Ch. 38- Learning: Disorders of Thyroid and Parathyroid and Adrenal Regulation

A patient scheduled for a rapid ACTH stimulating test asks the nurse which function the test is assessing. Which function should the nurse include in the response? A. Adrenocortical B. Thyroid C. Parathyroid D. Renal

A. Adrenocortical - The rapid ACTH stimulating test is performed to differentiate primary and secondary adrenocortical insufficiency. - Thyroid function is assessed with TSH, T3, and T4 levels. - Renal function is assessed with BUN and creatinine levels. - Parathyroid function is assessed by monitoring serum calcium levels.

The nurse is assessing a pregnant patient. Which system should the nurse suspect to be affected by maternal and fetal hypothyroidism? A. Nervous system B. Respiratory system C. Musculoskeletal system D. Circulatory system

A. Nervous system - Maternal iodine deficiency can result in nervous system abnormalities. - Iodine deficiency does not affect the musculoskeletal, circulatory, or respiratory systems during pregnancy.

While teaching a patient about hyperparathyroidism, which risk factor should the nurse include? A. Prolonged vitamin D deficiency B. Neck surgery C. Smoking D. Autoimmune disorder

A. Prolonged vitamin D deficiency - Prolonged vitamin D or calcium deficiency increases the risk of hyperparathyroidism. - Other risks include use of lithium, radiation treatment of the neck area, female gender, and being over the age of 50. - Surgery in the neck area increases the risk of hypoparathyroidism.

A nurse is teaching a patient newly diagnosed with Graves disease. Which information should the nurse include? A. Propylthiouracil decreases the production of the thyroid hormone. B. Spironolactone decreases the production of the thyroid hormone. C. Prednisone decreases the production of the thyroid hormone. D. Levothyroxine decreases the production of the thyroid hormone.

A. Propylthiouracil decreases the production of the thyroid hormone. - Propylthiouracil (PTU) is the only drug that decreases thyroid hormone. - Levothyroxine is a thyroid hormone replacement. - Spironolactone is an aldosterone antagonist. - Prednisone is a glucocorticoid.

A patient asks the nurse why it is important to maintain the lowest possible dosage of propylthiouracil during pregnancy. Which response should the nurse give? A. "Propylthiouracil causes hyperemesis gravidarum." B. "Propylthiouracil crosses the placental barrier." C. "Propylthiouracil causes teratogenic effects." D. "Propylthiouracil crosses the blood-brain barrier."

B. "Propylthiouracil crosses the placental barrier." - Propylthiouracil (PTU) crosses the placental barrier. General recommendations are to use PTU during the first trimester at the lowest effective dose, then switch to methimazole for the remainder of the pregnancy. - While PTU may cross the blood-brain barrier, this is not specific to pregnancy. - PTU does not cause hyperemesis gravidarum. - Methimazole is related to rare teratogenic effects.

Which disease process should alert the nurse to monitor calcium levels in a patient? A. Hyperthyroidism B. Chronic kidney disease C. Coronary artery disease D. Cushing syndrome

B. Chronic kidney disease - In chronic kidney disease, vitamin D metabolite production is decreased resulting in increased secretion of parathyroid hormone (PTH) and parathyroid hyperplasia. - Coronary artery disease, Cushing syndrome, and Graves disease are unrelated to calcium levels.

The lab results for a patient indicate very high levels of epinephrine and norepinephrine. Which adrenal gland health problem does the nurse suspect these findings to be indicative of? A. Adrenal hyperfunction B. Pheochromocytoma C. Addison disease D. Cushing disease

B. Pheochromocytoma - Pheochromocytomas are neuroendocrine tumors that arise from catecholamine-producing chromaffin cells that cause an oversecretion of the hormones epinephrine and norepinephrine. - Adrenal hyperfunction occurs only in the adrenal cortex with the overproduction of aldosterone and/or the overproduction of cortisol. - Cushing disease describes pituitary-dependent conditions. - Addison disease is caused by adrenal cortex insufficiency.

A patient has hoarseness, cervical lymphadenopathy, and a fixed nodule on the thyroid. Which disease should the nurse suspect in the patient? A. Multinodular goiter B. Thyroid cancer C. Hashimoto thyroiditis D. Toxic multinodular goiter

B. Thyroid cancer - Hoarseness and cervical lymphadenopathy, along with a fixed nodule, are present with thyroid cancer. - Goiters can also present as nodules; however, they lack the cervical lymphadenopathy.

The nurse is caring for a patient who is newly diagnosed with papillary cancer. Which initial treatment of cancer does the nurse anticipate for this patient? A. Radioactive iodine ablation B. Total thyroidectomy C. Administration of propylthiouracil D. Hemithyroidectomy

B. Total thyroidectomy - The initial treatment of papillary thyroid cancer is a total thyroidectomy. - Radioactive iodine ablation may be performed to destroy any remaining cancer. - A hemithyroidectomy is not indicated for papillary thyroid cancer. - Propylthiouracil (PTU) is administered for hyperthyroidism to suppress hormone production.

The nurse is caring for a patient with Graves disease who is experiencing exophthalmos (bulging eyes). Which potential problem is a priority for the nurse to address? A. Skin integrity B. Visual perception C. Constipation D. Pain

B. Visual perception - Visual perception is the priority potential problem for the nurse to address when caring for a patient with exophthalmos. - Skin integrity, constipation, and pain are not priority potential problems for the nurse when caring for a patient with Graves disease and exophthalmos.

Which clinical manifestation suggests hyperthyroidism? A. Bradycardia B. Weight loss with increased appetite C. Cold intolerance D. Constipation

B. Weight loss with increased appetite - Weight loss with increased appetite is a sign of hyperthyroidism. - Cold intolerance, constipation, and bradycardia are signs of hypothyroidism.

The nurse teaches a patient about the rapid adrenocorticotropic hormone (ACTH) test. Which patient statement indicates understanding of the test? A. "A normal rise in cortisol means I have primary adrenocortical insufficiency." B. "A normal rise in cortisol means I have secondary adrenocortical insufficiency." C. "A subnormal rise in cortisol means I have primary adrenocortical insufficiency." D. "A subnormal rise in cortisol means I have secondary adrenocortical insufficiency."

C. "A subnormal rise in cortisol means I have primary adrenocortical insufficiency." The rapid ACTH stimulation test assess adrenocortical function and helps differentiate primary from secondary adrenal insufficiency. In the rapid ACTH test, a dose of synthetic ACTH is injected, and plasma cortisol levels are drawn at specific predetermined times. A subnormal rise in cortisol in response to ACTH stimulation indicates primary adrenocortical insufficiency.

The nurse is planning to teach a patient about the radioactive iodine uptake test. Which statement should the nurse include? A. "This test will help isolate the thyroid cancer." B. "This test will ablate the thyroid so it no longer produces the hormone." C. "This test can help distinguish Graves disease from other hyperthyroid causes." D. "This test will help differentiate primary and secondary hypothyroidism."

C. "This test can help distinguish Graves disease from other hyperthyroid causes." - The radioactive iodine uptake (RAIU) test helps differentiate different etiologies of hyperthyroidism. An oral radioactive iodine is administered. A high concentration of the tracer throughout the thyroid is indicative of Graves disease. - This test does not ablate the thyroid. - Thyroid cancer is typically diagnosed as a nodule by palpation. - Primary and secondary hypothyroidism are determined by the cause. Primary hypothyroidism is located in the thyroid, while secondary hypothyroidism is caused by deficiencies with the hypothalamus or pituitary.

The nurse is prepaing a presentation on thyroid cancer. Which statement should the nurse include? A. "Men are the most likely to die from thyroid cancer." B. "Anaplastic thyroid cancers are rarely fatal." C. "Women are the most likely to die from thyroid cancer." D. "Medullary thyroid cancer is the most common form of thyroid cancer in the United States."

C. "Women are the most likely to die from thyroid cancer." - Women are the preponderance of thyroid cancer deaths. - Medullary thyroid cancer is the least common thyroid cancer in the United States. - Anaplastic thyroid cancer has a mortality of close to 100%.

The nurse is preparing a presentation about hyperparathyroidism. Which population should be included as being most at risk? A. A younger adult man B. A younger adult woman C. An older adult woman D. An older adult man

C. An older adult woman Hyperparathyroidism occurs most often in older adults and is three times more common in women than men. In a study, the prevalence tripled (76 to 233 per 100,000) in women as the age increased compared with men (30 to 85).

A patient reports muscle weakness, abdominal discomfort, and constipation for the past few weeks. The nurse suspects that the patient may have an increased calcium level. Which condition in the patient's health history should the nurse question that is specifically related to hypercalcemia and hyperparathyroidism? A. History of pancreatitis and liver or kidney disease B. Current manifestations of numbness and tingling around the mouth C. Current manifestations of increased urination, thirst, and changes in memory or thinking D. Current manifestations of shortness of breath

C. Current manifestations of increased urination, thirst, and changes in memory or thinking - The health history for a patient with hyperparathyroidism or hypercalcemia would include increased urination, thirst, and changes in memory or thinking. - The health history for a patient with hypoparathyroidism or hypocalcemia would include numbness and tingling around the mouth, and shortness of breath. - The health history for a patient with hypoparathyroidism or hypocalcemia would include acute and chronic conditions, such as pancreatitis and liver or kidney disease.

In Cushing syndrome, the amount of ACTH released from the pituitary gland is decreased. Which event is not a part of the process that decreases the amount of ACTH released from the pituitary gland? A. Release of an anti-inflammatory agent B. Stimulation of gluconeogenesis C. Development of inflammation D. Elevation of blood glucose

C. Development of inflammation The pathophysiology of Cushing syndrome includes elevated levels of cortisol that provide negative feedback on the pituitary, decreasing the amount of ACTH released from the pituitary gland. This process stimulates gluconeogenesis, elevates the blood glucose level, and causes a powerful anti-inflammatory agent to be released. Inflammation is not produced in the process.

The nurse is caring for a patient with hyperparathyroidism. Which lab values should the nurse expect to be elevated? A. PTH and sodium B. PTH and adrenocorticotropic hormone (ACTH) C. PTH and calcium D. PTH and vitamin D

C. PTH and calcium - Parathyroid hormone (PTH) and calcium levels are elevated in hyperparathyroidism. - ACTH is related to adrenocortical function. - Sodium is not related to hyperparathyroidism. - Vitamin D is decreased in hyperparathyroid disease.

The nurse plans to examine a patient diagnosed with hypoparathyroidism for latent tetany. Which should the nurse use? A. Babinski reflex B. Kernig sign C. Trousseau sign D. Moro reflex

C. Trousseau sign Latent tetany can be demonstrated through the use of Trousseau sign or Chvostek sign. To check for Chvostek sign, tap on the facial nerve anterior to the ear. Twitching of the muscle on the same side of the face is a positive sign. Trousseau sign can be elicited by applying a blood pressure cuff and inflating for 3 minutes. A positive sign will be contractions of the carpal muscles.

The nurse is teaching a patient about Graves disease. Which statement by the patient indicates an understanding? A. "I should not stop my prednisone unless instructed by my healthcare provider." B. "I should not stop my amiodarone unless instructed by my healthcare provider." C. "I should not stop my spironolactone unless instructed by my healthcare provider." D. "I should not stop my propylthiouracil unless instructed by my healthcare provider."

D. "I should not stop my propylthiouracil unless instructed by my healthcare provider." - Propylthiouracil (PTU) is used to suppress thyroid hormone synthesis. - Prednisone is a glucocorticoid not related to the thyroid. - Amiodarone is used for cardiovascular diseases. - Spironolactone is an aldosterone antagonist.

Which statement is accurate about patients diagnosed with thyroid cancer? A. "Mortality is greater for men than women." B. "Mortality is equally prevalent in both genders." C. "Mortality is not a factor in thyroid cancer." D. "Mortality is greater for women than men."

D. "Mortality is greater for women than men." The preponderance of deaths from thyroid cancer are in women. The American Cancer Society estimates about 1,090 female deaths, as compared to 920 male deaths in 2017; thus, mortality is greater in women than men.

The nurse gives a presentation on the etiology of primary adrenal hypofunction. Which participant statement indicates a need for further teaching? A. "The disorder can be related to disease of the adrenal cortex." B. "The disorder can be due to idiopathic causes." C. "The disorder can be related to congenital adrenal hyperplasia." D. "The disorder can be due to injury to the hypothalamus."

D. "The disorder can be due to injury to the hypothalamus." - Etiology for primary adrenal hypofunction includes congenital adrenal hyperplasia; disease of the adrenal cortex (related to autoimmune disease, adenoma, or infection); and idiopathic causes. Iatrogenic effects, such as corticosteroid therapy, lead to secondary adrenal hypofunction. - Injury to the hypothalamus leads to tertiary adrenal hypofunction.

Which factor is associated with primary hypothyroidism? A. Cerebellar dysfunction B. Fibrosis of adrenal gland C. Exogenous thyroid D. Dietary iodine deficiency

D. Dietary iodine deficiency - Dietary iodine deficiency is the only listed factor for primary hypothyroidism. - Cerebellar dysfunction has no bearing on the thyroid. - Fibrosis of the adrenal gland would cause other endocrine disorders. - An exogenous thyroid would cause hyperthyroidism.

A patient wants to know the risk factors for developing thyroid cancer. Which should the nurse include? A. Growing up around pesticides B. Living in a rural community C. Family history D. Exposure to ionizing radiation

D. Exposure to ionizing radiation - The most consistent risk factor for developing thyroid cancer is exposure to ionizing radiation in the form of x-rays to the head and neck during childhood. - Growing up around pesticides, living in a rural community, and family history are not consistent risk factors.

Which condition should the nurse include when teaching about hyperthyroidism? A. Insufficient thyroid-stimulating hormone (TSH) secretion B. Diabetes mellitus C. Postpartum status D. Graves disease

D. Graves disease - There are several factors that can lead to the development of hyperthyroidism. These factors include excess TSH secretion, Graves disease, thyroiditis, tumor, and excessive doses of thyroid hormone supplement. - During the postpartum period, a woman may experience hypothyroidism. - An insufficient production of TSH would lead to hypothyroidism, not hyperthyroidism. - Diabetes mellitus does not lead to hyperthyroidism.

The nurse is caring for a patient with newly diagnosed Graves disease. Which lab result is consistent with this diagnosis? A. Increased cortisol B. Increased thyroid-stimulating hormone (TSH) C. Increased aldosterone D. Increased triiodothyronine (T3) and thryoxine (T4)

D. Increased triiodothyronine (T3) and thryoxine (T4) - In Graves disease, the thyroid secretes excess T3 and T4, which in turn suppresses TSH. - Cortisol and aldosterone are related to the adrenal system.

The nurse finds severely decreased thyroid hormone levels in a patient experiencing emergent signs and symptoms of hypothyroidism. Which condition should the nurse suspect? A. Hashimoto disease B. Cretinism C. Thyroid storm D. Myxedema

D. Myxedema - Myxedema is the most severe form of hypothyroidism and is classified as a medical emergency. - Cretinism refers to effects of congenital hypothyroidism. - Hashimoto disease is a type of hypothyroidism caused by autoimmune response. - Thyroid storm is an emergent condition associated with hyperthyroidism.

The nurse is assessing a patient who has abdominal pain, generalized weakness, peripheral neuropathy, osteopenia, and hypercalcemia. Which disease process should the nurse suspect in the patient? A. Graves disease B. Cushing syndrome C. Primary adrenalcortical insufficiency D. Primary hyperparathyroidism

D. Primary hyperparathyroidism The parathyroid secretes parathyroid hormone (PTH). PTH is important in the regulation of calcium and phosphate. The primary effect of PTH is maintaining normal serum calcium.

The nurse is caring for a patient diagnosed with hyperparathyroidism who has not responded to medication and lifestyle interventions. Which surgery should the nurse anticipate may be necessary? A. Removal of the adrenal medulla B. Removal of the pineal gland C. Removal of the pituitary gland D. Removal of the parathyroid glands

D. Removal of the parathyroid glands - Surgical intervention may be necessary for some patients with hyperparathyroidism. Surgical intervention may include removal of the parathyroid glands or procedures similar to those used for subtotal thyroidectomy. - Removing the adrenal medulla, pituitary gland, or pineal gland would not have an impact on parathyroid hormone.

The nurse is assessing a patient who is diagnosed with hyperthyroidism. Which assessment is not related to hyperthyroidism? A. Palpation of thyroid B. Heart sounds and pulses C. Weight D. Use of insulin for drug therapy

D. Use of insulin for drug therapy - The use of insulin is not a recommended treatment for hyperthyroidism; the nurse would not assess this factor. - Other factors to include in the nursing assessment of the patient with hyperthyroidism include, but are not limited to, vital signs, palpation of gland, respiratory and cardiac assessment, weight (to assess for weight loss), energy level, and sleep patterns.

The nurse is preparing a presentation about Hashimoto disease. Which demographic should be included as having a higher incidence rate? A. Men B. African Americans C. Children D. Women

D. Women - Hashimoto disease occurs twice as often in women as in men. - The disorder is not commonly seen in children, and it is not more commonly seen in African Americans than in other ethnic groups.