Skull x-ray c. Chest x-ray d. MRI e. CT

abde

Which statements about hormones and the endocrine system are accurate? (SATA) a. There are specific normal blood levels of each hormone. b. Hormones exert their effects on specific target issues. c. Each hormone can bind with multiple receptor sites. d. The endocrine system works independently to regulate homeostasis e. More than one hormone can be stimulated before the target tissue is affected.

abe

Which statements about the pituitary glands are correct? (SATA) a. The main role of the anterior pituitary is to secrete tropic hormones. b. The posterior pituitary gland stores hormones produced by the hypothalamus c. The anterior pituitary is connected to the thalamus gland. d The anterior pituitary releases stored hormones produced by the hypothalamus. e. The anterior pituitary gland secretes gonadotropins

abe

Which statements about insulin secretion are correct (SATA) a. insulin levels increase following the ingestion of a meal. b. Insulin is stimulated primarily by fat ingestion. c. Basal levels are secreted continuously d. Insulin promotes glycogenolysis and gluconeogenesis e. carbohydrate intake is the main trigger for insulin secretion

ace

Which statements about the adrenal glands are correct? (SATA) a. The cortex secretes androgens in men and women. b. Catecholamines are secreted from the cortex. c. Glucocorticoids are secreted by the medulla d .The medulla secretes hormones essential for life e. The cortex secretes aldosterone that maintains extracellular fluid volume.

19. Preoperative care for a patient who has had a transphenoidal hypophysectomy includes which intervention? a. Encouraging coughing and deep-breathing to decrease pulmonary complications b. Testing nasal drainage for glucose to determine whether it contains CSF c. Keeping the bed flat to decrease central CSF leakage d. Assisting the patient with brushing the teeth to reduce risk of infection

20. While caring for a postoperative patient following a transsphenoidal hypophysectomy, the nurse observes nasal drainage that is clear with yellow color at the edge. This "halo sign" is indicative of which condition? a. Worsening neurologic status of the patient b. Drainage of CSF from the patient's nose c. Onset of postoperative infection d. An expected finding following this surgery

30. Which statement about the pathophysiology of SIADH is correct? a. ADH secretion is inhibited in the presence of low plasma osmolality. b. Water retention results in dilutional hyponatremia and expanded extracellular fluid (ECF) volume. c. The glumerulus is unable to increase its filtration rate to reduce the excess plasma volume. d. Renin and aldosterone are released and help decrease the loss of urinary sodium.

37. Which statement about pheochromocytoma is correct? a. It is most often malignant. b. It is a catecholamine-producing tumor. c. It is found only in the adrenal medulla. d. It is manifested by hypotension.

38. A patient in the emergency department is diagnosed with possible pheochromcytoma. What is the priority nursing intervention for this patient? a. Monitor the patient's intake and output and urine specific gravity. b. Monitor blood pressure for severe hypertension. c. Monitor blood pressure for severe hypotension. d. Administer medication to increase cardiac output.

40. Which intervention applies to a patient with pheochromocytoma? a. Assist to sit in a chair for blood pressure monitoring. b. Instruct not to smoke, drink coffee, or change positions suddenly. c. Encourage to maintain an active exercise schedule including activity such as running. d. Encourage one glass of red wine nightly to promote rest.

41. Which intervention is contraindicated for a patient with pheochromocytoma? a. Monitoring blood pressure b. Palpating the abdomen c. Collecting 24-hour urine specimens d. Instructing the patient to limit activity

51. A patient is scheduled for bilateral adrenalectomy. Before surgery, steroids are to be given. Which is the reasoning behind the administration of this drug? a. To promote glycogen storage by the liver for body energy reserves b. To compensate for sudden lack of adrenal hormones following surgery c. To increase the body's inflammatory response to promote scar formation d. To enhance urinary excretion of salt and water following surgery

53. Which statement about a patient with hyperaldosteronism after a successful unilateral adrenalectomy is correct? a. The low-sodium diet must be continued postoperatively. b. Glucocorticoid replacement therapy is temporary. c. Spironolactone (Aldactone) must be taken for life. d. Additional measures are needed to control hypertension.

57. A patient in the emergency department who reports lethargy, muscle weakness, nausea, vomiting, and weight loss over the past weeks is diagnosed with Addisonian crisis (acute adrenal insufficiency). Which drug(s) does the nurse expect to administer to this patient? a. Beta blocker to control the hypertension and dysrhythmias b. Solu-Cortef IV along with IM injections of hydrocortisone c. IV fluids of D5NS with KCl added for dehydration d. Spironolactone (Aldactone) to promote diuresis

A patient has a low serum cortisol level. Which hormone would the nurse expect to be secreted to correct this? a. Thyroid-stimulating hormone (TSH) b. Adrenocorticotropic hormone c. Parathyroid hormone d. Antidiuretic hormone

A patient is suspected of having a pituitary tumor. Which radiographic test aids in determining this diagnosis? a. Skull x-rays b. MRI/CT c. Angiography d. Ultrasound

The maintenance of internal body temperature at approximately 98.6 F ( 37 C) is an example of which endocrine process? a. "Lock and key" manner b. Neuroendocrine regulation c. Positive feedback mechanism d. Stimulus-response theory

What is the correct nursing action before beginning a 24-hour urine collection for endocrine studies? a. Place each voided specimen in a separate collection container b. Check whether any preservatives are needed in the collection container c. Start the collection with the first voided urine d. Weigh the patient before beginning the collection

Which statement about age-related changes in older adults and the endocrine system is true? a. All hormone levels are elevated b. Thyroid hormone levels decrease c. Adrenal glands enlarge d. They thyroid gland enlarges

Which statement about performing a physical assessment of the thyroid gland is correct? a The thyroid gland is easily palpated in all patients b. The patient is instructed to swallow sips of water to aid palpation c. The anterior approach is preferred fro thyroid palpation d. The thumbs are used to palpate the thyroid lobes

Which statement about pituitary hormones is correct? a. ACTH acts on the adrenal medulla b. Follicle-stimulating hormone (FSH) stimulates sperm production in men. c. Growth hormone promotes protein catabolism d. Vasopressin decreases systolic blood pressure.

33. Which are preoperative instructions for a patient having thyroid surgery? (Select all that apply.)

b. Teach the moving and turning technique of manually supporting the head and avoiding neck extension to minimize strain on the suture line. c. Inform the patient that hoarseness for a few days after surgery is usually the result of a breathing tube (endotracheal tube) used during surgery. d. Humidification of air may be helpful to promote expectoration of secretions. Suctioning may also be used. e. Clarify any questions regarding placement of incision, complications, and postoperative care.

47. Which foods will the nurse instruct a patient with hypoparathyroidism to avoid? (Select all that apply.)

b. Yogurt e. Milk f. Processed cheese

Which are the target organs of PTH in the regulation of calcium and phosphorus? (SATA) a. Stomach b. Kidney c. Bone d. Gastrointestinal tract e. Thyroid gland

bcd

Which statements about the thyroid gland and its hormones are correct? (SATA) a. The gland is located in the posterior neck below the cricoid cartilage. b. The gland has two lobes joined by a thin tissue called the isthmus c. T₄ and T₃ are to thyroid hormones d. Thyroid hormones increase red blood cell production e. Thyroid hormone production depends on dietary intake of iodine and potassium

bcd

Which endocrine tissues are most commonly found to have reduced function as a result of aging? (SATA) a. Hypothalamus b. Ovaries c. Testes d. Pancreas e. Thyroid gland

bcde

Which statements about the hormone cortisol being secreted by the adrenal cortex are accurate? (SATA) a. Cortisol peaks occur late in the day, with lowest points 12 hours after each peak. b. Cortisol has an effect on the body's immune function. c. Stress causes an increase in the production of cortisol d. Blood levels of cortisol have no effect on its secretion. e. Cortisol affects carbohydrate, protein, and fat metabolism

bce

15. A patient requires 100 g of oral glucose for suppression testing and GH levels are measured serially for 120 minutes. The results of the suppression testing are abnormal. The nurse assesses for the signs and symptoms of which endocrine disorder? a. Adrenal insufficiency b. DI c. Hyperpituitarism d. Hypothyroidism

22. The action of antidiuretic hormone (ADH) influences normal kidney function by stimulating which mechanism? a. Glomerulus to control the filtration rate b. Proximal nephron tubules to reabsorb water c. Distal nephron tubules and collecting ducts to reabsorb water d. Constriction of glomerular capillaries to prevent loss of protein in urine

29. Which patient's history puts him or her at risk for developing SIADH? a. 27-year-old patient on high-dose steroids b. 47-year-old hospitalized adult patient with acute renal failure c. 58-year-old with metastatic lung or breast cancer d. Older adult with history of a stroke within the last year

31. The effect of increased ADH in the blood results in which effect on the kidney? a. Urine concentration tends to decrease. b. Glomerular filtration tends to decrease. c. Tubular reabsorption of water increases. d. Tubular reabsorption of sodium increases.

What are tropic hormones? a. Hormones that trigger female and male sex characteristics b. Hormones that have a direct effect on final target tissues c. Hormones produced by the anterior pituitary gland that stimulate other endocrine glands. d. Hormones that are synthesized in the hypothalamus and stored in the posterior pituitary gland.

4. The assessment findings of a male patient with anterior pituitary tumor include reports of changes in secondary sex characteristics, such as episodes of impotence and decreased libido. The nurse explains to the patient that these findings are a result of overproduction of which hormone? a. Gonadotropins inhibiting prolactin (PRL) b. Thyroid hormone inhibiting PRL c. PRL inhibiting secretion of gonadotropins d. Steroids inhibiting production of sex hormones

c PRL inhibiting secretion of gonadotropins

13. Which statement about hormone replacement therapy for hypopituitarism is correct? a. Once manifestations of hypofunction are corrected, treatment is no longer needed. b. The most effective route of androgen replacement is the oral route. c. Testosterone replacement is contraindicated in men with prostate cancer. d. Clomiphene citrate (Clomid) is used to to suppress ovulation in women.

c Testosterone replacement is contraindicated in men with prostate cancer.

2. A malfunctioning posterior pituitary gland can result in which disorders? (Select all that apply.) a. Hypothyroidism b. Altered sexual function c. Diabetes insipidus (DI) d. Growth retardation e. Syndrome of inappropriate antidiuretic hormone (SIADH)

c, e Diabetes insipidus Syndrome of inappropriate antidiuretic hormone (SIADH)

How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? a) Blocks reabsorption of sodium b) Increases blood pressure c) Increases cardiac output d) Works as an antidiuretic hormone (ADH) in the kidneys

Correct Answer: d Desmopressin is a synthetic form of ADH that binds to kidney receptors and enhances reabsorption of water, thus reducing urine output. Desmopressin does not have any effect on sodium reabsorption. It may cause a slight increase or a transient decrease in blood pressure, but this does not affect urine output. Desmopressin does not increase cardiac output.

Patients diagnosed with an anterior pituitary tumor can have symptoms such as acromeglay or giantism. These symptoms are result of overproduction of which hormone? A) ACTH B) Prolactin C) Gonadotropins D) Growth Hormone

D) Growth hormone

Excessive secretion of ACTH

Excessive ACTH overstimulates the adrenal cortex causing high glucocorticoids, mineralocorticoids, androgens leading to Cushing's

A patient uses desmopressin acetate metered dose spray as replacement hormone for AntiDiuretic Hormone A D H. Which is an indication for another dose? Select all that apply.

Excessive urination and specific gravity of 1.003

A patient is scheduled for bilateral adrenalectomy. Before surgery, steroids are to be given. Which is the reasoning behind the administration of this drug?

To compensate for sudden lack of adrenal hormones following surgery.

The nurse determines a priority patient problems of altered self-concept in a female patient with Cushing's syndrome who expresses concern about the changes in her general appearance. What is the expected outcome for this patient?

To verbalize an understanding that treatment may reverse many of the problems.

Which medications are used in S I A D H to promote water excretion without causing sodium loss? Select all that apply.

Tolvaptan (Samsca) and Conivaptan (Vaprisol)

In the older adult female, which physiologic changes occur as a result of decreased function? a. Decreased bone density, decreased production of estrogen b. Decreased sensitivity fo peripheral tissues to the effects of insulin c. Decreased urine-concentrating ability of the kidneys d. Decreased metabolic rate

The anterior pituitary gland secretes tropic hormones in response to which hormones from the hypothalamus? a. Releasing hormones b. Target tissue hormones c. Growth hormones d. Demand hormones

The binding of a hormone to a specific receptor site is an example of which endocrine process? a. "Lock and key" manner b. Negative feedback mechanism c. Neuroendocrine regulation d. "fight-or-flight" response.

Which hormone is directly suppressed when circulating levels of cortisol are above normal? a. Corticotropin-releasing hormone (CRH) b. ADH c. Adrenocorticotropic hormone (ACTH) d. Growth hormone-releasing hormone (GH-RH)

5. A patient with a PRL-secreting tumor is likely to be treated with which medications? a. Dopamine agonists b. Vasopressin c. Steroids d. Growth hormone (GH)

a Dopamine agonists

9. When analyzing laboratory values, the nurse expects to find which value as a direct result of overproduction of GH? a. Hyperglycemia b. Hyperphosphatemia c. Hypocalcemia d. Hypercalcemia

a Hyperglycemia

31. Which signs and symptoms are assessment findings indicative of thyroid storm? (Select all that apply.)

a. Abdominal pain and nausea c. Elevated temperature d. Tachycardia e. Elevated systolic blood pressure

32. Management of the patient with hyperthyroidism focuses on which goals? (Select all that apply.)

a. Blocking the effects of excessive thyroid secretion b. Treating the signs and symptoms the patient experiences c. Establishing euthyroid function e. Maintaining an environment of reduced stimulation

43. Production of which hormone causes lower levels of calcium?

a. Calcitonin

52. Which medication therapies does the nurse expect patients with hypoparathyroidism to receive? (Select all that apply.)

a. Calcium chloride b. Calcium gluconate c. Calcitrol (Rocaltrol) e. Ergocalciferol

49. Which disorders/conditions can cause hyperparathyroidism? (Select all that apply.)

a. Chronic kidney disease b. Neck trauma d. Vitamin D deficiency

34. The nurse is preparing for a patient to return from thyroid surgery. What priority equipment does the nurse ensure is immediately available? (Select all that apply.)

a. Tracheostomy equipment b. Calcium gluconate or calcium chloride for IV administration d. Humidified oxygen e. Suction equipment f. Pillows

2. Which assessment findings indicate hyperthyroidism? (Select all that apply.)

a. Weight loss with increased appetite c. Increased heart rate d. Insomnia f. Heat intolerance

4. Which factor is a hallmark assessment finding that signifies hyperthyroidism?

c. Heat intolerance

16. The nurse is providing instructions to a patient taking levothyroxine (Synthroid). When does the nurse tell the patient to take this medication?

c. In the morning on an empty stomach

Which instructions are included when teaching a patient about urine collection for endocrine studies? (SATA) a. Fast before starting the urine collection b. Measure the urine in mL rather than ounces c. Empty the bladder completely, and then start timing d. Time the test for exactly the instructed number of hours e. Avoid taking any unnecessary drugs during endocrine testing f. Empty the bladder at the end of the time period and keep that specimen

cdef

14. A female patient has been prescribed hormone replacement therapy. What does the nurse instruct the patient to do regarding this therapy? a. Report any recurrence of symptoms, such as decreased libido, between injections. b. Monitor blood pressure at least weekly for potential hypotension. c. Treat leg pain, especially in the calves, with gentle muscle stretching. d. Take measures to reduce risk for hypertension and thrombosis.

39. The nurse expects to perform which diagnostic test for pheochromocytoma? a. 24-hour urine collection for sodium, potassium, and glucose b. Catecholamine-stimulation test c. Administration of beta-adrenergic blocking agent and monitor results. d. 24- hour urine collection for fractionated metanephrine and catecholamine levels.

42. Which diuretic is ordered by the health care provider to treat hyperaldosteronism? a. Furosemide (Lasix) b. Ethacrynic acid (Edecrin) c. Bumetanide (Bumex) d. Spironolactone (Aldactone)

43. Which statement about hyperaldosteronism is correct? a. Painful "charley horses" are common from hyperkalemia. b. It occurs more often in men than in women. c. It is a common cause of hypertension in the population. d. Hypokalemia and hypertension are the main issues.

44. When diagnosed with Cushing's syndrome, the manifestations are most likely related to an excess production of which hormone? a. Insulin from the pancreas b. ADH from posterior pituitary gland c. PRL from anterior pituitary gland d. Cortisol from the adrenal cortex

45. What is the most common cause of endogenous hypercortisolism, or Cushing's disease? a. Pituitary hypoplasia b. Insufficient ACTH production c. Adrenocortical hormone deficiency d. Hyperplasia of the adrenal cortex

52. The nurse is teaching a patient being discharged after bilateral adrenalcectomy. What medication information does the nurse emphasize in the teaching plan? a. The dosage of steroid replacement drugs will be consistent throughout the patient's lifetime. b. The steroid drugs should be taken in the evening so as not to interfere with sleep. c. The patient should take the drugs on an empty stomach. d. The patient should learn how to give himself an intramuscular injection of hydrocortisone.

58. The nurse determines that the administration of hydrocortisone for the Addisonian crisis is effective when which assessment is made? a. Increased urine output b. No signs of pitting edema c. Weight gain d. Lethargy improving; patient alert and oriented

59. Which nursing intervention is a preventive measure for adrenocortical insufficiency? a. Maintaining diuretic therapy b. Instructing the patient on salt restriction c. Reducing high-dose glucocorticoid therapy quickly d. Reducing high-dose glucocorticoid doses gradually

The target tissue for ADH is which organ? a. Hypothalamus b. Thyroid c. Ovary d. Kidney

Which hormone responds to elevated serum calcium blood level by decreasing bone resorption? a. PTH b. T₄ c. T₃ d. Calcitonin

Which statement about glucagon secretion is correct? a. It is stimulated by an increase in blood glucose levels b. It is stimulated by a decrease in amino acid levels. c. It exerts its primary effect on the pancreas. d. It acts to increase blood glucose levels

Which statement about the gonads is correct? a. Gonads are reproductive glands found in males only. b. The function of the hormones begins at birth in low, undetectable levels. c. The placenta secretes testosterone for the development of male external genitalia d. External genitalia maturation is stimulated by gonadotropins during puberty

Which statement about the pancreas is correct? a. Endocrine functions of the pancreas include secretion of digestive enzymes. b. Exocrine functions of the pancreas include secretion of glucagon and insulin c. The islets of Langerhans are the only source of somatostatin secretion. d. Somatostatin inhibits pancreatic secretion of glucagon and insulin

7. Patients diagnosed with an anterior pituitary tumor can have symptoms of acremegaly or gigantism. These symptoms are a result of overproduction of which hormone? a. ACTH b. PRL c. Gonadotropins d. GH

d GH

1. Problems in the hypothalamus that change the function of the anterior pituitary gland result in which condition? a. Adenohypophysis b. Panhypopituitarism c. Primary pituitary dysfunction d. Secondary pituitary dysfunction

d Secondary pituitary dysfunction

11. A deficiency of which anterior pituitary hormones is considered life-threatening? (Select all that apply.) a. GH b. Melanocyte-stimulating hormone (MSH) c. PRL d. Thyroid-stimulating hormone (TSH) e. ACTH

d, e Thyroid-stimulating hormone (TSH), ACTH

1. The nurse is performing a physical examination of a patient's thyroid gland. Precautions are taken in performing the correct technique because palpation can result in which occurrence?

d. Exacerbation of symptoms by releasing additional thyroid hormone

11. The nurse assessing a patient palpates enlargement of the thyroid gland, along with noticeable swelling of the neck. How does the nurse interpret this finding?

d. Goiter

23. Laboratory findings of elevated T3 and T4, decreased TSH, and high thyrotropin receptor antibody titer indicate which condition?

d. Graves' disease

42. Serum calcium levels are maintained by which hormone?

d. Parathyroid hormone (PTH)

55. What is the most common cause of death from myxedema coma?

d. Respiratory failure

Which patient's history puts her at risks for developing S I A D H?

58 year old with metastatic lung or breast cancer.

Psychosocial assessment for hypercortisolism

-emotional lability -sleep difficulty -fatigued

Which drug decreases cortisol production?

Aminoglutethimide (Cytadren)

Which hormones are secreted by the thyroid gland? (SATA) a Calcitonin b. Somatostatin c. Glucagon d. Thyroxine (T₄) e Aldosterone f. Triiodothyronine (T₃)

adf

6. Which sign/symptom is one of the first indicators of hyperthyroidism that is often noticed by the patient?

b. Vision changes or tiring of the eyes

***Interferes with A C T H production

Cypropheptadine (Periactin)

Which medications are used to treat Diabetes Insipidus D I?

Chlorpropamide (Diabinese) or Desmopressin acetate (DDAVP)

Which are physical findings of Cushing's syndrome? Select all that apply.

"Moon-faced" appearance, Truncal obesity, Thin easily damaged skin, and Extremity muscle wasting

A malfunctioning posterior pituitary glands can result in which disorder? Select all that apply. A) Hypothyroidism B) Altered Sexual Function C) Diabetes insipidus (DI) D) Growth retardation E) Syndrome of inappropriate antidiuretic hormone (SIADH)

C) Diabetes insipidus D I D) Syndrome of inappropriate antidiuretic hormone (SIADH)

The nurse is caring for a patient with Diabetes Insipidus D I. What is the priority goal of collaborative care?

Correct the water metabolism problem

When diagnosed with Cushing's syndrome, the manifestations are most likely related to an excess production of which hormone?

Cortisol from the adrenal cortex

Most life-threatening hypopituitary deficiencies

Deficiency in *ACTH* or *TSH* are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands.

***Which are hormones produced and secreted by the anterior pituitary gland? Select all that apply.

Growth hormone (GH; somatropin), Prolactin (PRL), Thyrotropin (Thyroid stimulating hormone TSH), and Gonadotropins (follicle stimulating hormone FSH and luteinizing hormone LH).

Which lab finding does the nurse expect to find with Cushing's syndrome? Select all that apply.

Increased serum glucose, increased serum sodium, and decreased serum calcium

In S I A D H as a result of water retention from excess A D H, which lab value does the nurse expect to find? Select all that apply.

Increased urine osmolarity/increased sodium in the urine, increased specific gravity/concentrated urine, and decreased serum osmolarity.

Which intervention applies to a patient with pheochromocytoma?

Instruct not to smoke or drink coffee or change positions suddently

The nurse determines that the administration of hydrocortisone for Addisonian crisis is effective when which assessment is made?

Lethargy improving; patient alert and oriented.

Secondary neurogenic diabetes insipidus

Not caused by a direct problem with the posterior pituitary but is a result of tumors in or near the hypothalamus or pituitary gland, head trauma, infectious processes, brain surgery, or metastatic tumors.

Nonsurgical management of hyperpituitarism: radiation

Radiation therapy doesn't have immediate effects in reducing pituitary hormone excesses, and months to years may pass before a therapeutic effect can be seen. It is not recommended to manage acromegaly. The use the gamma knife or stereotactic confocal radiotherapy method of delivering radiation to pituitary tumors had reduced the long-term side effects of this therapy.

Which diuretic is ordered by the doctor to treat hyperaldosteronism?

Spironolactone (Aldactone)

The nurse is teaching a patient being discharged after a bilateral adrenalectomy. What medication information does the nurse emphasize in the teaching plan?

The patient should learn how to give himself an intramuscular injection of hydrocortisone.

Drug-related Diabetes Insipidus

Usually caused by lithium carbonate (Eskalith, Lithobid) and demeclocycline (Declomycin). These drugs can interfere with the response of the kidneys to ADH.

19. A patient who has been diagnosed with Graves' disease is going to receive radioactive iodine (RAI) in the oral form of 131I. What does the nurse teach the patient about how this drug works?

b. It destroys the tissue that produces thyroid hormones.

26. Which condition is a life-threatening emergency and serious complication of untreated or poorly treated hypothyroidism?

b. Myxedema coma

Excessive secretion of GH

high levels result in acromegaly (skin thickness, organ enlargement, bone thinning, cartilage breakdown, hypertrophy of vocal cord/ligament/eustachian tube) -nerve entrapment and hyperglycemia (elevated blood glucose) are common -Early detection and treatment are essential to prevent irreversible enlargement of the face, hands, and feet. Other changes include increased skeletal thickness, hypertrophy of the skin, and enlargement of many organs such as the liver and the heart. Some changes may be reversible after treament, but skeletal changes are permanent.

Key features of Pituitary Hypofunction (Chart 62-1)

p.1246

Key features of Diabetes Insipidus (Chart 62-5)

*Cardiovascular symptoms* -Hypotension -Tachycardia -Weak peripheral pulses -Hemoconcentration *Kidney/Urinary symptoms* -Increased urine output -Dilute, low specific gravity *Skin symptoms* -Poor turgor -Dry mucous membranes *Neurologic symptoms* -Decreased cognition* -Ataxia* -Increased thirst -Irritability* *Occurs when access to water is limited and rapid dehydration results

Hypertensive crisis s/s

-severe headaches -palpitations -profuse diaphoresis -flushing -apprehension -a sense of impending doom -Pain in chest or abdomen with n/v

The nurse expects to perform which diagnostic test for pheochromocytoma?

24 hour urine collection for vanillymandelic acid V M A. or 24 hour urine collection for fractionated metanephrine and catecholamine levels

A patient with Prolactin (PRL) secreting tumor is likely to be treated with which medication? A) Dopamine agonists B) Vasopressin C) Steroids D) Growth hormone

A) Dopamine agonists

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.) a. A 20-year-old female with benign pituitary tumors b. A 32-year-old male with diplopia c. A 41-year-old female with anorexia nervosa d. A 55-year-old male with hypertension e. A 60-year-old female who is experiencing shock f. A 68-year-old male who has gained weight recently

A, C, D, E (Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.)

A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

A, C, D, E, F (Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.)

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28 f. pH: 7.50

A, C, F (Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.)

A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first? a. Reassure the client that the voice change is temporary. b. Document the finding and assess the client hourly. c. Place the client in high-Fowler's position and apply oxygen. d. Contact the provider and prepare for intubation.

ANS: D Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.

Which glands are part of the endocrine system? (SATA) a. Thyroid b. Occipital c. Parathyroid d. Adrenal e. Pituitary

Acde

Acromegaly vs Gigantism

Acromegaly= GH hypersecretion *after* puberty Gigantism= onset of GH hypersecretion *before* puberty

An A C T H stimulation test is the most definitive test for which disorder?

Adrenal insufficiency

The pituitary and adrenal gland secrete hormones that affect what?

Affect the cellular regulation of the entire body, including fluid & electrolyte balance. -When too much or too little of one or more hormones is secreted, physical and psychological changes are induced.

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

B, D, E (Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.)

A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

B, D, E (The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.)

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? Document symptoms of incisional infection or meningitis. Give over-the-counter laxatives if the client is constipated. Set up medications as prescribed for the day. Test any nasal drainage for the presence of glucose. Correct

Cerebrospinal fluid (CSF) will test positive using a glucose "dipstick." Nasal drainage that is positive for glucose after a transsphenoidal hypophysectomy would indicate a CSF leak that would require immediate notification of the health care provider. Home health aides can be taught the correct technique to perform this procedure. Assessing for symptoms of infection and documenting them in the record, medication administration, and setting up medication are not within the scope of practice of the home health aide.

The action of antidiuretic hormone A D H influences normal kidney function by stimulating which mechanism?

Distal nephron tubules and collecting ducts to reabsorb water.

A client with Cushing's disease says that she has lost 1 pound. What does the nurse do next? Auscultates the lungs for crackles Checks urine for specific gravity Forces fluids Weighs the client Correct

Fluid retention with weight gain is more of a problem than weight loss in clients with Cushing's disease. Weighing the client with Cushing's disease is part of the nurse's assessment. Crackles in the lungs indicate possible fluid retention, which would cause weight gain, not weight loss. Urine specific gravity will help assess hydration status, but this would not be the next step in the client's assessment. Forcing fluids is not appropriate because usually excess water and sodium reabsorption cause fluid retention in the client with Cushing's disease.

Which statement about a patient with hyperaldosteronism after a successful unilateral adrenalectomy is correct?

Glucocorticoid replacement therapy is temporary.

Treatment for adrenal gland hypofunction

Hormone replacement therapy: -Cortisol & aldosterone deficiencies are corrected by HRT. -Hydrocortisone corrects glucocorticoid deficiency. -Oral cortisol replacement regimens and dosages vary. -*The most common drug used for this purpose is prednisone.* Generally, divided doses are given, with 2/3 given upon arising in the morning and 1/3 at 6pm to mimic the normal release of this hormone.

What is the most common cause of endogenous hypercortisolism, or Cushing's syndrome?

Hyperplasia of the adrenal cortex

Which statement about hyperaldosteronism is correct?

Hypokalemia and hypertension are the main issues.

Which interventions are necessary for a patient with acute adrenal insufficiency, Addisonian crisis? Select all that apply.

I V infusion of normal saline, Hourly glucose monitoring, and Insulin administration

Analysis: interpreting Potential for injury due to skin thinning, poor wound healing, and bone density loss Interventions for this problem?

Interventions based around preventing injury ØSkin -assess -turn patient every 2 hrs & pad bony prominences if patient is immobile -teach patient to avoid activities than can result in skin trauma -teach patient to use soft toothbrush and electric shaver -Use tape sparingly on skin ØFractures -Pathologic fractures from bone density loss and osteoporosis are possible for months to years after cortisol levels return to normal -High-calorie diet with increased amount of calcium and vitamin D: milk, cheese, yogurt, green leafy/root vegetables. Avoid caffeine and alcohol. ØGI bleed -common with hypercortisolism because cortisol (1) inhibits production of the thick, gel-like mucus that protects the stomach lining, (2) decreases blood flow to the area, and (3) triggers release of excess hydrochloric acid. -Antacids taken on a regular schedule rather than a PRN basis -H2 receptor blocker like cimetidine, ranitidine, and nizatidine. Also omeprazole or esomeprazole, to interfere with production of hydrochloric acid. -Avoid NSAIDs -Avoid smoking fasting, alcohol, and caffeine

Which statement about pheochromocytoma is correct?

It is a catecholamine producing tumor.

Which statement about diabetes insipidus D I are accurate? Select all that apply.

It is caused by antidiuretic hormone deficiency, urine output of greater than 4 L/24 hours is the first diagnostic indication, and water loss increases plasma osmolarity.

Which drug is an adrenal cytotoxic agent used for inoperable adrenal tumors

Mitotane (Lysodren)

A patient in the E R is diagnosed with possible pheochromocytoma. What is the priority nursing intervention?

Monitor blood pressure for severe hypertension.

What does the nurse instruct patients with permanent Diabetes Insipidus D I to do? Select all that apply.

Monitor for recurrence of polydipsia, excessive thirst, and polyuria, excessive urination, monitor and record weight daily, and wear a medical alert bracelet.

An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first? a. Obtain intravenous access. b. Administer hydrocortisone succinate (Solu-Cortef). c. Assess blood glucose. d. Administer insulin and dextrose.

Obtain intravenous access. All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.

Genetic considerations for hyperpituitarism

One cause of hyperpituitarism is multiple endocrine neoplasia, type 1 (MEN1), in which there is inactivation of the suppressor gene MEN1. MEN1 has an autosomal-dominant inheritance pattern and may result in benign tumor of the pituitary, parathyroid glands, or pancreas. In the pituitary, this problem causes excessive production of growth hormone and acromegaly. Ask a patient with acromegaly whether either parent also has this problem or has had a tumor of the pancreas or parathyroid glands.

Analysis: interpreting Potential for acute adrenal insufficiency Interventions for this problem?

Prevent acute adrenal insufficiency -The patient most at risk for acute adrenal insufficiency is the one who has Cushing's syndrome as a result of glucocorticoid drug therapy. The exogenous drug inhibits the feedback control pathway, preventing the hypothalamus from secreting corticotropin-releasing hormone (CRH). The lack of CRH inhibits secretion of ACTH from the anterior pituitary gland. Without normal levels of ACTH, the adrenal glands atrophy and stop production of corticosteroids. As a result, the patient completely depends on the exogenous drug. If the drug is stopped, even for a day or two, the atrophied adrenal glands cannot produce the glucocorticoids; and the patient develops acute adrenal insufficiency, a life-threatening condition.

Analysis: interpreting Potential for infection due to hormone-induced reduced immunity Interventions for this problem?

Prevent infection ØS/S not obvious: steroids reduce inflammation and body's response to intruder

Sodium: 150 mEq/L Potassium: 2.5 mEq/L pH: 7.28 Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first? a. Encourage range-of-motion exercises. b. Document the finding and monitor the client. c. Take vital signs, including temperature. d. Assess pain and administer pain medication.

Take vital signs, including temperature. Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Documentation should be done after all assessments are completed and should not be the only action. Although pain medication may be a palliative measure, it is not the most appropriate initial action.

Education for pheochromocytoma

Teach patient not to smoke, drink caffeine-containing beverages, or change position suddenly, which can stimulate blood pressure changes. Provide a diet rich in calories, vitamins, and minerals.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L, K+ 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? Administer insulin and dextrose in normal saline to shift potassium into cells. Correct Give spironolactone (Aldactone) 100 mg orally. Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. Obtain arterial blood gases to assess for peaked T waves.

This client is hyperkalemic. The nurse should anticipate a request to administer 20 to 50 units of insulin with 20 to 50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells. Spironolactone is a potassium-sparing diuretic that helps the body keep potassium, which the client does not need. Although H2 blocker therapy would be appropriate for this client, it is not the first priority. Arterial blood gases are not used to assess for peaked T waves associated with hyperkalemia; an electrocardiogram needs to be obtained instead.

The effect of increased A D H in the blood results in which effect on the kidney?

Tubular reabsorption of water increases.

Urine output is increased. Specific gravity is decreased. Urine osmolality is decreased. Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

A nurse plans care for a client with Cushings disease. Which action should the nurse include in this clients plan of care to prevent injury? a. Pad the siderails of the clients bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the clients position. d. Keep suctioning equipment at the clients bedside.

Use a lift sheet to change the clients position. Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The client should not require suctioning.

21. A patient with a hypophysectomy can postoperatively experience transient DI. Which manifestation alerts the nurse to this problem? a. Output much greater than intake b. Change in mental status indicating confusion c. Laboratory results indicating hyponatremia d. Nonpitting edema

Key features of anterior pituitary hyperfunction (Chart 62-2)

pp.1248

Causes of Primary and secondary adrenal insufficiency

*Primary causes:* -Autoimmune disease (most common) -Tuberculosis -Metastatic cancer -AIDS -Hemorrhage -Gram-negative sepsis -Adrenalectomy -Abdominal radiation therapy -Drugs (mitotane) and toxins *Secondary causes:* -Pituitary tumors -Postpartum pituitary necrosis -Hypophysectomy -High-dose pituitary or whole brain radiation -Cessation of long-term corticosteroid drug therapy (most common)

Drug therapy for diabetes insipidus

*Ø* Desmopressin acetate -This is a synthetic form of vasopressin given orally, as a sublingual "melt", or intranasally in a metered spray. -Frequency of dosing varies with patient response -Teach patients that each metered spray delivers 10mcg and those with mild DI may need only one or two doses in 24h. For more severe DI, one or two metered doses two or three times daily may be needed. -During severe dehydration, ADH may be given IV or IM. -Ulceration of the mucous membranes, allergy, a sensation of chest tightness, and lung inhalation of the spray may occur with the use of the intranasal preparations. If side effects occur or if the patient has an upper respiratory infection, oral or SQ vasopressin is used. *Ø* Hydration: -DO NOT withhold fluids from patient -Strict I&O -Check urine specific gravity (Spg) -Teach patient to weigh daily since drugs for DI induce water retention and can cause fluid overload. *weigh at the same time of day on the same scale wearing similar amount of clothing. *If weight gain of more than 1kg, along with other signs of water toxicity: headache, confusion, n/v, = call 911 *Ø* Lifelong vasopressin therapy for permanent condition

Which hormone responds to a low serum calcium blood level by increasing bone resorption? a. Parathyroid hormone (PTH) b. T₄ c. T₃ d. Calcitonin

Cause of hypopituitarism (etiology)

-Cause varies. -Benign or malignant pituitary tumors can compress and destroy pituitary tissue. -Pituitary function can be impaired by malnutrition or rapid loss of body fat. -Shock or severe hypotension reduces blood flow to the pituitary gland, leading to hypoxia, infarction, and reduced hormone secretion -Other causes include head trauma, brain tumors or infection, radiation or surgery of the head and brain, and AIDS. -Idiopathic hypopituitarism has an unknown cause. -Postpartum hemorrhage is the most common cause of pituitary infarction, which results in decreased hormone secretion. This clinical problem is known as *Sheehan's syndrome.* The pituitary gland enlarges during pregnancy; and, the hypotension during delivery results from hemorrhage, ischemia and necrosis of the gland occur.

Physical assessment/S&S for hypopituitarism

-Changes in physical appearance and target organ function occur with deficiencies of specific pituitary hormones (See chart 62-1 for specific changes) -Gonadotropin (LH and FSH) deficiency results in the loss of or change in secondary sexual characteristics in men and women. In male patients, look for facial and body hair loss. Ask about impotence and decreased libido. Women may report amenorrhea, dyspareunia (painful intercourse), infertility, and decreased libido. In women, check for dry skin, breast atrophy, and decrease or absence of axillary and pubic hair. -*Neurologic symptoms of hypopituitarism as a result of tumor growth often first occurs as changes in vision (vision change is the first change to occur with tumor).* Assess the patient's visual acuity, especially peripheral vision, for changes or loss. Headaches, diplopia, and limited eye movement are common.

Nonsurgical management of hyperpituitarism: *medications*

-Drug therapy may be used alone or in combo with surgery and/or radiation: most common are dopamine agonists *bromocriptine (Parlodel) *cabergoline (Dostinex) > These drugs stimulate dopamine receptors in the brain and inhibit the release of GH and PRL. In most cases, small tumors decrease until the pituitary gland is of normal size. Large pituitary tumors usually decrease to some extent. > *teach patients taking bromocriptine to seek medical care immediately if chest pain, dizziness, or watery nasal discharge occurs because of the possibility of serious side effects, including cardiac dysrhythmias, coronary artery spasms, and CSF leakage.* > Side effects of bromocriptine: orthostatic hypotension, headaches, nausea, abdominal cramps, and constipation. Give with meal or snack to reduce GI side effects. Tx starts with a low dose and is gradually increased until the desired level is reached. *If pregnancy occurs, the drug is stopped immediately.* Other agents used for acromegaly: -Ocreotide (Sandostatin) *inhibits GH release thru negative feedback. -Lanreotide (Somatuline) -Pegvisomant (Somavert) *blocks GH receptor activity and blocks production of insulin-like growth factor (IGF) *combination therapy with monthly injections of somatostatin analog and weekly injections of pegvisomant has provided good control of the dz.

Interventions for SIADH

-Fluid restriction: 500-1000mL/day; saline in place of water for cares/meds; I&O; daily weight; moisten mouth -Drug therapy (diuretics, hypertonic saline, demeclocycline) Ø Vasopressin receptor antagonists (vaptans) like tolvaptan or conivaptan: used to treat SIADH when hyponatremia is present in hospitalized patients. Administer these ONLY in hospital setting so serum sodium levels can be monitored closely for the development of hypernatremia. These drugs work by promoting water excretion without causing sodium loss. -Diuretics are used when sodium gets near normal and if heart failure is present -hypertonic saline (3%) infusion slowly -Demeclocycline may help with fluid and electrolyte balance (off-label) -Monitor for fluid overload Ø S/S: increased daily weight of 1+ Kg increase/day; crackles, dyspnea, bounding pulse, distended neck veins, edema, low UOP Ø Concern -Safe environment: if Na below 120, risk for mental changes and sz; protect patient, decrease stimulation -Neurologic assessment: Neuro checks as often as patient needs. Assess for subtle changes like twitch, irritable, restless before they progress to seizures or coma.

Interventions for hypopituitarism

-Focus is on replacement of deficient hormones to ensure appropriate -Men who have gonadotropin deficiency receive sex steroid replacement therapy with androgens (testosterone). The most effective routs of androgen replacement are parenteral and transdermal. *Therapy begins with high-dose testosterone and is continued until virilization (presence of male secondary sex characteristics) is achieved, with responses that include increases in penis size, libido, muscle bass, bone size, and bone strength. *Chest, facial, pubic, and axillary hair growth also increase. *Patients usually report improved body image after therapy is initiated. *The dose may then be decreased, but therapy continues throughout life. *Therapy to increase fertility requires gonadotropin-releasing hormone (GnRH) injections, rather than testosterone therapy. -Androgen therapy is avoided in men with prostate cancer to prevent enhancing tumor cell growth. -Side effects of therapy include gynecomastia, acne, baldness, and prostate enlargement. -Women who have gonadotropin deficiency receive HRT with a combination of estrogen and progesterone. *The risk for hypertension or thrombosis is increased with estrogen therapy, especially among smokers. *Emphasize measures to reduce risk and the need for regular health visits. *For inducing pregnancy, certain hormones may be given to trigger ovulation. -Adult patients with GH deficiency may be treated with Sub-Q injections of human GH (hGH). Injections are given at night to mimic normal GH release.

Adrenal Gland hyperfunction: Hypercortisolism (Cushing's Disease) Pathophysiology

-Hypersecretion of cortisol by adrenal cortex results in Cushing's syndrome/disease, or excessive androgen production. -Increased glucocorticoid affects metabolism and all body systems.

Hyperaldosteronism pathophysiology

-Increased secretion of aldosterone results in mineralocorticoid excess. -Primary hyperaldosteronism (Conn's syndrome) result of excessive secretion of aldosterone from one or both adrenal glands -In secondary hyperaldosteronism, excessive secretion of aldosterone is caused by high levels of angiotensin II that are stimulated by the high plasma renin levels. Some causes include kidney hypoxia, diabetic nephropathy, and excessive sue of some diuretics.

Hyperpituitarism etiology (causes)

-The most common cause of hyperpituitarism is a pituitary adenoma: a benign tumor of one or more tissues within the anterior pituitary. -Usually caused by benign tumors from one pituitary cell type. Can also be caused by a hypothalamic problem of excessive production of releasing hormones, which them overstimulate a normal pituitary gland. -Adenomas are classified by the hormone secreted. -As an adenoma gets larger and compresses brain tissue, neurologic changes, as well as endocrine problems, may occur. -Symptoms include visual disturbances, headache, and increased ICP.

Lab and diagnostic assessments for hypopituitarism

-Laboratory assessment of some pituitary hormones involves measuring the effects of the hormones rather than the actual hormone levels. *For example, blood levels of triiodothyronine (T3) and thyroxine (T4) from the thyroid, testosterone and estradiol from the gonads, and prolactin levels are measured easily. If any of these hormones are low, further pituitary evaluation is necessary. -Pituitary problems may cause changes in the sella turcica (the bone nest where the pituitary gland rests) that can be seen with skull x-rays. *Changes may include enlargement, erosion, and calcifications as a result of pituitary tumors. *CT and MRi can more distinctly define bone or soft-tissue lesions, -An angiogram may be used to rule out the presence of an aneurysm or other vascular problems in the area before surgery.

Imaging/lab assessment for hyperpituitarism

-MRI is the best imaging assessment for diagnosis -Skull x-rays may be used to identify abnormalities of the sella turcica -Suppression testing can help dx hyperpituitarism. High BG levels usually suppress the release of GH. Giving 100 g of oral glucose or 0.5g/kg of body weight is followed by serial GH level measurements GH levels that do not fall below 5ng/mL (Mcg/L) indicate a positive (abnormal) result

Physical assessment/S&S for hyperaldosteronism

-Most common problems are hypokalemia and hypertension -Other problems include headache, fatigue, muscle weakness, dehydration, and loss of stamina. -Polydipsia and polyuria occur more rarely. -Paresthesias may occur if potassium depletion is severe. -Lab/Diagnostics: Blood: -Low potassium -High sodium -Low renin -High aldosterone -Metabolic alkalosis (hydrogen ion loss=high (alkalotic) pH) Urine: -low specific gravity -high alsosterone

Physical assessment/S&S for diabetes insipidus

-Most symptoms of DI are related to dehydration. -Key symptoms are an increase in urination and excessive thirst. -Ask about a history of recent surgery, head trauma, or drug use (I.e., lithium). -Although increased fluid intake prevents serious volume depletion, the patient who is deprived of fluids or who cannot increase oral fluid intake may develop shock from fluid loss. -Symptoms of dehydration (e.g., poor skin turgor, dry or cracked mucous membranes) may be present. -Water loss changes blood & urine tests. The 24-hour fluid intake and output is measured without restricting food or fluid intake. DI is considered is urine output is more than 4 L during this period and is greater than the volume ingested. -The amount of urine excreted in 24 hours by patients with DI may vary from 4 to 30 L/day. -Urine is dilute with a low specific gravity: *less than 1.005* and a low osmolarity (50 to 200) or osmolality.

Postoperative care for hypophysectomy

-Observe for complications: *transient DI *CSF leakage *infection *increased ICP -Keep the head of bed elevated after surgery! -Teach patient to report any nasal drainage. If the patient has persistent, severe headaches, CSF fluid may have leaked into the sinus area. -Teach patient to avoid coughing early after surgery because it increases pressure in the incision area and may lead to a CSF leak. -Assess for indications of infection, especially meningitis, such as headache, fever, and nuchal (neck) rigidity. -If entire pituitary gland had been removed, replacement of thyroid hormones and glucocorticoids is lifelong. (thyroid, cortisol, gonadal) -Prevent constipation -No toothbrushing for about 2 weeks after transsphenoidal surgery -Vasopressin may be needed to maintain fluid balance

Adrenal gland hypofunction: S/S

-Skin: hyperpigmentation for primary (Increased ACTH and MSH); no change for secondary. Hair loss. -Hypoglycemia -Hypovolemia -Hyperkalemia -Hyponatremia -Hypotension Decreased Aldosterone: decreases potassium excretion which promotes reabsorption of hydrogen ions (acidosis), increases sodium and water excretion

Treatment for hyperaldosteronism

-Surgery is common treatment: adrenalectomy (removal of one or both adrenal glands) *Patient's potassium level must be corrected before surgery Drug therapy: -Potassium supplements -Glucocorticoid replacement -Spironolactone therapy when surgery is not an option to diurese and spare potassium while treating hypertension -Note in general about the action of excess aldosterone: Aldosterone retains sodium and water, excretes potassium

Treatment for pheochromocytoma

-Surgery is main treatment. One or both adrenal glands are removed depending on whether the tumor is bilateral. After surgery, nursing interventions are focused on promoting adequate tissue perfusion, nutritional needs, and comfort measures -Patient is hydrated before surgery because decreased blood volume increases risk for hypotension during and after surgery. Assess for fluid overload. -Patient's BP is stabilized with adrenergic blocking agents such as phenoxybenzamine starting 7 to 10 days before surgery because of the increased risk for severe HTN during surgery. -When tumors are inoperable, management is medical, with alpha-adrenergic and beta-adrenergic blocking agents. For these patients, self-measurement of BP with home-monitoring equipment is essential. -HTN is the main sign of the disease and the most common complication after surgery. Monitor BP regularly and place cuff consistently on the same arm with patient in lying and standing positions. -Do not palpate the abdomen of a patient with a pheochromocytoma, because this action could stimulate a sudden release of catecholamines and trigger severe HTN.

Hypopituitarism pathophysiology

-The anterior pituitary gland (adenohypophysis) secretes these hormones to maintain homeostasis: 1.) Growth hormone (GH; somatotropin) 2.) Thyrotropin (thyroid-stimulating hormone [TSH]) 3.) Corticotropin (adrenocorticotropic hormone [ACTH]) 4.) Follicle-stimulating hormone (FSH) 5.) Luteinizing hormone (LH) 6.) Melanocyte-stimulating hormone (MSH) 7.) Prolactin (PRL) -An adult with hypopituitarism usually has a deficiency of one pituitary hormone, a condition known as selective hypopituitarism. (most common) -Decreased production of all of the anterior pituitary hormones (panhypopituitarism) is rare. -This hyposecretion causes metabolic and sexual problems ØMetabolic problems: DI, cholesterol, thyroid, cortisol, etc. ØSexual dysfunction: atrophy, low levels of sex characteristics

What do the anterior and posterior pituitary hormones regulate?

-The anterior pituitary hormones regulate growth, metabolism, and sexual development -The posterior pituitary hormone, vasopressin (antidiuretic hormone [ADH]), helps maintain fluid and electrolyte balance. -Adrenal gland hormones are life sustaining.

Lab assessment for pheochromocytoma

-The most common diagnostic test is blood and 24-h urine collection for fractioned metanephrine and catecholamine levels, all of which are elevated in the presence of a pheochromocytoma.

Diabetes Insipidus (DI) pathophysiology

-disorder of the posterior pituitary gland in which water loss is caused by either an ADH deficiency or an inability of the kidneys to respond to ADH. -The result of DI is the excretion of large volumes of dilute urine because the distal kidney tubules and collecting ducts do not reabsorb water; this leads to polyuria, dehydration, and disturbed fluid and electrolyte balance. -Dehydration from massive water loss increases plasma osmolarity and serum sodium levels, which stimulate the sensation of thirsty. Thirst promotes increased fluid intake and aids in maintaining hydration. *If the thirst mechanism is poor or absent or if the adult is unable to obtain water independently, dehydration becomes more severe and can lead to death.* > *ACTION ALERT*: ensure that no patient suspected of having DI is deprived of fluids for more than 4 hours because he or she cannot reduce urine output and severe dehydration can result. -ADH deficiency is classified as neurogenic (primary or secondary), nephrogenic, or drug-related, depending on whether the problem is caused by insufficient production of ADH or an inability of the kidney to respond to the presence of ADH. Hypothalamus produces ADH (aka vasopressin) and oxytocin and sends them to be stored in the post pit Hypothalamus shares circulatory system with ant pit; when releases its hormones, that triggers ant pit to release necessary hormones Post pit stores ADH and oxytocin

Hyperpituitarism pathophysiology

-hormone over secretion that occurs with anterior pituitary tumors or tissue hyperplasia (tissue overgrowth). -tumors occur most often in the anterior pituitary cells that produce growth hormone (GH) prolactin (PRL) and adrenocorticotropic hormone (ACTH). *(most common hormones affected: PRL, GH, ACTH) *Overproduction of PRL also may occur in response to tumors that overproduce GH & ACTH.

Hyperpituitarism Physical assessment/S&S

-symptoms of hyperpituitarism vary with the hormone produced in excess. *Most common ones: GH, PRL, ACTH **GH*: increased size of facial and hand/feet features; back ache, joint pain, HA, vision changes **PRL*: sexual function difficulty **ACTH*: increased cortisol- moon face, hump, skinny legs/arms, truncal obesity, muscle waste -Obtain the patient's age, gender, and family hx. -Ask about any change in hat, glove, ring, or shoe size and the presence of fatigue. -The patient with high GH levels may have backache and joint pain from bone changes. -The patient with hyper secretion of PRL often reports sexual function difficulty: ask about menstrual changes, decreased libido, painful intercourse, and any difficulty in becoming pregnant. Men may report decreased libido and impotence. -Changes in appearance and target organ function occur with excess of specific anterior pituitary hormones. Symptoms of GH excess are: *increases in lip and nose sizes *a prominent brow ridge *increases in head, hand, and foot sizes

Excessive secretion of PRL

-targets mammary gland-stimulates breast milk production (galactorrhea) -most common pituitary adenoma -high levels inhibit gonadotropin and sex hormone secretion (causing galactorrhea, amenorrhea, infertility)

20. A patient who has been diagnosed with Graves' disease is to receive RAI in the oral form of 131I as a treatment. What instructions does the nurse include in the teaching plan about preventing radiation exposure to others?

.a.Do not share a toilet with others for 2 weeks after treatment. b. Flush the toilet three times after each use. c. Wash clothing separately from others in the household. d. Limit contact with pregnant women, infants, and children.

Which type of I V fluid does the nurse use to treat a patient with S I A D H when the serum sodium level is very low?

3% normal saline

The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor? A.Antidiuretic hormone (ADH) production B.General metabolism C.Glucose tolerance D.Ovarian production of estrogen

A A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss. A decrease in general metabolism causes decreased tolerance to cold, decreased appetite, and decreased heart rate and blood pressure; it is not related to fluid intake or hydration. A decrease in glucose tolerance does not affect fluid intake or hydration. A decrease in estrogen production causes a decrease in bone density and is not related to fluid intake and hydration.

The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client is the most appropriate to assign to an LPN/LVN? A.Client with Cushing's syndrome who requires orthostatic vital signs assessments B.Client with diabetes mellitus who was admitted with a blood glucose of 45 mg/dL C.Client with exophthalmos who has many questions about endocrine function D.Client with possible pituitary adenoma who has just arrived on the nursing unit

A An LPN/LVN will be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs. The client with a blood glucose of 45 mg/dL, the client with questions about endocrine function, and the client with a possible pituitary adenoma all have complex needs that require the experience and scope of practice of an RN.

A client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response? A."Can you please tell me more?" B."Don't worry. That is normal." C."How does she feel?" D."Should I make an appointment with a counselor?"

A Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly. Telling a client that something is "normal" is dismissive; this is new to the client and is a concern for him. The focus of the nurse's response needs to be on the client, not on the wife initially. Referring the client to a counselor is not an appropriate first step; this dismisses the client's concerns and does not allow him to express his frustrations at the moment.

The nurse is teaching a client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish? A.Iodized salt for cooking B.More red meat C.More green vegetables D.Salt substitute for cooking

A Dietary deficiencies in iodide-containing foods may be a cause of an endocrine disorder. For clients who do not eat saltwater fish on a regular basis, teach them to use iodized salt in food preparation. The client should eat a well-balanced diet that includes less animal fat. Eating vegetables contributes to a proper diet; however, this does not prevent an endocrine disorder. Using a salt substitute does not prevent an endocrine disorder; in addition, salt substitutes may contain high levels of potassium, which may lead to electrolyte imbalances.

The nurse is instructing a client who will undergo a suppression test. Which statement by the client indicates that teaching was effective? A."I am being tested to see whether my hormone glands are hyperactive." B."I am being tested to see whether my hormone glands are hypoactive." C."I am being tested to see whether my kidneys work at all." D."I will be given more hormones as a trigger."

A Suppression tests are used when hormone levels are high or in the upper range of normal. Failure of suppression of hormone production during testing indicates hyperfunction. A stimulation test assesses whether hormone glands are hypoactive. The adrenal glands are endocrine glands that are located on the kidneys; a suppression test does not measure kidney function. Hormones are given as a trigger in a stimulation test.

Which gland releases catecholamines? A.Adrenal B.Pancreas C.Parathyroid D.Thyroid

A The adrenal medulla releases catecholamines in response to stimulation of the sympathetic nervous system. The principal hormones of the pancreas are insulin, glucagon, and somatostatin. Parathyroid hormone is the principal hormone of the parathyroid gland. Triiodothyronine (T3), thyroxine (T4), and calcitonin are the principal hormones of the thyroid.

A (All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.)

A 20-year-old female with benign pituitary tumors A 41-year-old female with anorexia nervosa A 55-year-old male with hypertension A 60-year-old female who is experiencing shock Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal insufficiency? (Select all that apply.) a. A 22-year-old female with metastatic cancer b. A 43-year-old male with tuberculosis c. A 51-year-old female with asthma d. A 65-year-old male with gram-negative sepsis e. A 70-year-old female with hypertension

A 22-year-old female with metastatic cancer A 43-year-old male with tuberculosis A 65-year-old male with gram-negative sepsis Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key manifestation of Cushings disease. These are not risk factors for adrenal insufficiency.

3. Which serum laboratory values alert the nurse to the possibility of hyperaldosteronism? (Select all that apply.) a. Sodium, 150 mEq/L b. Sodium, 130 mEq/L c. Potassium, 2.5 mEq/L d. Potassium, 5.0 mEq/L e. pH, 7.28 f. pH, 7.50

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. The other values are not indicative of hyperaldosteronism.

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? a. A 36-year-old female who has used oral contraceptives for 5 years b. A 42-year-old male who experienced head trauma 3 years ago c. A 55-year-old female with a severe allergy to shellfish and iodine d. A 64-year-old male with adult-onset diabetes mellitus

A 42-year-old male who experienced head trauma 3 years ago Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

What is pheochromocytoma?

A catecholamine secreting tumor of the adrenal medulla -These tumors usually occur in one adrenal gland, although they can be bilateral or in the abdomen. -Usually benign but about 10% are malignant -The tumors produce, store, and release epinephrine and norepinephrine (NE.) *Excessive epinephrine and norepinephrine stimulate adrenergic receptors and can have wide-ranging adverse effects mimicking the action of the sympathetic nervous system (SNS.) *This can lead to a hypertensive crisis

The nurse is caring for a client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? Asks another nurse to care for the client Monitors the client for cold-like symptoms Refuses to care for the client Wears a facemask when caring for the client Correct

A client with hypercortisolism will be immune-suppressed. Anyone with a suspected upper respiratory infection who must enter the client's room must wear a mask to prevent the spread of infection. Although asking another nurse to care for the client might be an option in some facilities, it is not generally realistic or practical. The nurse, not the client, feels the onset of the cold, so monitoring the client for cold-like symptoms is part of good client care for a client with hypercortisolism. Refusing to care for the client after starting care would be considered abandonment.

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL Correct Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L Client with pituitary adenoma who is reporting a severe headache

A glucose level of 36 mg/dL is considered an emergency; this client must be assessed and treated immediately. Although it is important to maintain medications on schedule, the client requiring a dose of desmopressin is not the first client who needs to be seen. A serum potassium of 3.4 mEq/L in the client with hyperaldosteronism may be considered normal (or slightly hypokalemic), based on specific hospital levels. The client reporting a severe headache needs to be evaluated as soon as possible after the client with acute adrenal insufficiency. As an initial measure, the RN could delegate obtaining vital signs to unlicensed assistive personnel.

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? Anxiety Headache Correct Nausea Weight loss

A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the client's blood pressure should be monitored. Anxiety is not a side effect of fludrocortisone and is not associated with adrenal hypofunction. Nausea is associated with adrenal hypofunction; it is not a side effect of fludrocortisone. Sodium-related fluid retention and weight gain, not loss, are possible with fludrocortisone therapy.

Following a hypophysectomy, the patient requires instruction on hormone replacement for which hormones? Select all that apply. A) Cortisol B) Thyroid C) Gonadal D) Vasopressin E) PRL

A) Cortisol B) Thyroid C) Gonadal D) Vasopressin

Which statements abut the etiology of hypopituitarism are correct? Select all that apply. A) Dysfunction can result from radiation treatment to the head or brain. B) Dysfunction can result from infection or a brain tubor. C) Infraction following systemic shock can result in hypopituitarism. D) Severe malnutrition and body fat depletion can depress pituitary gland function. E) There is always and underlying cause of hypopituitarism.

A) Dysfunction can result from radiation treatment to the head or brain, B) dysfunction can result from infection or a brain tumor, C) Infarction following systemic shock can result in hypopituitarism, and D) severe malnutrition and body fat depletion can depress pituitary gland function.

A patient is prescribed bromocriptine mesylate (Parlodel). Which information does the nurse teach the patient? Select all that apply A) Get up slowly from a lying position. B) Take medication on an empty stomach. C) Take daily for purposes of raising growth hormone (GH) levels to reduce symptom of acromegaly. D) Begin therapy with maintenance level dose. E) Report watery nasal discharge to the health care provider immediately.

A) Get up slowly from a lying position E) report watery nasal discharge to the health care provider immediately.

When analyzing lab values, the nurse expects to fins which value as a direct result of overproduction of growth hormone (GH)? A) Hyperglycemia B) Hyperphosphatemia C) Hypocalcemia D) Hypercalcemia

A) Hyperglycemia

In caring for a patient with hyperpituitarism, which symptoms does the nurse expect the patient to report? Select all that apply. A) Joint pain B) Visual disturbances C) Changes in menstruation D) Increased libido E) Headache F) Fatigue

A) Joint pain B) visual disturbances C) changes in menstruation E) headache. F) fatigue

A patient with a hypophysectomy can postoperatively experience transient diabetes insipidus. Which manifestation alerts the nurse to this problem? A) Output much greater than intake. B) Change in mental status indicating confusion. C) Laboratory results indicating hypoatremia. D) Nonpitting edema.

A) Output much greater than intake.

A malfunctioning anterior pituitary gland result in which disorder? Select all that apply. A) Pituitary hypofunction B) Pituitary hyperfunction C) Diabetes insipidus (DI) D) Hypothyroidism E) Osteoporosis

A) Pituitary hypofunction B) pituitary hyper function D) hypothyroidism E) osteoporosis

A client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client? Adrenocorticotropic hormone (ACTH) suppression test Chest x-ray Cranial computed tomography (CT) Correct Renal sonography

ADH is a hormone of the posterior pituitary. Brain abscess, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These can be seen on a CT scan of the brain. ACTH triggers the release of cortisol from the adrenal cortex and is not related to ADH. A chest x-ray would not show a pituitary tumor or brain abscess. Even though ADH acts on distal convoluted tubules in the kidneys, a renal sonogram would diagnose the cause of syndrome of inappropriate antidiuretic hormone.

While assessing a client with Graves' disease, the nurse notes that the client's temperature has risen 1° F. Which action should the nurse take first? a. Turn the lights down and shut the client's door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the client's apical-radial pulse deficit. d. Administer a dose of acetaminophen (Tylenol).

ANS: A A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.

17. The nurse is teaching a client about self-care after menopause. Which teaching topic is the priority? a.Weight-bearing exercise b.Skin care c.Intimacy needs d.Body image changes

ANS: A After menopause, the ovaries produce less estrogen. This leads to decreased bone mass. The client should engage in regular weight-bearing exercise to prevent fractures. The other topics are appropriate but do not take priority over safety needs.

3. A client has a deficiency of aldosterone. Which assessment finding does the nurse correlate with this condition? a.Increased urine output b.Vasoconstriction c.Blood glucose, 98 mg/dL d.Serum sodium, 144 mEq/L

ANS: A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Sodium and potassium levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia. Vasoconstriction is not related.

25. A client is brought to the emergency department via rescue squad in acute adrenal crisis. Which action by the nurse is the priority? a. Start an IV line if the client does not already have one. b. Administer hydrocortisone sodium succinate (Solu-Cortef). c. Instruct the nursing assistant to check the client's blood glucose. d. Administer 20 units of insulin and 20 mg of dextrose in normal saline.

ANS: A All actions are appropriate for the client with adrenal crisis. However, therapy is given IV, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.

5. When performing personal care on a middle-aged woman, the nurse observes that the client has very little pubic and axillary hair. Which is the nurse's best action? a. Ask the client if she has less pubic hair now than 5 years ago. b. Ask the client the date of her last menstrual period. c. Examine the client's scalp hair for texture and thickness. d. Draw blood for hormonal immune assays.

ANS: A Although pubic hair thickness varies from person to person, loss of pubic hair is associated with gonadotropin deficiency. The nurse needs to determine whether this manifestation is normal for this client. A middle-aged woman may be postmenopausal, which would not give the nurse helpful information. Examining the client's scalp also would not yield helpful information. Diagnostic studies should not be undertaken without further assessment.

21. The client has chronic hypercortisolism. Which intervention is the highest priority for the nurse? a. Wash the hands when entering the room. b. Keep the client in protective isolation. c. Observe the client for increased white blood cell counts. d. Assess the daily chest x-ray.

ANS: A Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the client's risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.

18. The nursing assistant reports that while pouring urine into a 24-hour urine container, some urine splashed the nursing assistant's hand. Which action by the nurse is best? a.Ask the assistant if he or she washed the hands afterward. b.Call the laboratory to see if the container has preservative in it. c.Have the assistant fill out an incident report. d.Send the assistant to Employee Health right away.

ANS: A For safety, the nurse should find out if the assistant washed his or her hands. The nursing assistant should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the assistant is washing hands if needed. The nursing assistant would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The nursing assistant also needs further education on Standard Precautions, which include wearing gloves.

26. A female client has a decrease in all pituitary hormones. Which assessment question by the nurse elicits the best information? a. "Do you have any biological children?" b. "Do you have a decreased sex drive?" c. "Have you noticed increased facial hair?" d. "Are you more intolerant of heat?"

ANS: A Hypofunction of all anterior pituitary hormones is often caused by postpartum hemorrhage of the anterior pituitary gland. This usually occurs immediately after delivery but may be delayed for several years. Asking the client if she has children of her own would let the nurse know of this possibility. The other questions are assessments for specific hormone dysfunction.

A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's teaching? (Select all that apply.) a. Increased carbohydrates b. Decreased fats c. Increased calorie intake d. Supplemental vitamins e. Increased proteins

ANS: A, C, E The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.

20. The new nurse is assessing a client with suspected pheochromocytoma. Which action by the nurse requires the precepting nurse to intervene? a. Auscultating, palpating, and percussing the client's abdomen b. Taking the client's blood pressure for reports of chest pain c. Assessing the client's diet for red wine and aged cheeses d. Limiting visitors while the client is sleeping

ANS: A Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a pheochromocytoma can cause intense release of catecholamines and can precipitate a hypertensive crisis. The experienced nurse should intervene if the new nurse attempts this. The other actions would be appropriate.

15. A client asks why a 24-hour urine collection is necessary to measure excreted hormones instead of a random voided specimen. Which response by the nurse is most accurate? a."We are testing for a hormone secreted on a circadian rhythm." b."The hormone is so dilute in urine, we need a large volume." c."We want to see when the hormone is secreted in both large and small amounts." d."You'd have to be here at a specific time of the day for a random urinalysis."

ANS: A Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. The other responses are not accurate.

19. A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. "Read the label before using salt substitutes." b. "Do not add salt to your food when you eat." c. "Avoid exposure to sunlight." d. "Take Tylenol instead of aspirin for pain."

ANS: A Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the client's potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

9. Which pulse rate finding in a client taking a drug that stimulates beta1 receptors requires immediate action by the nurse? a.50 beats/min b.95 beats/min c.85 beats/min d.100 beats/min

ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other heart rates are within normal limits but on the higher end and would be considered a therapeutic response to the medication.

6. A client is admitted to the hospital with exacerbation of heart failure, which had been stable for several years. Which finding does the nurse associate with the client's current condition? a.Recent prescription for thyroid hormone replacement medication b.Recent onset of menopause c.Patchy areas of depigmentation on the face d.Absence of fish in the diet, but inclusion of the iodized form of table salt

ANS: A Thyroid hormones regulate metabolism. Starting on thyroid replacement therapy can lead to an increase in heart rate and tissue oxygen use, which can lead to an exacerbation of heart failure if the client's heart is not able to meet these increased demands. Menopause and vitiligo (depigmentation of the skin) would not be related. Thyroid function is needed to produce thyroid hormones. The client who does not eat shellfish should use iodized table salt.

11. A client has bilateral patchy areas of skin depigmentation on the arms and the face. Which action by the nurse is best? a.Assess the client's mucous membranes. b.Draw a laboratory specimen for thyroid hormone levels. c.Schedule the client for fasting blood glucose. d.Question the client about sexual functioning.

ANS: A Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of the adrenal glands. Other assessment findings in this condition include uneven pigmentation on the mucous membranes. The other assessments are not related to vitiligo.

1. Which are common key features of hormones? (Select all that apply.) a.Hormones may travel long distances to get to their target tissues. b.Continued hormone activity requires continued production and secretion. c.Control of hormone activity is caused by negative feedback mechanisms. d.Most hormones are stored in the target tissue for use later. e.Most hormones cause target tissues to change activities by changing gene activity.

ANS: A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity.

Which key interventions should be implemented postoperatively for the patient after undergoing a hypophysectomy? (Select all that apply.) A.Report any postnasal drip. B.Keep the head of the bed elevated. C.Have the patient avoid coughing soon after surgery. D.Monitor for a light-yellow color at the edge of clear drainage. E.Instruct the patient to take thyroid and glucocorticoid replacement for at least 6 months.

ANS: A, B, C, D After hypophysectomy, the patient will need thyroid and glucocorticoid replacement for the rest of her life.

A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the client's level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.) a. Infuse intravenous fluids. b. Cover the client with warm blankets. c. Monitor blood pressure every 4 hours. d. Maintain a patent airway. e. Administer oral glucose as prescribed.

ANS: A, B, D A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.

2. Which conditions may cause hypopituitarism? (Select all that apply.) a. Benign pituitary tumors b. Diplopia c. Anorexia nervosa d. Hypotension e. Shock f. Weight gain

ANS: A, C, D, E These four conditions can cause hypopituitarism. The other options are not causes of hypopituitarism.

1. Which physical characteristics are indicative of anterior pituitary hyperfunction? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

ANS: A, C, D, E, F Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.

A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the nurse include in this client's education? (Select all that apply.) a. "Do not share utensils, plates, and cups with anyone else." b. "You can play with your grandchildren for 1 hour each day." c. "Eat foods high in vitamins such as apples, pears, and oranges." d. "Wash your clothing separate from others in the household." e. "Take a laxative 2 days after therapy to excrete the radiation."

ANS: A, D, E A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or bones, which will leave contaminated remnants; to wash clothing separate from others in the household and run an empty cycle before washing other people's clothing; and to take a laxative on days 2 and 3 after receiving treatment to help excrete the contaminated stool faster.

A 56-year-old woman is admitted to the ED with a blood pressure of 168/92 and reports of fatigue and muscle weakness. She has bruising on her arms and 2+ swelling in her ankles. Her weight has gone from 150 to 185 lbs over the past 6 months. Assessment reveals that she has truncal obesity and thin extremities. Which diagnosis does the nurse suspect? A.Hyperpituitarism (acromegaly) B.Hypercortisolism (Cushing's disease) C.Hyperaldosteronism (Conn's syndrome) D.Adrenal insufficiency (Addison's disease)

ANS: B The patient's manifestations of elevated blood pressure, fatigue, muscle weakness, bruising, dependent edema, weight gain, and truncal obesity with thin extremities are all key features of hypercortisolism, or Cushing's disease. Other manifestations of Cushing's disease include "moon face," "buffalo hump," osteoporosis, and thinning skin with striae.

16. An older client is being admitted to the hospital for pneumonia. The client has no other health problems. Which action by the nurse is best? a.Place the client on airborne precautions. b.Offer the client fluids every hour or two. c.Leave the bathroom light on at night. d.Palpate the client's thyroid gland on admission.

ANS: B A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more dilute urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with a simple pneumonia would not need Airborne Precautions. The client may or may not need/want the bathroom light left on at night. Palpating the client's thyroid gland is a part of a comprehensive examination but is not specifically related to this client.

After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional instruction? a. "I may need calcium replacement after surgery." b. "After surgery, I won't need to take thyroid medication." c. "I'll need to take thyroid hormones for the rest of my life." d. "I can receive pain medication if I feel that I need it."

ANS: B After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain medication postoperatively.

10. A client is going home after an endoscopic transnasal hypophysectomy. Which statement by the client indicates an adequate understanding of discharge instructions? a. "I will wear dark glasses whenever I am outdoors." b. "I will keep food on upper shelves so I do not have to bend over." c. "I will wash the incision line every day with peroxide and redress it immediately." d. "I will remember to cough and deep breathe every 2 hours while I am awake."

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress.

A nurse cares for a client newly diagnosed with Graves' disease. The client's mother asks, "I have diabetes mellitus. Am I responsible for my daughter's disease?" How should the nurse respond? a. "The fact that you have diabetes did not cause your daughter to have Graves' disease. No connection is known between Graves' disease and diabetes." b. "An association has been noted between Graves' disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves' disease." c. "Graves' disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus." d. "Unfortunately, Graves' disease is associated with diabetes, and your diabetes could have led to your daughter having Graves' disease."

ANS: B An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mother's diabetes did not cause her daughter's Graves' disease. The other statements are inaccurate.

5. A client has a condition of excessive catecholamine release. Which assessment finding does the nurse correlate with this condition? a.Decreased blood pressure b.Increased pulse c.Decreased respiratory rate d.No change in vital signs

ANS: B Catecholamines are responsible for the "fight-or-flight" stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. The other options are not correlated with excessive catecholamine release.

A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism? a. A 29-year-old female with pregnancy-induced hypertension b. A 41-year-old male receiving dialysis for end-stage kidney disease c. A 66-year-old female with moderate heart failure d. A 72-year-old male who is prescribed home oxygen therapy

ANS: B Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.

22. A female client is beginning treatment with bromocriptine (Parlodel). The nurse has initiated teaching sessions about potential side effects. Which is the most important point of instruction? a. "Take and record your temperature daily." b. "Be sure to eat 20 to 30 grams of fiber daily." c. "Plan to take the medication on an empty stomach." d. "I will need to teach you how to give the injection."

ANS: B Constipation is an expected side effect of treatment with bromocriptine, so the client should be taught ways to prevent and/or manage it. Eating plenty of fiber and drinking fluids is a good plan. Taking the client's temperature daily is not necessary. The medication, which is given orally, should be taken with food to reduce side effects.

14. A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate? a."Do you have the money to pay for treatment?" b."I'm interested in knowing how you feel about yourself." c."Many treatment options are available for this problem." d."What can you do to prevent this from happening?"

ANS: B Hirsutism, excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should gently inquire into the client's body image and self-perception. Asking about the client's financial status sounds judgmental. Simply stating that treatment options are available minimizes the client's concerns. The client is not doing anything to herself to cause the problem, so the last question is inappropriate.

A client is taking a drug that blocks a hormone's receptor site. What is the effect on the client's hormone response? a.Greater hormone metabolism b.Decreased hormone activity c.Increased hormone activity d.Unchanged hormone response

ANS: B Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when the level of the hormone is decreased.

17. The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." Which is the nurse's best response? a. "I will ask your doctor to order a psychiatric consult for you." b. "You feel this way because of your hormone levels." c. "Can I bring you information about support groups?" d. "I will close the door to your room and restrict visitors."

ANS: B Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client's plan of care? a. Ask the client to ambulate in the hallway twice a day. b. Use a lift sheet to assist the client with position changes. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the unlicensed assistive personnel to strain the client's urine for stones.

ANS: B Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client.

A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy? a. Blurred and double vision b. Increased thirst and urination c. Profuse nausea and diarrhea d. Decreased attention and insomnia

ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.

14. A client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking corticosteroids. Which is the nurse's best response? a. "It is possible for the inflammation to recur if you stop the drugs." b. "Once you start corticosteroids, you have to be weaned off them." c. "You must decrease the dose slowly so your hormones will begin to work again." d. "The drug suppresses your immune system, which needs to be built back up."

ANS: B One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone (ACTH) and adrenal production of cortisol.

24. A client has cortisol deficiency and is being treated with prednisone (Deltasone). Which instruction by the nurse is most appropriate? a. "You will need to learn how to rotate the injection sites." b. "If you work outside when it's hot, you may need another drug." c. "Be sure to stay on your salt restriction even though it's difficult." d. "Take one tablet in the morning and two tablets at night to start."

ANS: B Steroid dosage adjustment may be needed and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

4. The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. Which is the nurse's best answer? a. "When your blood levels of testosterone are normal, the therapy is no longer needed." b. "When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever." c. "When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy." d. "When you start to have undesirable side effects, the dose is decreased to the lowest possible level, and treatment is continued until you are 50 years old."

ANS: B Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life.

13. Which dietary alterations does the nurse make for a client with Cushing's disease? a. High carbohydrate, low potassium b. Low carbohydrate, low sodium c. Low protein, low calcium d. High carbohydrate, low potassium

ANS: B The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium.

4. A male client reports fluid secretion from his breasts. What does the nurse assess next in this client? a.Posterior pituitary hormones b.Adrenal medulla functioning c.Anterior pituitary hormones d.Parathyroid functioning

ANS: C Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones do not influence this process.

11. A client with suspected syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 114 mEq/L. Which action by the nurse is best? a. Consult with the registered dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 900 mL/24 hr. c. Handle the client gently by using turn sheets for repositioning. d. Instruct the nursing assistants to measure intake and output.

ANS: B With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. The client should be on intake and output (I&O); however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium. Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue.

A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) a. Oral potassium chloride b. Intravenous calcium chloride c. 3% normal saline IV solution d. 50% magnesium sulfate e. Oral calcitriol (Rocaltrol)

ANS: B, D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.

The student nurse is creating a care plan for the patient. Which priority problems should be the focus of the care plan? (Select all that apply.) A.Fatigue B.Fluid overload C.Sleep deprivation D.Potential for infection E.Predisposition to injury

ANS: B, D ,E Fluid overload, risk for injury, and inadequate nutrition are common problems in patients with Cushing's disease. Sleep deprivation and fatigue are additional possible focus areas, but not as essential as the other three.

Which priority question should the nurse ask a patient with a pituitary tumor? A."Have you had an unexpected weight loss?" B."Have you noticed a change in your libido?" C."Do you have any changes in your visual acuity?" D."Have you experienced a change in growth of your facial hair?"

ANS: C Changes in vision are frequently the first and most common symptom associated with hypopituitarism as a result of tumor growth. Changes in weight, hair growth patterns, and secondary sex characteristics should also be assessed.

The next day, a student nurse is caring for the patient, who is scheduled for an MRI of the head. The student nurse asks why a patient with Cushing's disease needs this test. What is the nurse's best response? A."They are looking for brain cancer which may have caused the disease." B."The patient may have had headaches and they are looking for the cause." C."The most common cause of Cushing's is a pituitary tumor called an adenoma." D."A tumor of the adrenal gland can cause about 15% of Cushing's disease cases."

ANS: C Pituitary adenoma is the most common cause of Cushing's disease, and magnetic resonance imaging (MRI) would visualize such a tumor.

During evening shift, the patient's MRI reveals the presence of a pituitary adenoma. The following day, surgery is performed to remove the tumor. What is the nurse's priority concern for the patient postoperatively? A.Airway management B.Assessing for systemic infection C.Monitoring for neurologic changes D.Development of transient diabetes mellitus

ANS: C Removal of a pituitary adenoma is completed by a transsphenoidal hypophysectomy. Postoperatively, it is essential to monitor the patient for neurologic response, documenting changes in vision, mental status, level of consciousness, or decreased strength in the extremities.

A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this client's plan of care? a. Monitor the client's intravenous site every shift. b. Administer acetaminophen (Tylenol) for fever. c. Ensure that working suction equipment is in the room. d. Assess the client's vital signs every 4 hours.

ANS: C A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the client's room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.

1. A client has a hormone deficiency. Which deficiency is the highest priority? a. Growth hormone b. Luteinizing hormone c. Thyroid-stimulating hormone d. Follicle-stimulating hormone

ANS: C A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.

23. The nurse is caring for a client who has undergone a hypophysectomy. Which is the nurse's priority postoperative intervention? a. Keep the head of the bed flat and the client supine. b. Instruct the client to cough, turn, and deep breathe hourly. c. Report clear or yellow drainage from the nose or incision site. d. Apply petroleum jelly to the client's lips to avoid mouth dryness.

ANS: C A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal leakage. Although application of petroleum jelly to the lips will help with mouth dryness, this instruction is not as important as reporting the yellowish drainage.

8. A client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment? a. "I will drink whenever I feel thirsty after surgery." b. "I'm glad no visible incision will result from this surgery." c. "I hope I can go back to wearing size 8 shoes instead of size 12." d. "I will wear slip-on shoes after surgery so I don't have to bend over."

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over, reassured that the incision will not be visible.

12. Which safety measure is most important for the nurse to institute for a client who has Cushing's disease? a. Pad the siderails of the client's bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the client's position. d. Keep suctioning equipment at the client's bedside.

ANS: C Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. The client should not require suctioning. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet.

15. A client has received vasopressin (DDAVP) for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy? a. Urine output is increased; specific gravity is increased. b. Urine output is increased; specific gravity is decreased. c. Urine output is decreased; specific gravity is increased. d. Urine output is decreased; specific gravity is decreased.

ANS: C Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, "How long will I need to take this thyroid medication?" How should the nurse respond? a. "You will need to take the thyroid medication until the goiter is completely gone." b. "Thyroiditis is cured with antibiotics. Then you won't need thyroid medication." c. "You'll need thyroid pills for life because your thyroid won't start working again." d. "When blood tests indicate normal thyroid function, you can stop the medication."

ANS: C Hashimoto's thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The client will not be able to stop taking the medication.

A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention

ANS: C Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The client's family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the client's environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.

3. Which safety measure does the nurse use for the adult client who has growth hormone deficiency? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to reposition the client. d. Assist the client to change positions slowly.

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

9. A client who had a trans-sphenoidal hypophysectomy 2 days ago now has nuchal rigidity. Which is the nurse's priority action? a. Have the client do active range-of-motion exercises for the neck. b. Document the finding and monitor the client. c. Take the client's temperature and other vital signs. d. Assess using a pain scale and administer pain medication.

ANS: C Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Although pain medication may be a palliative measure, it is not the most appropriate initial action. Documentation should be done after all assessments are completed and should not be the only action.

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, "I feel numbness and tingling around my mouth." What action should the nurse take? a. Offer mouth care. b. Loosen the dressing. c. Assess for Chvostek's sign. d. Ask the client orientation questions

ANS: C Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek's sign and Trousseau's sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

7. A client has abnormal calcium levels. Which hormone does the nurse anticipate testing for? a.Thyroxine (T4) b.Triiodothyronine (T3) c.Thyrocalcitonin (calcitonin) d.Propylthiouracil (PTU)

ANS: C Parafollicular cells produce thyrocalcitonin (calcitonin [TCT]), which helps regulate serum calcium levels. The other hormones are not related directly to calcium levels.

13. Which client statement indicates the need for clarification regarding the instructions for collecting a 24-hour urine specimen for assessment of endocrine function? a."I will continue to take all my prescribed medicine during the test." b."I will add the preservative to the container at the beginning of the test." c."I will start the collection by saving the first urine of the morning." d."At the end of 24 hours, I will urinate and save that last specimen."

ANS: C The 24-hour urine collection specimen is started when the client first arises and urinates. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. Clients can continue to take all their normal medications during a timed urine collection. They should, however, avoid unnecessary medications.

12. A new nurse is palpating a client's thyroid gland. Which action requires intervention from the nurse's mentor? a.The nurse stands behind, instead of in front of, the client. b.The client is asked to swallow while the nurse finds the thyroid gland. c.The nurse palpates the right lobe with his or her left hand. d.The client is placed in a sitting position with the chin tucked down.

ANS: C The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.

18. A client on medication after a bilateral adrenalectomy calls the clinic asking to be seen for "stomach flu" with nausea and vomiting. Which response by the nurse is best? a. "I will call in a prescription for an antiemetic medication for you." b. "Try to drink extra fluids until you can come in for an appointment." c. "You need to go to the nearest emergency department today." d. "Double the dose of your medication today and tomorrow."

ANS: C The client with bilateral adrenalectomy is on lifelong cortisol replacement therapy. The client cannot skip any doses of his or her medication. If the client has nausea and vomiting for longer than 24 hours and cannot give himself or herself an injection of hydrocortisone, the client must go to the nearest emergency department to get it. The other answers are inappropriate.

2. How does a tropic hormone differ from other hormones? a.Tropic hormones are given to clients who have a hormone deficiency. b.Tropic hormones are exclusively involved in the production of sex hormones. c.Tropic hormones stimulate other endocrine glands to secrete hormones. d.Tropic hormones are not under negative feedback control.

ANS: C The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. The other statements are inaccurate.

A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. Which actions should the nurse take? (Select all that apply.) a. Administer levothyroxine (Synthroid). b. Administer propranolol (Inderal). c. Monitor the apical pulse. d. Assess for Trousseau's sign. e. Initiate telemetry monitoring.

ANS: C, E The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau's sign is a test for hypocalcemia.

The nurse is caring for a patient diagnosed with small cell lung cancer. The nurse understands the patient may also present with which endocrine disorder? A.Adrenal crisis B.Cushing's syndrome C.Diabetes insipidus (DI) D.Syndrome of inappropriate antidiuretic hormone (SIADH)

ANS: D Cancer (especially lung cancers) increases the risk of the patient developing SIADH. Other risk factors include recent head trauma, cerebrovascular disease, and tuberculosis or other pulmonary disease. A review of past and current medications is also important in searching for the cause of SIADH.

The patient is admitted to the acute medical care unit for a workup for Cushing's disease. When she is assessed, she is found sitting at the bedside crying. She states, "I just don't know what to do. I feel so confused and down in the dumps." What is the nurse's best response? A."Would you like to speak with a pastor or priest?" B."Have you experienced this kind of confusion before?" C."It's going to be fine. We'll find out what's wrong and take care of it." D."Have you noticed if your mood goes quickly from happy to sad?"

ANS: D Hypercortisolism can result in emotional lability, including mood swings, irritability, confusion, and depression. Asking this question helps in performing a psychosocial assessment of the patient.

The nurse knows which patient with Cushing's disease is at greatest risk for developing heart failure? A.60-year-old with pneumonia B.59-year-old with a history of hypertension C.32-year-old with a history of hepatitis B infection D.42-year-old with a serum creatinine level of 3.7 mg/dL

ANS: D The 42-year-old patient has compromised kidney function evidenced by an elevated serum creatinine level. Preventing fluid overload that may quickly lead to pulmonary edema and heart failure is a primary concern for patients with Cushing's disease. Any patient with Cushing's disease is at risk for developing fluid overload, regardless of age. However, the older adult or one who has coexisting cardiac problems, kidney problems, pulmonary problems, or liver problems is at greater risk.

A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the nurse to the possibility of hypothyroidism? a. "My sister has thyroid problems." b. "I seem to feel the heat more than other people." c. "Food just doesn't taste good without a lot of salt." d. "I am always tired, even with 12 hours of sleep."

ANS: D Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism.

10. Which situation or condition is likely to result in increased production of thyroid hormones? a.Starvation b.Dehydration c.Adequate sleep d.Cold environmental temperature

ANS: D Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which, when bound to target tissues, increase the rate of metabolism to maintain body temperature near normal. The other situations would not lead to an increase in thyroid hormone production.

16. A client with hypercortisolism has an irregular pulse. Which is the nurse's priority intervention? a. Documenting the finding and reassessing in 1 hour b. Assessing blood pressure in both arms c. Administering atropine sulfate d. Assessing the telemetry reading

ANS: D Hypercortisolism causes potassium imbalances, which can lead to fatal dysrhythmias. With an irregular pulse, the nurse should assess the client's cardiac rhythm. The finding should be documented, but the nurse cannot wait an hour to take further action. Assessing bilateral blood pressures will not provide useful information. No indications for atropine are known.

Primary neurogenic diabetes insipidus

Caused by a defect in the hypothalamus or pituitary gland, resulting in a lack of ADH production or release.

A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm3. d. Heart rate is 70 beats/min and regular.

ANS: D Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

8. Which is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone? a.Hypoglycemia and hyperkalemia b.Irritability and insomnia c.Increased urine output d.Darkening of the skin

ANS: D Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) that they produce. The other actions do not occur as the result of excessive melanocyte-stimulating hormone function.

6. A client thought to have a problem with the pituitary gland is given a stimulation test using insulin. A short time later, blood analysis reveals elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). Which is the nurse's interpretation of this finding? a. Pituitary hypofunction b. Pituitary hyperfunction c. Pituitary-induced diabetes mellitus d. A normal pituitary response to insulin

ANS: D Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. For example, the presence of insulin in those with normal pituitary function causes increased release of GH and ACTH. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 U/kg of body weight) and checking circulating levels of GH and ACTH.

Addisonian crisis vs. Addison's disease

Addisonian Crisis: acute, life threatening event in which the need for cortisol and aldosterone is greater than supply. Often occurs in response to a stressor of the adrenal cortex, like trauma or surgery. Sodium decrease, Potassium increase, Hypotension from blood volume loss (Hct high) since aldosterone is not telling body to retain fluid. Addison's Disease: due to Primary or Secondary causes; most common T62-2

The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? Client in Addisonian crisis who is receiving IV hydrocortisone Client admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer Client being discharged after a unilateral adrenalectomy to remove an adrenal tumor Client with Cushing's syndrome who has elevated blood glucose and requires frequent administration of insulin Correct

An RN who works with pediatric clients would be familiar with glucose monitoring and insulin administration. A client in Addisonian crisis would best be monitored by an RN from the medical-surgical floor. Although the float RN could complete the admission history, the client with SIADH secondary to lung cancer might require teaching and orientation to the unit that a nurse more familiar with that area would be better able to provide. Discharge teaching specific to adrenalectomy should be provided by the RN who is regularly assigned to the medical-surgical floor and is more familiar with taking care of postoperative adult clients with endocrine disorders.

A client with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the client's care would be best to delegate to unlicensed assistive personnel (UAP)? Assist with personal hygiene and skin care. Correct Develop a plan of care to minimize risk for infection. Instruct the client on the reasons to avoid overeating. Monitor for signs and symptoms of fluid retention.

Assisting a client with bathing and skin care is included in UAP scope of practice. It is not within their scope of practice to develop a plan of care, although they will play a very important role in following the plan of care. Client teaching requires a broad education and should not be delegated to UAP. Monitoring for signs and symptoms of fluid retention is part of client assessment, which requires a higher level of education and clinical judgment.

The nurse is teaching a client about the correct procedure for a 24-hour urine test for creatinine clearance. Which statement by the client indicates a need for further teaching? A."I should keep the urine container cool in a separate refrigerator or cooler." B."I should not eat any protein when I am collecting urine for this test." C."I won't save the first urine sample." D."To end the collection, I must empty my bladder, adding it to the collection."

B Eating protein does not interfere with collection or testing of the urine sample. Because the specimen must be kept cool, it can be placed in an inexpensive cooler with ice; the client should not keep the specimen container with food or beverages. The timing of the 24-hour collection begins after the initial void. To end a 24-hour urine specimen, emptying the bladder and adding it to the collection is the proper procedure.

Which statement is true about hormones and their receptor sites? A.Hormone activity is dependent only on the function of the receptor site. B.Hormones need a specific receptor site to work. C.Hormones need to be plasma-bound to activate the receptor site. D.Hormone stores are available for activation until needed.

B In general, each receptor site type is specific for only one hormone. Hormone receptor actions work in a "lock and key" manner, in that only the correct hormone (key) can bind to and activate the receptor site (lock). Hormones travel through the blood to all body areas, but exert their actions only on target tissues. Not all hormones are plasma-bound; for example, thyroid hormones are plasma protein-bound, whereas posterior pituitary hormones are transported by axons. Only certain cells manufacture specific hormones and store the hormones in vesicles.

A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN? A.Assess the client for clinical manifestations of hypopituitarism. B.Inject regular insulin for the growth hormone stimulation test. C.Palpate the thyroid gland for size and firmness. D.Teach the client about the adrenocorticotropic hormone stimulation test.

B Injection of insulin is within the LPN/LVN scope of practice. Client assessment for clinical manifestations of hypopituitarism, palpating the thyroid gland, and client education are complex skills requiring training and expertise, and are best performed by an RN.

In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose? A.Glucose intolerance B.Homeostasis C.Insulin intolerance D.Negative feedback

B Insulin injections maintain homeostasis, or normal balance, between insulin and glucose in the client with type 1 diabetes. Type 1 diabetes is a lack of insulin production, not glucose intolerance, and requires frequent doses of insulin. Negative feedback does not occur in type 1 diabetes because of lack of insulin.

The nurse is assessing a client for endocrine dysfunction. Which comment by the client indicates a need for further assessment? A."I am worried about losing my job because of cutbacks." B."I don't have any patience with my kids. I lose my temper faster." C."I don't seem to have any stressors now." D."My weight has been stable these past few years."

B Many endocrine problems can change a client's behavior, personality, and psychological responses; the client stating that he or she has become short-tempered warrants further assessment. Worrying about losing a job is a normal concern but does not give any indication of a need for further assessment. The nurse will need to assess the client's claim that he or she has no stressors at present because the client's response does not provide enough information to make this determination; however, the client's statement about losing patience is the priority. Weight gain or loss may or may not be an indication of an endocrine disorder.

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond? a. I will ask your doctor to order a psychiatric consult for you. b. You feel this way because of your hormone levels. c. Can I bring you information about support groups? d. I will close the door to your room and restrict visitors.

B (Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.)

A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this clients instructions? a. You will need to learn how to rotate the injection sites. b. If you work outside in the heat, you may need another drug. c. You need to follow a diet with strict sodium restrictions. d. Take one tablet in the morning and two tablets at night.

B (Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.)

After a hypophysectomy, home care monitoring by the nurse includes assessing which factors? Select all that apply. A) hypoglycemia B) bowel habits C) possible leakage of cerebrospinal fluid (CSF) D) 24-hour intake of fluids and urine output E) 24-hour diet recall F) activity level

B) Bowel habits C) possible leakage of cerebrospinal fluid (CSF) D) 24 hour intake of fluids and urine output E) 24 hour diet recall, and activity level.

A patient requires 100 g of oral glucose for suppression testing and growth hormone G H levels are measured serially for 120 minutes. The results are abnormal. The nurse would assess for the signs and symptoms of which endocrine disorder? A) Adrenal insufficiency B) DI C) Hyperpituitarism D) Hypothyroidism

C) Hyperpituitarism

Analysis: Interpreting Fluid overload due to hormone-induced water and sodium retention Interventions for this problem?

Based around restoring fluid balance ØPatient safety ØDrug Therapy: -Metyrapone. aminoglutethimide. and ketoconazole use different pathways to decrease cortisol production. -For patients with hypercortisolism resulting from increased ACTH production, cyproheptadine may be used because it interferes with ACTH production. -Mitotane is an adrenal cytotoxic agent used for inoperable tumors causing hypercortisolism -For adults with increased ACTH production who have DM2 and don't respond to other therapies, another drug mifepristone, is a synthetic steroid that blocks glucocorticoid receptors. ALERT: can't be used during pregnancy because it also blocks progesterone receptors and would cause termination of the pregnancy. ØNutrition Therapy -May involve restriction of both fluid and sodium intake to control fluid volume -Often sodium restriction involves only "no added salt" to ordinary table foods when fluid overload is mild. -For more severe fluid overload, patient may be restricted from 2-4g per day. ØMonitor -I&O -Weight (fluid volume indicator) -Urine specific gravity (below 1.005 may indicate fluid overload) ØSurgical removal: hypophysectomy -Removal leads to glucocorticoid administration, since removal causes sudden drop in cortisol levels

Which hormones are secreted by the posterior pituitary gland? (SATA) a. Testosterone b. Oxytocin c. Growth hormone (GH) d. Antidiuretic hormone (ADH) e Cortisol

A client diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate (Parlodel). As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain? Decreases the risk for cerebrovascular disease Increases the risk for depression Inhibits the release of some pituitary hormones Correct Stimulates the release of some pituitary hormones

Bromocriptine mesylate inhibits the release of both prolactin and growth hormone. It does not decrease the risk for cerebrovascular disease leading to stroke. Increased risk for depression is not associated with the use of bromocriptine mesylate; however, hallucinations have been reported as a side effect. Bromocriptine mesylate does not stimulate the release of any hormones.

A client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client? A.Adrenocorticotropic hormone (ACTH) suppression test B.Chest x-ray C.Cranial computed tomography (CT) D.Renal sonography

C ADH is a hormone of the posterior pituitary. Brain abscess, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These can be seen on a CT scan of the brain. ACTH triggers the release of cortisol from the adrenal cortex and is not related to ADH. A chest x-ray would not show a pituitary tumor or brain abscess. Even though ADH acts on distal convoluted tubules in the kidneys, a renal sonogram would diagnose the cause of syndrome of inappropriate antidiuretic hormone.

A client is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? A.Ask about risk factors for adrenocortical problems. B.Assess the client's response to physiologic stressors. C.Check the client's blood glucose levels every 4 hours. D.Teach the client how to do a 24-hour urine collection.

C Blood glucose monitoring is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill. Assessing risk factors for adrenocortical problems is not part of a nursing assistant's education. Assessing the client's response to physiologic stressors requires the more complex skill set of licensed nursing staff. Teaching the proper method for a 24-hour urine collection is a multi-step process; this task should not be delegated.

Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients? A.Alpha cells of the pancreas B.Beta cells of the pancreas C.Glucagon release D.Insulin release

C Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, which keeps blood sugar levels normal during sleep. Alpha cells are responsible for synthesizing and secreting the hormone glucagon. Beta cells are responsible for synthesizing and secreting the hormone insulin. Insulin is the hormone responsible for lowering blood glucose. Insulin improves glucose uptake by the cell.

A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first? a. Keep the head of the bed flat and the client supine. b. Instruct the client to cough, turn, and deep breathe. c. Report clear or light yellow drainage from the nose. d. Apply petroleum jelly to lips to avoid dryness.

C (A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help with dryness, this instruction is not as important as reporting the yellowish drainage.)

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? a) Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL b) Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due c) Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L d) Client with pituitary adenoma who is reporting a severe headache

Correct Answer: a A glucose level of 36 mg/dL is considered an emergency; this client must be assessed and treated immediately. Although it is important to maintain medications on schedule, the client requiring a dose of desmopressin is not the first client who needs to be seen. A serum potassium of 3.4 mEq/L in the client with hyperaldosteronism may be considered normal (or slightly hypokalemic), based on specific hospital levels. The client reporting a severe headache needs to be evaluated as soon as possible after the client with acute adrenal insufficiency. As an initial measure, the RN could delegate obtaining vital signs to unlicensed assistive personnel.

A client with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the client's care would be best to delegate to unlicensed assistive personnel (UAP)? a) Assist with personal hygiene and skin care. b) Develop a plan of care to minimize risk for infection. c) Instruct the client on the reasons to avoid overeating. d) Monitor for signs and symptoms of fluid retention.

Correct Answer: a Assisting a client with bathing and skin care is included in UAP scope of practice. It is not within their scope of practice to develop a plan of care, although they will play a very important role in following the plan of care. Client teaching requires a broad education and should not be delegated to UAP. Monitoring for signs and symptoms of fluid retention is part of client assessment, which requires a higher level of education and clinical judgment.

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? a) Desmopressin (DDAVP) b) Dopamine hydrochloride (Intropin) c) Prednisone d) Tolvaptan (Samsca)

Correct Answer: a Desmopressin is the drug of choice for treatment of severe DI. It may be administered orally, nasally, or by intramuscular or intravenous routes. Dopamine hydrochloride is a naturally occurring catecholamine and inotropic vasopressor; it would not be used to treat DI. Prednisone would not be used to treat DI. Tolvaptan is a selective competitive arginine vasopressin receptor 2 antagonist and is not used with DI.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L, K+ 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? a) Administer insulin and dextrose in normal saline to shift potassium into cells. b) Give spironolactone (Aldactone) 100 mg orally. c) Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. d) Obtain arterial blood gases to assess for peaked T waves.

Correct Answer: a This client is hyperkalemic. The nurse should anticipate a request to administer 20 to 50 units of insulin with 20 to 50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells. Spironolactone is a potassium-sparing diuretic that helps the body keep potassium, which the client does not need. Although H2 blocker therapy would be appropriate for this client, it is not the first priority. Arterial blood gases are not used to assess for peaked T waves associated with hyperkalemia; an electrocardiogram needs to be obtained instead.

A client diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate (Parlodel). As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain? a) Decreases the risk for cerebrovascular disease b) Increases the risk for depression c) Inhibits the release of some pituitary hormones d) Stimulates the release of some pituitary hormones

Correct Answer: c Bromocriptine mesylate inhibits the release of both prolactin and growth hormone. It does not decrease the risk for cerebrovascular disease leading to stroke. Increased risk for depression is not associated with the use of bromocriptine mesylate; however, hallucinations have been reported as a side effect. Bromocriptine mesylate does not stimulate the release of any hormones.

Which laboratory result indicates that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? a) Decreased hematocrit b) Decreased serum osmolality c) Increased serum sodium d) Increased urine specific gravity

Correct Answer: c Increased serum sodium due to fluid restriction indicates effective therapy. Hemoconcentration is a result of hypovolemic hyponatremia caused by SIADH and diabetes insipidus. Plasma osmolality is decreased as a result of SIADH. Urine specific gravity is decreased with diabetes insipidus and is increased with SIADH.

The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? a) Client in Addisonian crisis who is receiving IV hydrocortisone b) Client admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer c) Client being discharged after a unilateral adrenalectomy to remove an adrenal tumor d) Client with Cushing's syndrome who has elevated blood glucose and requires frequent administration of insulin

Correct Answer: d An RN who works with pediatric clients would be familiar with glucose monitoring and insulin administration. A client in Addisonian crisis would best be monitored by an RN from the medical-surgical floor. Although the float RN could complete the admission history, the client with SIADH secondary to lung cancer might require teaching and orientation to the unit that a nurse more familiar with that area would be better able to provide. Discharge teaching specific to adrenalectomy should be provided by the RN who is regularly assigned to the medical-surgical floor and is more familiar with taking care of postoperative adult clients with endocrine disorders.

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? a) Document symptoms of incisional infection or meningitis. b) Give over-the-counter laxatives if the client is constipated. c) Set up medications as prescribed for the day. d) Test any nasal drainage for the presence of glucose.

Correct Answer: d Cerebrospinal fluid (CSF) will test positive using a glucose "dipstick." Nasal drainage that is positive for glucose after a transsphenoidal hypophysectomy would indicate a CSF leak that would require immediate notification of the health care provider. Home health aides can be taught the correct technique to perform this procedure. Assessing for symptoms of infection and documenting them in the record, medication administration, and setting up medication are not within the scope of practice of the home health aide.

A patient is recovering from a transphenoidal hypophysectomy. What post operative nursing intervention apply to this patient? Select all that apply. A) Encouraging the patient to perform deep breathing exercises. B) Vigorous coughing and deep-breathing exercises. C) Instructing on the use of soft-bristled toothbrush for busing the teeth. D) Strict monitoring of fluid balance. E) Hourly neurological checks for the first 24 hours. F) Instructing the patient to alert the nurse regarding post nasal drip.

D) Strict monitoring of fluid balance. E) Hourly neurological checks for the first 24 hours. F) Instructing the patient to alert the nurse regarding post nasal drip.

A female patient has been prescribed hormone replacement therapy. What does the nurse instruct the patient to do regarding this type of therapy? A) Report any recurrence of symptoms, such as decreased libido, between injections. B) Monitor blood pressure at least weekly for potential hypotension. C) Treat leg pain, especially in the calves, with gentle muscle stretching. D) Take measures to reduce risk for hypertension and thrombosis.

D) Take measures to reduce risk for hypertension and thrombosis.

Which statement about hormone replacement therapy for hypopituitarism is correct? A) Once manifestations of hypofunction are corrected, treatment is no longer needed. B) The most effective route of androgen replacementis the oral route. C) Testosterone replacement therapy is contraindicated in men with prostate cancer. D) Clomiphene citrate (Clomid) is used to suppress ovulation in women.

D) Testosterone replacement therapy is contraindicated in men with prostate cancer.

A deficiency of which anterior pituitary hormone is considered life threatening? Select all that apply. A) Growth Hormone B) Melanocyte-stimulating hormone C) Prolactin D) Thyroid-stimulating hormone E) Adrenocorticotropic hormone

D) Thyroid stimulating hormone (TSH) E) Adrenocorticotropic hormone (ACTH)

** *Which statement about the etiology and incidence of S I A D H is correct?

Democlocycline may be used to treat S I A D H.

Intraoperative care for hypophysectomy

Depending on tumor size & location, a transsphenoidal approach or a minimally invasive endoscopic transnasal approach with smaller instruments is used instead of a more invasive procedure. General anesthesia is used. Nasal packing is inserted after the transphenoidal incision is closed and a mustache dressing is applied. There are not needed for the minimally invasive trans nasal procedure. If the tumor cannot be reached by either the endoscopic transnasal or the transsphenoidal approach, a craniotomy may be indicated

How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? Blocks reabsorption of sodium Increases blood pressure Increases cardiac output Works as an antidiuretic hormone (ADH) in the kidneys Correct

Desmopressin is a synthetic form of ADH that binds to kidney receptors and enhances reabsorption of water, thus reducing urine output. Desmopressin does not have any effect on sodium reabsorption. It may cause a slight increase or a transient decrease in blood pressure, but this does not affect urine output. Desmopressin does not increase cardiac output.

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? Desmopressin (DDAVP) Correct Dopamine hydrochloride (Intropin) Prednisone Tolvaptan (Samsca)

Desmopressin is the drug of choice for treatment of severe DI. It may be administered orally, nasally, or by intramuscular or intravenous routes. Dopamine hydrochloride is a naturally occurring catecholamine and inotropic vasopressor; it would not be used to treat DI. Prednisone would not be used to treat DI. Tolvaptan is a selective competitive arginine vasopressin receptor 2 antagonist and is not used with DI.

What is the disorder that results from a deficiency of vasopressin from the posterior pituitary gland called?

Diabetes insipidus

A client with a possible adrenal gland tumor is admitted for testing and treatment. Which nursing action is most appropriate for the charge nurse to delegate to the nursing assistant? Assess skin turgor and mucous membranes for hydration status. Discuss the dietary restrictions needed for 24-hour urine testing. Plan ways to control the environment that will avoid stimulating the client. Remind the client to avoid drinking coffee and changing position suddenly. Correct

Drinking caffeinated beverages and changing position suddenly are not safe for a client with a potential adrenal gland tumor because of the effects of catecholamines. Reminding the client about previous instructions is an appropriate role for a nursing assistant who may observe the client doing potentially risky activities. Client assessment, client teaching, and environment planning are higher-level skills that require the experience and responsibility of the RN, and are not within the scope of practice of the nursing assistant.

A client with diabetes insipidus (DI) has dry lips and mucous membranes and poor skin turgor. Which intervention does the nurse provide first? Force fluids Correct Offer lip balm Perform a 24-hour urine test Withhold desmopressin acetate (DDAVP)

Dry lips and mucous membranes and poor skin turgor are indications of dehydration, which can occur with DI. This is a serious condition that must be treated rapidly. Encouraging fluids is the initial step, provided the client is able to tolerate oral intake. Lip balm may make the client more comfortable, but does not address the problem of dehydration. A 24-hour urine test will identify loss of electrolytes and adrenal androgen metabolites, but will not correct the dehydration that this client is experiencing. Desmopressin acetate is a synthetic form of antidiuretic hormone that is given to reduce urine production; it improves DI and should not be withheld.

These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? Dry lips and oral mucosa on examination Nasal drainage that tests negative for glucose Client report of a headache and stiff neck Correct Urine specific gravity of 1.016

Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. Dry lips and mouth are not unusual after surgery. Frequent oral rinses and the use of dental floss should be encouraged because the client cannot brush the teeth. Any nasal drainage should test negative for glucose; nasal drainage that tests positive for glucose indicates the presence of a cerebrospinal fluid leak. A urine specific gravity of 1.016 is within normal limits.

***When assessing a patient with Cushing's syndrome, what does the nurse expect to find?

Hypertension

After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will no longer need to limit my fluid intake after surgery. b. I am glad no visible incision will result from this surgery. c. I hope I can go back to wearing size 8 shoes instead of size 12. d. I will wear slip-on shoes after surgery to limit bending over.

I hope I can go back to wearing size 8 shoes instead of size 12. Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.

If you work outside in the heat, you may need another drug. Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will wear dark glasses to prevent sun exposure. b. Ill keep food on upper shelves so I do not have to bend over. c. I must wash the incision with peroxide and redress it daily. d. I shall cough and deep breathe every 2 hours while I am awake.

Ill keep food on upper shelves so I do not have to bend over. After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.

***Which are causes for decreased production of adrenalcortical steroids? Select all that apply.

Inadequate secretion of A C T H, dysfunction of hypothalamic-pituitary control mechanism, adrenal gland dysfunction, cancer, and AIDS.

Low carbohydrate Low calories Low sodium The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

A nurse cares for a client after a pituitary gland stimulation test using insulin. The clients post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). How should the nurse interpret these results? a. Pituitary hypofunction b. Pituitary hyperfunction c. Pituitary-induced diabetes mellitus d. Normal pituitary response to insulin

Normal pituitary response to insulin Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking circulating levels of GH and ACTH. The presence of insulin in clients with normal pituitary function causes increased release of GH and ACTH.

A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop taking these medications? How should the nurse respond? a. It is possible for the inflammation to recur if you stop the medication. b. Once you start corticosteroids, you have to be weaned off them. c. You must decrease the dose slowly so your hormones will work again. d. The drug suppresses your immune system, which must be built back up.

Once you start corticosteroids, you have to be weaned off them. One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the clients immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

Which intervention is contraindicated of a patient with pheohromocytoma?

Palpating the abdomen.

Which patient is at risk for developing a secondary adrenal insufficiency?

Patient who suddenly stops taking high dose steroid therapy.

The nurse would instruct a patient who is taking hydrocortisone to report which symptoms to the doctor for possible dose adjustment? Select all that apply.

Rapid weight gain, Round face, and Fluid retention

A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. Read the label before using salt substitutes. b. Do not add salt to your food when you eat. c. Avoid exposure to sunlight. d. Take Tylenol instead of aspirin for pain.

Read the label before using salt substitutes. Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the clients potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

Report clear or light yellow drainage from the nose. A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help with dryness, this instruction is not as important as reporting the yellowish drainage.

Which nursing intervention is the priority for a patient with S I A D H?

Restrict fluid intake.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the clients fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

Restrict the clients fluid intake to 600 mL/day. With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium.

A patient in the E R who reports lethargy, muscle weakness, nausea, vomiting, and weight loss over the past weeks is diagnosed with Addisonian crisis, an acute adrenal insufficiency. Which drugs does the nurse expect to administer to this patient?

Solu-Cortef IV along with IM injections of hydrocortisone

A client has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? Encourages the client to cough and deep-breathe Instructs the client not to strain during a bowel movement Correct Instructs the client to blow the nose for postnasal drip Places the client in the Trendelenburg position

Straining during a bowel movement increases ICP and must be avoided. Laxatives may be given and fluid intake encouraged to help with this. Although deep breathing is encouraged, the client must avoid coughing early after surgery because this increases pressure in the incision area and may lead to a cerebrospinal fluid (CSF) leak. If the client has postnasal drip, he or she must inform the nurse and not blow the nose; postnasal drip may indicate leakage of CSF. The head of the bed must be elevated after surgery.

Surgical management of hyperpituitarism

Surgical removal of the pituitary gland and tumor (*hypophysectomy*) is the most common tx for hyperpituitarism. Successful surgery decreases hormone levels, relieves headaches, and may reverse changes in sexual functioning.

A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? Avoids palpating the abdomen Correct Monitors for pulmonary edema with a chest x-ray Obtains a 24-hour urine specimen on admission Places the client in a room with a roommate for distraction

The abdomen must not be palpated in a client with pheochromocytoma because this action could cause a sudden release of catecholamines and severe hypertension. The tumor on the adrenal gland causes sympathetic hyperactivity, increasing blood pressure and heart rate, not pulmonary edema. A 24-hour urine collection will already have been completed to determine the diagnosis of pheochromocytoma. A client diagnosed with a pheochromocytoma may feel anxious as part of the disease process; providing a roommate for distraction will not reduce the client's anxiety.

Which gland releases catecholamines? Adrenal Correct Pancreas Parathyroid Thyroid

The adrenal medulla releases catecholamines in response to stimulation of the sympathetic nervous system. The principal hormones of the pancreas are insulin, glucagon, and somatostatin. Parathyroid hormone is the principal hormone of the parathyroid gland. Triiodothyronine (T3), thyroxine (T4), and calcitonin are the principal hormones of the thyroid.

A client with syndrome of inappropriate antidiuretic hormone is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider does the nurse address first? Administer infusion of 150 mL of 3% NaCl over 3 hours. Correct Draw blood for hemoglobin and hematocrit. Insert retention catheter and monitor urine output. Weigh the client on admission and daily thereafter.

The client with a sodium level of 105 mEq/L is at high risk for seizures and coma. The priority intervention is to increase the sodium level to a more normal range. Ideally, 3% NaCl should be infused through a central line or with a small needle through a large vein to prevent irritation. Monitoring laboratory values for fluid balance and monitoring urine output are important, but are not the top priority. Monitoring client weight will help in the assessment of fluid balance; however, this is also not the top priority.

A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this clients plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to re-position the client. d. Assist the client to dangle before rising.

Use a lift sheet to re-position the client. In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take? a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the clients daily chest x-ray.

Wash hands when entering the room. Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.

Which statement about the pathophysiology of S I A D H is correct?

Water retention results in dilution hyponatremia and expanded extracellular fluid (ECF) volume.

A nurse cares for a male client with hypopituitarism who is prescribed testosterone hormone replacement therapy. The client asks, How long will I need to take this medication? How should the nurse respond? a. When your blood levels of testosterone are normal, the therapy is no longer needed. b. When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever. c. When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy. d. With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years old.

When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever. Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life. Therapy will continue throughout life; therefore, it will not be discontinued when blood levels are normal, at the age of 50 years, or when sperm counts are high.

You feel this way because of your hormone levels. Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

27. The nurse is caring for a patient with DI. What is the priority goal of collaborative care? a. Correct the water metabolism problem. b. Control blood sugar and blood pH. c. Measure urine output, specific gravity, and osmolality hourly. d. Monitor closely for respiration distress.

28. Which medication is used to treat DI? a. Desmopressin acetate (DDAVP) b. Lithium (Eskalith) c. Vasopressin (Pitressin) d. Demeclocycline (Declomycin)

33. Which nursing intervention is the priority for a patient with SIADH? a. Restrict fluid intake. b. Monitor neurologic status at least every 2 hours. c. Offer ice chips frequently to ease discomfort by dry mouth . d. Monitor urine tests for decreased sodium levels and low specific gravity.

48. The nurse determines a priority patient problem of altered self-concept in a female patient with Cushing's syndrome who expresses concern about the changes in her general appearance. What is the expected outcome for this patient? a. To verbalize an understanding that treatment will reverse many of the problems b. To ventilate about the frustration of these lifelong physical changes c. To verbalize ways to cope with the changes such as joining a support group or changing style of dress d. To achieve a personal desired level of sexual functioning

49. Which drug is an adrenal cytotoxic agent used for inoperable adrenal tumors? a. Mitotane (Lysodren) b. Aminoglutethimide (Cytadren) c. Cyprohepatadine (Periactin) d. Fludrocortisone (Florinef)

54. Which patient is at risk for developing secondary adrenal insufficiency? a. Patient who suddenly stops taking high-dose steroid therapy b. Patient who tapers the dosages of steroid therapy c. Patient deficient in ADH d. Patient with an adrenal tumor causing excessive secretion of ACTH

55. An ACTH stimulation test is the most definitive test for which disorder? a. Adrenal insufficiency b. Cushing's syndrome c. Pheochromocytoma d. Acromegaly

An older adult reports a lack of energy and not being able to do the usual daily activities without several naps during the day. Which problem may these symptoms indicate that is often seen in the older adult? a. Hypothyroidism b. Hyperparathyroidism c. Overproduction of cortisol d. underproduction of glucagon

26. A hospital patient is prescribed desmopressin acetate metered dose spray as a replacement hormone for ADH. Which is an indication for another dose? (Select all that apply.) a. Excessive urination b. Specific gravity of 1.003 c. Dark, concentrated urine d. Edema in the legs e. Decreased urination

a, b

60. The nurse should instruct a patient who is taking hydrocortisone to report which symptoms to the health care provider for possible does adjustment? (Select all that apply.) a. Rapid weight gain b. Round face c. Fluid retnetion d. Gastrointestinal irritation e. Urinary incontinence

a, b, c

12. Which statements about the etiology of hypopituitarism are correct? (Select all that apply.) a. Dysfunction can result from radiation treatment to the head or brain. b. Dysfunction can result from infection or a brain tumor. c. Infarction following systemic shock can result in hypopituitarism. d. Severe malnutrition and body fat depletion can depress pituitary gland function. e. There is always an underlying cause of hypopituitarism.

a, b, c, d Dysfunction can result from radiation treatment to the head or brain. Dysfunction can result from infection or a brain tumor. Infarction following systemic shock can result in hypopituitarism. Severe malnutrition and body fat depletion can depress pituitary gland function.

10. In caring for a patient with hyperpituirarism, which symptoms does the nurse expect the patient to report? a. Joint pain b. Visual disturbances c. Changes in menstruation d. Increase libido e. Headache f. Fatigue

a, b, c, e, f Joint pain, Visual disturbances, Changes in menstruation, Headache, Fatigue

3. A malfunctioning anterior pituitary gland can result in which disorder? (Select all that apply.) a. Pituitary hypofunction b. Pituitary hyperfunction c. DI d. Hypothyroidism e. Osteoporosis

a, b, d, e Pituitary hypofunction Pituitary hyperfunction Hypothyroidism Osteoporosis

24. Which statements about DI are accurate? (Select all that apply.) a. It is caused by ADH deficiency. b. It is characterized by a decrease in urination. c. Urine output of greater than 4 L/24 hours is the first diagnostic indication. d. The water loss increases plasma osmolarity. e. Nephrogenic DI can be caused by lithium (Eskalith).

a, c, d

32. In SIADH, which laboratory value does the nurse expect to find? (Select all that apply.) a. Increased sodium in urine b. Elevated serum sodium level c. Increased specific gravity (concentrated urine) d. Decreased serum osmolarity e. Decreased urine specific gravity

a, c, d

56. Which interventions are necessary for a patient with acute adrenal insufficiency (Addisonian crisis)? (Select all that apply.) a. IV infusion of normal saline b. IV infusion of 3% saline c. Hourly glucose monitoring d. Insulin administration e. IV potassium therapy

a, c, d

35. In addition to IV fluids, a patient with SIADH is on a fluid restriction as low as 500 to 600 mL/24 hours. Which serum and urine results demonstrate effectiveness of this treatment? (Select all that apply.) a. Decreased urine specific gravity b. Decreased serum sodium c. Increased urine output d. Increased urine specific gravity e. Increased serum sodium f. Decreased urine output

a, c, e

46. Which are physical findings of Cushing's disease? (Select all that apply.) a. "Moon-faced" appearance b. Decreased amount of body hair c. Truncal obesity d. Coarse facial features e. Thin, easily damaged skin f. Extremity muscle wasting

a, c, e, f

36. Which medications are used in SIADH to promote water excretion without causing sodium loss? (Select all that apply.) a. Tolvaptan (Samsca) b. Demeclocycline (Declomycin) c. Furosemide (Lasix) d. Conivaptan (Vaprisol) e. Spironolactone (Aldactone)

a, d

16. A patient is recovering from a transphenoidal hypophysectomy. What postoperative nursing interventions apply to this patient? (Select all that apply.) a. Encouraging the patient to perform deep-breathing exercises b. Vigorous coughing and deep-breathing exercises c. Instructing on the use of a soft-bristled toothbrush for brushing the teeth d. Struct monitoring of fluid balance e. Hourly neurologic checks for first 24 hours f. Instructing the patient to alert the nurse regarding postnasal drip

a, d, e, f

6. A patient is prescribed bromocriptine mesylate (Parlodel). Which information does the nurse teach the patient? (Select all that apply.) a. Get up slowly from a lying position. b. Take medication on an empty stomach. c. Take daily for purposes of raising GH levels to reduce symptom of acromegaly. d. Begin therapy with a maintenance level dose. e. Report watery nasal discharge to the health care provider immediately.

a, e Get up slowly from a lying position. Report watery nasal discharge to the health care provider immediately.

22. The nurse is assessing a patient with a diagnosis of Hashimoto's disease. What are the primary manifestations of this disease? (Select all that apply.)

a. Dysphagia b. Painless enlargement of the thyroid gland

50. A patient has hyperparathyroidism and high levels of serum calcium. Which initial treatment does the nurse prepare to administer to the patient?

a. Furosemide (Lasix) with IV saline

25. After a visit to the health care provider's office, a patient is diagnosed with general thyroid enlargement and elevated thyroid hormone level. Which condition do these findings indicate?

a. Hyperthyroidism and goiter

29. A patient has the following assessment findings: elevated TSH level, low T3 and T4 levels, difficulty with memory, lethargy, and muscle stiffness. These are clinical manifestations of which disorder?

a. Hypothyroidism

a. Increased carbohydrates c. Increased calorie intake e. Increased proteins ANS: A, C, E The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.

18. The patient who is prescribed methimazole (Tapazole) 4 mg orally every 8 hours tells the nurse that his heart rate is slow (60/minute), he has gained 7 pounds, and he wears a sweater even on warm days. What does the nurse suspect?

a. Indications of hypothyroidism will require a lower dosage.

28. Which factors are considered to be triggers for thyroid storm? (Select all that apply.)

a. Infection c. Vigorous palpation of a goiter d. Diabetic ketoacidosis

a. Infuse intravenous fluids. b. Cover the client with warm blankets. d. Maintain a patent airway. ANS: A, B, D A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.

39. Which statements about thyroiditis are accurate? (Select all that apply.)

a. It is an inflammation of the thyroid gland. b. Hashimoto's disease is the most common type. d. There are three types: acute, subacute, and chronic. e. The patient must take thyroid hormones.

40. Which statements about acute thyroiditis are accurate? (Select all that apply.)

a. It is caused by a bacterial infection of the thyroid gland. b. It is treated with antibiotic therapy. e. Manifestations include neck tenderness, fever, and dysphagia.

15. Which statements about hyperthyroidism are accurate? (Select all that apply.)

a. It is most commonly caused by Graves' disease. b. It can be caused by overuse of thyroid replacement medication. e. Serum T3 and T4 results will be elevated.

21. Which statements about hypothyroidism are accurate? (Select all that apply.)

a. It occurs more often in women. b. It can be caused by iodine deficiency. d. It can be caused by autoimmune thyroid destruction. e. Myxedema coma is a rare but serious complication.

51. Which are assessment findings of hypocalcemia? (Select all that apply.)

a. Numbness and tingling around the mouth b. Muscle cramping

44. Bone changes in the older adult are often seen with endocrine dysfunction and increased secretion of which substance?

a. PTH

53. Discharge planning for a patient with chronic hypoparathyroidism includes which instructions? (Select all that apply.)

a. Prescribed medications must be taken for the patient's entire life. c. Eat foods high in calcium, but low in phosphorus.

a. Protrusion of the lower jaw c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.

56. Which conditions may precipitate myxedema coma? (Select all that apply.)

a. Rapid withdrawal of thyroid medication c. Untreated hypothyroidism d. Surgery

9. The clinical manifestations of hyperthyroidism are known as which condition?

a. Thyrotoxicosis

18. After a hypophysectomy, home care monitoring by the nurse includes assessing which factors? (Select all that apply.) a. Hypoglycemia b. Bowel habits c. Possible leakage of cerebrospinal fluid (CSF) d. 24-hour intake of fluids and urine output e. 24-hour diet recall f. Activity level

b, c, d, e, f

25. What does the nurse instruct patients with permanent DI to do? (Select all that apply.) a. Continue vasopressin therapy until symptoms disappear. b. Monitor for recurrent of polydipsia and polyuria. c. Monitor and record weight daily. d. Check urine specific gravity three times a week. e. Wear a medical alert bracelet.

b, c, e

47. Which laboratory findings does the nurse expect to find with Cushing's syndrome? (Select all that apply.) a. Decreased serum sodium b. Increased serum glucose c. Increased serum sodium d. Increased serum potassium e. Decreased serum calcium

b, c, e

38. After hospitalization for myxedema, a patient is prescribed thyroid replacement medication. Which statement by the patient demonstrates a correct understanding of this therapy?

b. "I'll be taking thyroid medication for the rest of my life."

30. A patient has been prescribed thyroid hormone for treatment of hypothyroidism. Within what time frame does the patient expect improvement in mental awareness with this treatment?

b. 2 weeks

5. Which factor is a main assessment finding that signifies hypothyroidism?

b. Cold intolerance

17. The nurse is providing instructions to a patient who is taking the antithyroid medication propylthiouracil (PTU). The nurse instructs the patient to notify the health care provider immediately if which sign/symptom occurs?

b. Dark-colored urine

41. What is the hallmark of thyroid cancer?

b. Elevated serum thyroglobulin level

10. What is the most common cause of hyperthyroidism?

b. Graves' disease

46. A patient has positive Trousseau's and Chvostek's signs resulting from hypoparathyroidism. What condition does this assessment finding indicate?

b. Hypocalcemia

3. The nurse assesses a patient in the emergency department (ED) and finds the following: constipation, fatigue with increased sleeping time, impaired memory, facial puffiness, and weight gain. Which deficiency does the nurse recognize?

b. Hypothyroidism

54. In older adults, assessment findings of fatigue, altered thought processes, dry skin, and constipation are often mistaken for signs of aging rather than assessment findings for which endocrine disorder?

b. Hypothyroidism

8. The laboratory results for a 53-year-old patient indicate a low T3 level and elevated thyroid stimulating hormone (TSH). What do these results indicate?

b. Hypothyroidism

1. A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy? a. Blurred and double vision b. Increased thirst and urination c. Profuse nausea and diarrhea d. Decreased attention and insomnia

b. Increased thirst and urination ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.

MULTIPLE RESPONSE 1. A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) a. Oral potassium chloride b. Intravenous calcium chloride c. 3% normal saline IV solution d. 50% magnesium sulfate e. Oral calcitriol (Rocaltrol

b. Intravenous calcium chloride d. 50% magnesium sulfate ANS: B, D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.

12. The nurse is assessing a patient diagnosed with hyperthyroidism and observes dry, waxy swelling of the front surfaces of the lower legs. How does the nurse interpret this finding?

b. Pretibial myxedema

c. Monitor the apical pulse d. Initiate telemetry monitoring ANS: C, E The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau's sign is a test for hypocalcemia

37. The nurse is assessing a patient after thyroid surgery and discovers harsh, high-pitched respiratory sounds. What is the nurse's best first action?

c. Notify the Rapid Response Team.

45. In addition to regulation of calcium levels, PTH and calcitonin regulate the circulating blood levels of which substance?

c. Phosphate

27. A patient with exophthalmos from hyperthyroidism reports dry eyes, especially in the morning. The nurse teaches the patient to perform which intervention to help correct this problem?

c. Tape the eyes closed with non allergenic tape.

24. The patient has multiple thyroid nodules resulting in thyroid hyperfunction. What is the most likely cause of this hyperthyroidism?

c. Toxic multi nodular goiter -

13. Which statement best describes globe lag in a patient with hyperthyroidism?

c. Upper eyelid pulls back faster than the eyeball when the patient gazes upward

History of SIADH (contributes to cause)

ØRecent head trauma ØCerebrovascular disease ØTuberculosis or other pulmonary disease ØCancer ØAll past and current drug use ØDecrease in serum sodium levels

Physical assessment/S&S for hypercortisolism

Øskin changes -vessel fragility -striae -acne -fine hair on face and body -clitoral hypertrophy -balding in women Øcardiac changes -hypervolemia (bounding pulses, edema, elevated BP) Ømusculoskeletal changes -muscle mass decrease -weakness -thin bones -osteoporosis -fracture risk Øglucose metabolism -fasting levels high (liver releases glucose but insulin receptors are less sensitive Øimmune changes -decreased circulation of lymphocytes -inhibited macrophage activity -reduced antibody synthesis -inhibited production of cytokines and inflammatory chemicals

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