Chapter 52: Assessment and Management of Patients with Endocrine Disorders (Exam 2)

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: thyroiditis. Graves' disease. Hashimoto's thyroiditis. multinodular goiter.

Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? Hypophosphaturia Hyperphosphatemia Hypocalcemia Hypercalcemia

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

The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: Weight gain Fatigue Constipation Intolerance to heat

Intolerance to heat With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism.

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

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

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

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

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test? Serum immunoassay for TSH Free T4 analysis Fine-needle biopsy of the thyroid gland Ultrasound of the thyroid gland

Fine-needle biopsy of the thyroid gland Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.

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

Inadvertent removal of the parathyroid may occur during neck dissection surgery, resulting in hypocalcemia. This condition is treated with the IV administration of calcium gluconate. Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? Monitor laboratory values daily for elevated thyroid-stimulating hormone. Observe for swelling of the neck, tracheal deviation, and severe pain. Evaluate the quality of the client's voice postoperatively, noting any drastic changes. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.

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

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

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

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

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? "The head of your bed must remain flat for 24 hours after surgery." "You should avoid deep breathing and coughing after surgery." "You won't be able to swallow for the first day or two." "You must avoid hyperextending your neck after surgery."

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

An 84-year-old client who is experiencing cognitive decline is scheduled for a diagnostic test. Which action by the nurse reflects best practice when recording the client's drug history before the diagnostic test? Giving printed directions to the client about participation in the test. Consulting with the client's family or caregiver to confirm the information. Offering assurance about the diagnostic test. Consulting with the institution's procedure manual for specific instructions.

Consulting with the client's family or caregiver to confirm the information. Obtaining a drug history is essential before a diagnostic examination for an older adult because side effects or interactions may contribute to changes in endocrine function. If the older adult is cognitively impaired, a family member or the caregiver should provide information regarding medications and dosage history. Giving printed instructions would be an effective teaching strategy once the drug history is confirmed. Offering assurance about the test would be helpful in alleviating the client's and family's anxiety. Consulting the institution's procedure manual provides information about preparation for the test. It is unrelated to the client's drug history.

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? Thiazide diuretics Diabinese Desmopressin (DDAVP) Ibuprofen

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

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? Use nasal desmopressin acetate (DDAVP). Exercise to improve cardiovascular fitness. Keep an accurate record of intake and output. Have regular follow-up care.

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

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

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

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? Come to the clinic for IV fluid therapy daily. Limit the fluid intake at night. Consume adequate amounts of fluid. Weigh daily.

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

A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? "I will take my pain medications according to the schedule we developed." "I will increase my fluid and calcium intake." "I'll schedule a follow-up visit with my physician as soon as I get home." "I'll call my physician if I notice tingling around my lips."

"I will increase my fluid and calcium intake." The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with his physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.

The primary function of the thyroid gland includes which of the following? Control of cellular metabolic activity Facilitation of milk ejection Reabsorption of water Reduction of plasma level of calcium

Control of cellular metabolic activity The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.

The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? Hypothyroidism Hyperthyroidism Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes insipidus (DI)

Hyperthyroidism Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.

A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? Hypophysectomy Thyroidectomy Hysteroscopy Ablation

Hypophysectomy The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.

A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of: Risk for imbalanced fluid volume related to excessive sodium loss. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. Decreased cardiac output related to hypotension secondary to Cushing's syndrome.

Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.

Which suggestion would the nurse include for a client who has had a thyroidectomy to reduce tension on the suture line? Take the prescribed analgesics before any strenuous activity. Keep ambulatory activities to minimum. Maintain complete bed rest for 2 days postoperatively. Use the hands to support the head when rising from a sitting position.

Use the hands to support the head when rising from a sitting position. After a thyroidectomy, the client should use the hands to support the head while rising from a sitting position. This type of support helps avoid strain to the neck muscles and surgical incision. The client is encouraged to gradually increase his or her activity level as tolerated. Comfort measures, such as analgesics, would be used to manage pain; however they would have no effect on reducing tension on the suture line.

Cardiac effects of hyperthyroidism include decreased pulse pressure. decreased systolic BP. bradycardia. palpitations.

palpitations. Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.

The nurse is aware that the best time of day for the total large corticosteroid dose is between: 7:00 AM and 8:00 AM 4:00 AM and 5:00 AM 8:00 PM and 9:00 PM 4:00 PM and 6:00 PM

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

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

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

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: insulin. vasopressin. furosemide. potassium chloride.

vasopressin. Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? "Do you have to get up at night to empty your bladder?" "Have you experienced any headaches or sinus problems?" "Do you experience fatigue even if you have slept a long time?" "Can you describe the amount of stress in your life?" TAKE ANOTHER QUIZ

"Do you experience fatigue even if you have slept a long time?" With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? "I will eat lots of chicken and dairy products." "I may stop taking this medication when I feel better." "I will avoid friends and family members who are sick." "I will see my ophthalmologist regularly for a check-up."

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

A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? "It regulates the function of other endocrine glands." "It regulates metabolism." "It is the gland that is responsible for regulating the hypothalamus." "The gland does not have any other function other than to cause secretion of the growth hormones."

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

The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? A rise in serum calcium stimulates the release of T lymphocytes. A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. A rise in serum calcium inhibits the release of calcitonin. A rise in serum calcium stimulates the release of erythropoietin.

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

A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? Methylprednisolone Fludrocortisone Calcium gluconate Sodium bicarbonate

Calcium gluconate Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? Above-normal urine and serum osmolality levels Below-normal urine and serum osmolality levels Above-normal urine osmolality level, below-normal serum osmolality level Below-normal urine osmolality level, above-normal serum osmolality level

Below-normal urine osmolality level, above-normal serum osmolality level In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.

A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient? Glucose Sodium Calcium Potassium

Calcium Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels.

A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of: Potassium chloride Calcium gluconate Magnesium sulfate Sodium phosphate

Calcium gluconate Inadvertent removal of the parathyroid may occur during neck dissection surgery, resulting in hypocalcemia. This condition is treated with the IV administration of calcium gluconate.

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? Calcium gluconate Synthroid Propylthiouracil (PTU) Tapazole

Calcium gluconate Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.

What dietary modifications should be recommended to a client with hyperthyroidism? Restrict calorie intake. Limit intake of nutritionally dense foods such as milk products, eggs, and cheese. Consume a high-protein diet. Increase calorie intake by 70%.

Consume a high-protein diet. A high protein intake helps replenish losses from muscle catabolism. Metabolism is increased with hyperthyroidism. Calorie needs increase between 10% and 50% above normal to replenish glycogen stores and correct weight loss. Encourage frequent meals and the intake of nutritionally dense foods (fortified milkshakes, foods fortified with skim milk powder, eggs, cheese, butter, or milk).

A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for? Pituitary tumor Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Hypothyroidism Diabetes insipidus (DI)

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

Which nursing action would the nurse include when caring for a client with endemic goiter and experiencing respiratory symptoms? Avoiding physical exertion. Providing proper air circulation in the room. Providing a diet high in iodine. Elevating the head of the bed.

Elevating the head of the bed. The nurse should monitor the respiratory status and elevate the head of the bed to relieve respiratory symptoms. A high-iodine diet does not relieve respiratory distress. Although proper air circulation in the room and avoiding physical exertion may be important, these actions do not address the respiratory symptoms.

A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? Retinal detachment Periorbital swelling Bulging eyes Exophthalmos

Exophthalmos Exophthalmos is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment.

A nurse should perform which intervention for a client with Cushing's syndrome? Offer clothing or bedding that's cool and comfortable. Suggest a high-carbohydrate, low-protein diet. Explain that the client's physical changes are a result of excessive corticosteroids. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? Capillary blood glucose test Fluid deprivation test Serum ketone test Urine glucose test

Fluid deprivation test The fluid deprivation test involves withholding water for 4 to 18 hours and periodically checking urine and plasma osmolarity. A client with diabetes insipidus will have an increased serum osmolarity of less than 300 mOsm/kg. Urine osmolarity won't increase. The capillary blood glucose test rapidly measures glucose level in whole blood. The serum ketone test is used to diagnose diabetic ketoacidosis. The urine glucose test monitors glucose levels in urine; however, diabetes insipidus doesn't affect urine glucose levels, so this test isn't appropriate.

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

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

Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? Cardiac dysrhythmia Hand flexing inward Bulging forehead Moon face and buffalo hump

Hand flexing inward Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? Iodine Thyrotropin Thyroxine Calcitonin

Iodine Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.

Which intervention is the most critical for a client with myxedema coma? Warming the client with a warming blanket Maintaining a patent airway Administering an oral dose of levothyroxine (Synthroid) Measuring and recording accurate intake and output

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

A client is scheduled for a thyroid panel. The nurse understands that this test would involve which of the following? Radiograph of the neck Radioactive iodine uptake test Measurement of blood hormone levels Scan using an injected radioactive substance

Measurement of blood hormone levels A thyroid panel measures the blood hormone levels of TSH, T3, and T4. It is a blood test, not a radiograph (x-ray). A radioactive iodine uptake test is a radionuclide study that determines thyroid function. A thyroid scan would involve the use of a radioactive substance to visualize the thyroid gland or its activity.

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

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

Hypocalcemia is associated with which of the following manifestations? Muscle twitching Bowel hypomotility Fatigue Polyuria

Muscle twitching Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are not associated with hypocalcemia.

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? Observe the color of stool. Monitor bowel patterns. Monitor vital signs every 4 hours. Observe urine output.

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

A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction? Thyroid gland Parathyroid gland Thymus gland Adrenal gland

Parathyroid gland The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level. The thyroid, thymus, and adrenal gland do not secrete calcium.

The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? Potassium of 6.0 mEq/L Sodium of 140 mEq/L Glucose of 100 mg/dL A blood pressure reading of 135/90 mm Hg

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

Patients with hyperthyroidism are characteristically: Calm Emotionally stable Sensitive to heat Apathetic and anorexic

Sensitive to heat Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? Stimulate more hormones using the negative feedback system Stimulate more hormones using the positive feedback system The feedback loop will be unable to perform in response to low levels of thyroid hormone. Produce a new hormone to try and regulate the thyroid function

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

Parathyroid hormone (PTH) has which effects on the kidney? Increased absorption of vitamin D and excretion of vitamin E Increased absorption of vitamin E and excretion of vitamin D Stimulation of phosphate reabsorption and calcium excretion Stimulation of calcium reabsorption and phosphate excretion

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

Parathyroid hormone (PTH) has which effects on the kidney? Stimulation of calcium reabsorption and phosphate excretion Stimulation of phosphate reabsorption and calcium excretion Increased absorption of vitamin D and excretion of vitamin E Increased absorption of vitamin E and excretion of vitamin D

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

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: iodine and thyroid-stimulating hormone (TSH). thyrotropin-releasing hormone (TRH) and TSH. TSH, triiodothyronine (T3), and calcitonin. T3, thyroxine (T4), and calcitonin.

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

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

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

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? The concentration of a substance in plasma Details about the size of the organ and its location The functioning of endocrine glands The client's blood sugar level

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

Which group of clients should not receive potassium iodide? Those who are allergic to corticosteroids Those taking medications such as cough medicines Those who are allergic to seafood Those who are pregnant

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

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

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

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? Heart rate of 62 Blood pressure 90/58 mm Hg Oxygen saturation of 96% Temperature of 102ºF

Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.

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

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

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

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

Which diagnostic test is done to determine suspected pituitary tumor? radiographs of the abdomen measurement of blood hormone levels computed tomography scan radioimmunoassay

computed tomography scan A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.

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

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

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

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