Endocrine (HESI/NCLEX) prep 2

Because of *hypofunction* of the *adrenal gland*, clients with skin pigmentation conditions, such as vitiligo, are mainly instructed to

consume more water.

Clients who have hyperfunction of adrenocorticotropic hormone have

weight gain and changes in facial shape called "moon face."

Protein and lipid catabolism occur in type 1 DM because carbohydrates cannot be used by the cells; this results in

weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes.

After a teaching session, the nurse evaluates the client's understanding of hypoparathyroidism. Which statement made by the client indicates the need for further education?

"I should include yogurt in my diet. Further education is needed for the client. Clients with hypoparathyroidism have hypocalcemia. In order to replenish the calcium levels of the body, the client should consume foods that are rich in calcium. However, foods rich in phosphorus such as yogurt, processed cheese, and milk should be avoided. All the other comments are correct and require no further education by the nurse. Oranges are good source of vitamin C and fibers. They help to improve healing and remove wastes from the body. Exercising is good for overall health. Sitting in the sun allows exposure of the client to sunlight, which is a natural source of vitamin D. Vitamin D helps in the absorption of calcium from the gastrointestinal tract.

2 hormones that are secreted by the hypothalamus include

1- prolactin-inhibiting hormone 2- corticotropin-releasing hormone

ACTH stimulates production of adrenal hormones. Inadequate ACTH will result in

Addisonian signs and symptoms.

The nurse is assessing a client suspected of having hypersecretion of growth hormone. Which question should the nurse ask the client?

Have you noticed a thickening of your lips

Seizures are common in clients who have

pituitary tumors.

Cortisol, thyrotropin, and growth hormone levels peak during

SLEEP

With *diabetic ketoacidosis* the *serum glucose levels* are generally

above 300 mg/dL (16.7 mmol/L).

Joint pain with deformities are the clinical manifestations of

acromegaly.

Cushing syndrome results from

excessive cortical hormones.

Tetany is associated with

severe hypocalcemia; that condition can be caused by hypoparathyroidism.

*Myxedema* is the

severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones.

More than 60% of clients with type 2 diabetes have

some degree of retinopathy after 20 years.

Clients who are diabetic have peripheral neuropathy, which is characterized by

hypoactive, reflexes.

Removal of the parathyroids causes

hypocalcemia and associated neuromuscular irritability.

Diabetic retinopathy is a

leading cause of blindness in diabetics.

*Diabetic retinopathy* is characterized by a

Abnormal growth of new blood vessels in the retina (neovascularization).

Dilute urine with decreased fluid intake indicates a

decrease in antidiuretic hormone production.

The ketones produced excessively in diabetes are a by-product of the breakdown of body fats and proteins for energy; this occurs when

insulin is not secreted or is unable to be used to transport glucose across the cell membrane into the cells. The major ketone, acetoacetic acid, is an alpha-ketoacid that lowers the blood pH, resulting in acidosis.

*Hyperplasia of the adrenal cortex* leads to

*increased secretion of cortical hormones*, which causes signs of Cushing syndrome.

Desmopressin acetate is administered either

1. orally 2. intranasally with a metered spray to treat *diabetes insipidus*

Hyperpituitarism manifests with

1. vision disturbances 2. severe headaches 3. Change in menstrual cycle in females (due to hyper-secretion of prolactin)

Central Diabetes Insipidus

ADH deficiency due to hypothalamic or psoterior pituitary pathology (tumor, trauma, infection, inflammation)

On the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports a sore throat when swallowing. What should the nurse do first?

Administer analgesics as prescribed before meals. Soreness is to be expected. A progression to a soft diet will provide nutrients needed for healing and energy and will stimulate the return of bowel activity. Analgesics as prescribed will reduce soreness during meals. Reordering the full-fluid diet is not within the legal role of the nurse. Soreness is to be expected; this is not an emergency necessitating medical action. The soreness is not because of drying; when the client is at home, humidified air might help reduce the soreness, but it will not help the client eat the soft diet. Gargling involves hyperextension of the neck, which may put tension on the suture line.

A client is admitted to the hospital with a diagnosis of cancer of the thyroid gland and a thyroidectomy is performed. What should the nurse do during the first six to eight hours after surgery?

Assess the sides and back of the client's neck for evidence of bleeding. In a back-lying (supine) position, blood will flow with gravity down the sides of the neck and not be seen. Positioning two pillows behind the client's head flexes the neck excessively and increases tension on the suture line which may inhibit the passage of gases through the oral, pharyngeal, and tracheal areas. A small pillow behind the head keeps the head and neck in functional alignment and limits tension on the suture line. Seizures are a complication of hyponatremia and not a common complication of hypocalcemia. Although deep breathing should be encouraged, coughing should not be encouraged during the first 24 to 48 hours, to limit stress on the suture line.

During a follow-up visit, the nurse finds increased intracranial pressure in a client who has undergone nasal hypophysectomy for hyperpituitarism. Which action taken by the client is responsible for this condition?

Blowing nose and sneezing A client who underwent hypophysectomy should be taught to *perform activities that reduce intracranial pressure*. Blowing the nose and sneezing can increase intracranial pressure. Constipation may result in increased intracranial pressure. Therefore, the client should be advised to take *stool softeners* and change to a *high-fiber diet* to prevent the risk of increased intracranial pressure. *Performing deep breathing exercises* can reduce intracranial pressure. *Bending the knees and lowering the body to pick up objects* reduces the risk of intracranial pressure

*Thyroxin levels* decrease during cold temperatures, thus hypothyroidism causes the client to become very sensitive to cold.

Clients are advised to dress warmly in cold weather to prevent worsening the situation. A client with any disease condition should be instructed to take the medication on time. Hypothyroidism may cause the client to gain weight due to poor metabolic activity. Therefore, the client should be instructed to perform regular exercises and increase proteins in the diet to meet nutritional requirements.

Which drug will the nurse administer to trigger ovulation?

Clomiphene

Moon face, hypertension, and truncal obesity are clinical manifestations of

Cushing's syndrome

Metyrapone is used to treat

Cushing's syndrome.

*Deep respirations* and a *fruity odor* to the breath are classic signs of

DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid.

The primary healthcare provider prescribed carbamazepine to a client with central diabetes insipidus. The serum osmolarity is 600 mOsm (mmol)/kg. Which will be an effective outcome of the drug

Decreased thirst Carbamazepine helps to decrease thirst associated with central diabetes insipidus (DI).

To prevent flexion contractures of the hip, the client w/ an above the knee amputation should not sit for a prolonged time. Raising the head of the bed flexes the hips, which may result in hip flexion contractors.

Ensuring the client's residual limb is elevated may result in a hip flexion contracture and should be avoided.

The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). What measures should the nurse include to increase arterial blood flow to the extremities?

Exercises that promote muscular activity

A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient?

Fats

A client with adrenal insufficiency reports feeling weak and dizzy, especially in the morning. What should the nurse determine is the most probable cause of these symptoms?

Hypoglycemia

nephrogenic diabetes insipidus

Impaired renal response to ADH

The nurse is caring for a client who had a thyroidectomy. Which symptoms will the client exhibit if having a thyrotoxic crisis?

Increased temp and pulse rate

The nurse is caring for a client with *nephrogenic diabetes insipidus* who is prescribed a *low-sodium diet* and *chlorothiazide therapy*. The client fails to respond to the therapy. Which alternative treatment should the nurse be prepared to administer?

Indomethacin

are most readily absorbed and thus increase the blood glucose level quickly.

Liquids containing simple carbohydrates Complex carbohydrates and protein take longer to increase the blood glucose level, so they should be administered after a simple carbohydrate. 50% dextrose may be given if the client is comatose

A client complains of joint pain with deformities. On assessing the client, the nurse suspects that the client has acromegaly. Which medication is beneficial to the client?

Octreotide

While assessing a postpartum client who is suspected of having a thyroid disorder, the nurse suspects that the client has *autoimmune thyroiditis*. Which diagnostic studies are most suitable for confirming the diagnosis?

Radioactive iodine uptake The postpartum client may have silent, painless thyroiditis. Radioactive iodine uptake is suppressed in silent thyroiditis, so this test would be beneficial in diagnosing the thyroiditis. A computed tomography scan is used to detect thyroid nodules. Magnetic resonance imaging is also used in evaluating thyroid nodules. A blood test for thyroid-stimulating hormone is used to evaluate thyroid function

Which parameter monitoring should be the nurse's priority while caring for a client with hypothyroidism?

Respirations Hypothyroidism is associated with a *decreased respiratory rate*. Therefore monitoring the client's respiratory rate should be the nurse's top priority. While hypotension, hypothermia, and pulse rate are important, they are not the priority.

Generally pedal (dependent) edema is not seen in

SIADH despite the water retention.

Pituitary HYPOPLASIA is a malfunction of the pituitary that will result in

Simmonds disease (panhypopituitarism), which has clinical manifestations similar to those for Addison disease.

An individual treated for a thyroid problem by intake of radioactive iodine (131I) becomes mildly radioactive, particularly in the region of the thyroid gland, which preferentially absorbs the iodine.

Such clients should be treated with routine safety precautions for *48 hours* - avoid prolonged contact or near-contact w/ others, - flush toilet 2x's after using b/c radioactive iodine is excreted via the urine -thoroughly wash hands after toileting B/c radioactive iodine is internalized, the client becomes the source of radioactivity. The amt of radioactive iodine used is not enough to cause high radioactivity.

client is scheduled to have a thyroidectomy for thyroid cancer. What specific instruction about postoperative care should the nurse provide the client during preoperative teaching?

Support the head with the hands when changing position Supporting the head with the hands when changing position relieves tension on the incision and limits the risk of dehiscence.

On reviewing the data of a client with thyroid disorder, the primary healthcare provider prescribed atenolol. Which assessment findings would indicate the need for atenolol therapy? Select all that apply. 1 Tachycardia 2 Atrial fibrillation 3 Distant heart sounds 4 Systolic hypertension 5 Decreased cardiac output

Tachycardia A fib Hyper t

The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness (unless that illness is causing vomiting)

The client checking the urine for ketones when blood sugar is over 250, alternating water and Gatorade intake, and continuing insulin indicate that the client has an understanding of the basic sick day rules.

A client is injured in a motor vehicle accident and is admitted to the critical care unit. Twelve hours later the client complains of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed, and an emergency splenectomy is scheduled. What should the nurse emphasize when preparing the client for surgery?

The presence of abdominal drains for several days after the surgery Drains usually are inserted into the splenic bed to facilitate removal of fluid that may lead to abscess formation. Splenectomy has a low mortality rate (5%) except when multiple injuries are present (15% to 40%). Bleeding occurs more commonly with splenic repair than with removal. Educating the client about the risks associated with surgery is the responsibility of the primary healthcare provider. There is no need to frighten the client unnecessary

SIADH is manifested in the form of retention of free water. This is because of excessive secretion of vasopressin causing reabsorption of water in renal tubules.

There is hyponatremia and dilution of serum sodium in SIADH.

Growth hormone level of 7 ng/ml indicates an abnormality. An abnormal increase in shoe size and backache are indicative of hypersecretion of growth hormone.

Therefore *suppression testing* should be performed because *high glucose levels* are known to *suppress the release of growth hormone*. After administering *100 g of oral glucose*, if the client's *levels of growth hormone fail to fall below 5 ng/mL* then an *abnormality in the secretion of growth hormone* is considered.

Nutritional deficiencies due to inadequate diet, especially *decreases in protein* and *iodine intake*, may be a cause for certain endocrine disorders, such as *hypothyroidism*.

Therefore, to meet *nutritional requirements* clients with hypothyroidism are instructed to *increase the intake of seafood* and *proteins* to *60 mg/day*

Thyroglobulin, thyroid peroxidase, and thyroid-stimulating antibodies are assessed in a thyroid antibody test.

This test helps to differentiate other forms of thyroiditis from autoimmune thyroid disease. An active component of total T4 is measured by free thyroxine but cannot differentiate the origin. Thyroid-stimulating hormone levels are used to evaluate a thyroid dysfunction but cannot differentiate the origin.

Graves disease results from an excess of

Thy roid hormones.

Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia).

When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger.

Acromegaly may occur due to overproduction of growth hormone by the pituitary gland, which results in a few physical changes. The client with acromegaly would experience

a barrel-shaped chest thickened lips enlarged hands and feet.

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine

To improve metabolism, clients with diabetes mellitus are advised to

add high-fiber food to their diet

*Human growth hormone therapy* shows BEST results when the hormone is

administered at *nighttime* because the body naturally produces growth hormone at night. Therefore the normal body rhythm is being mimicked to ensure effective therapy. *Subcutaneous* injections of growth hormone yield effective results.

*Decreased estrogen production* associated with

aging affects skin texture makes the skin dry and thin Therefore the nurse should refrain from using tape on the client's skin to prevent skin injury.

an angiogram should be prescribed to rule out the probability of

an aneurysm prior to pituitary tumor removal surgery.

Adequate fluid intake is necessary for urine production; Addison disease involves salt wasting and dehydration, which necessitates

an increased fluid intake

A localized swelling or inflammation in an arterial wall is called an

aneurysm.

A client with *adrenocorticotropic imbalances* experiences

anorexia decreased sodium levels (hyponatremia) postural hypotension.

Growth hormone, follicle-stimulating hormone, and melanocyte-stimulating hormone are hormones secreted by the

anterior pituitary gland.

Clients with Addison disease chronically

are dehydrated and do not have edema. Because of fluid deficits, the client will be hypovolemic, and the blood pressure will be decreased.

A skull x-ray will reveal tumor-induced changes in the

bony sella turcica, which houses the pituitary gland.

Hyperpituitarism is treated by the administration of

bromocriptine which should be taken along with food to reduce side effects.

Anemia is seen in a client with a hypofunctional thyroid and

decreased levels of thyroid hormone. Decreased appetite and distant heart sounds are symptoms of a hypofunctional thyroid gland.

Peripheral vascular disease is indicated by

dependent rubor with pallor on elevation

Blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of.

diabetes

Decreased vasopressin is seen in

diabetes insipidus.

Clients with *cortisol deficiencies* will have

diminished axillary and pubic hair.

An increased extracellular fluid volume is evidenced by

edema, increased blood pressure, and crackles.

Decreased glucose tolerance causes

elevated fasting and random blood glucose levels.

*Stress and activity* increase the secretion of adrenocorticotropic hormone (ACTH) and adrenocortical hormones,

elevating the urine values for the by-products of these hormones, thus invalidating the test results.

Diminished axillary and pubic hair, protruding eyeballs, and elevated blood pressure are signs of

endocrine dysfunction.

Acromegaly results from

excess growth hormone in adults once the epiphyses are closed.

*Thyrotoxic crisis* is *severe hyperthyroidism*;

excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature. During crisis there usually is no increase in the difference between the apical and the peripheral pulse rates (pulse deficit). The *blood pressure will increase* to meet the *oxygen demand* caused by the *increased metabolic rate* during crisis. Because of the increased metabolic rate, the pulse and respiratory rates increase to meet the body's oxygen needs.

Incomplete oxidation of fat results in

fatty acids that further break down to ketones.

Insulin is administered when glucose levels are high as it increases the

glucose reuptake, thereby reducing blood glucose levels.

A combination of *estrogen and progesterone* is generally administered to treat female clients who have a

gonadotropin deficiency.

Clomiphene is used to trigger ovulation for women with

gonadotropin deficiency.

Human growth hormone injections are administered to treat adults with

growth hormone deficiency.

Anorexia is associated with.

hyperglycemia

*Somatostatin* is a hormone released by *delta cells* of the *pancreas* that

inhibits insulin and glucagon.

The primary medication used for the treatment of acromegaly

is octreotide. It is given by *subcutaneous injection* *three times a week*.

A client with *hypoglycemia* suffers with *weakness* and *vision disturbances* due to

low glucose levels

Because of its inverse relationship with calcium, when serum calcium levels increase,

serum phosphorus levels decrease (greater than 3 mg/dL; greater than 0.17 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparath

Because the client has type 1 diabetes, it is essential & priority that

the blood glucose level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage.

Increased blood pressure indicates the presence of pheochromocytoma. The increase in blood pressure could be due to

the increased production of catecholamines, indicating endocrine imbalance Therefore, the client could have a blood pressure of 190/90 mmHg.

*Lysine vasopressin* is also prescribed to clients with *central DI* Because

the kidney is unable to respond to antidiuretic hormone

*Papillary carcinoma* is the *most common* type of

thyroid cancer; it is most often seen in younger women.

Carbamazepine, chlorpropamide, and cyclophosphamide are the medications used in the treatment of

syndrome of inappropriate antidiuretic hormone secretion.

Tolvaptan and conivaptan are used to treat

syndrome of inappropriate antidiuretic hormone.

Slowed cognition is observed in clients with

thyroid hormone imbalance.

*Clomiphene* is used to induce pregnancy by

triggering ovulation. If the desired result is not obtained, the second alternative is to administer *human chorionic gonadotropin* and *gonadotropin-releasing hormone to stimulate ovulation*.

An angiogram is a diagnostic procedure used to

visualize blood flow in arteries.

A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. What is the best response by the nurse?

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

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Administering fluid replacement As a result of *osmotic pressures* created by an *increased serum glucose level*, the *cells become dehydrated*; the client must receive 1. fluid and then 2. insulin. Oxygen therapy is not necessarily indicated.

Research demonstrates that socks with synthetic fibers wick away moisture better than other fabrics when participating in vigorous activities.

Ppl w DM SHOULD WEAR THEM WHEN EXERSIZING

The nurse is assessing a client with a suspected thyroid disorder. Which diagnostic studies will be most appropriate to confirm that the thyroid disorder is autoimmune in origin? Select all that apply.

Thyroglobulin antibody Thyroid peroxidase antibody Thyroid-stimulating antibody Thyroglobulin, thyroid peroxidase, and thyroid-stimulating antibodies are assessed in a thyroid antibody test. This test helps to differentiate other forms of thyroiditis from autoimmune thyroid disease. An active component of total T4 is measured by free thyroxine but cannot differentiate the origin. Thyroid-stimulating hormone levels are used to evaluate a thyroid dysfunction but cannot differentiate the origin.

Computed tomography and magnetic resonance imaging are useful to

obtain distinct images of bony and soft-tissue lesions.

Follicular carcinoma occurs most often in

older adults. (Type of thyroid cancer)

*Medullary carcinoma* is seen mostly in clients

older than 50 years. (Type of thyroid cancer)

*Adrenal insufficiency* is clinically manifested as

patchy white areas on the skin (vitiligo).

Ulcerated skin is a sign of

peripheral neuropathy and peripheral vascular disease.

Weakness with dizziness on arising is

postural hypotension,

In DKA - Serum bicarbonate levels will be low —

below 15 mEq/L (15 mmol/L).

A client exhibiting signs of decreased glucose tolerance, such as - slow wound healing - recurrent yeast infections should be tested for

blood glucose levels.

In pt's w/ central Diabetes insipidus *Chlorpropamide* helps to

decrease thirst seen in clients with central DI.

Decreased ovarian production of estrogen may result in

decreased bone density and thin and dry skin.

Warm clothing and monitoring heart rate are needed for older adult clients with

decreased general metabolism or hypothyroidism

The clinical manifestations of decreased general metabolism are

decreased heart rate Decrased blood pressure decreased appetite decreased tolerance to cold.

While carbamazepine is an antiseizure medication, when given to clients with central DI, it

decreases thirst.

Increased specific gravity is a sign of

fluid volume deficit.

When the head of the pancreas is removed, the client has a

greatly reduced number of insulin-producing cells, and *hyperglycemia* will occur; immediate treatment is necessary. Jaundice, indigestion, and weight loss are not immediately life threatening and will take time to develop.

Decrease muscle strength is seen in clients with

growth hormone imbalance.

Constipation & Hypoactive reflexes is a sign of

hypercalcemia.

Diarrhea and weight loss are the characteristic manifestations of a

hyperfunctional thyroid gland.

*Kussmaul respirations* are associated with

hyperglycemia or ketoacidosis.

Hyperreflexia is observed in clients with

hyperthyroidism and hypoparathyroidism.

Clients with hypoparathyroidism have

hypocalcemia. In order to replenish the calcium levels of the body, the client should consume foods that are rich in calcium. However, *foods rich in phosphorus* such as - - yogurt - processed cheese - milk should be avoided. All the other comments are correct and require no further education by the nurse. Oranges are good source of vitamin C and fibers. They help to improve healing and remove wastes from the body. Exercising is good for overall health. Sitting in the sun allows exposure of the client to sunlight, which is a natural source of vitamin D. Vitamin D helps in the absorption of calcium from the gastrointestinal tract.

Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with

hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.

Dry skin is associated with

hypothyroidism.

Lethargy is found in clients with

hypothyroidism.

When a *low-sodium diet* and *thiazide drugs* such as *chlorothiazide* are *ineffective* in a client with *nephrogenic diabetes insipidus (DI)*, *indomethacin* is prescribed. This drug helps to

increase the renal responsiveness to antidiuretic hormone (ADH)

Bending over at the waist should be avoided after hypophysectomy as this position

increases intracranial pressure in clients who underwent hypophysectomy.

Hydrocortisone is a glucocorticoid that *prevents hypoglycemia* by

increasing liver gluconeogenesis and inhibiting peripheral glucose use.

*Glucagon* is the hormone secreted by the pancreas that helps with

increasing the blood glucose levels.

*Excess fat* alters *glucose metabolism*, causing cells to become

insulin resistant.

With *diabetic ketoacidosis* blood urea nitrogen level generally

is INCREASED b/c of dehydration.

Surgery is most often performed by laparoscopic procedure. The body has two adrenal glands; an aldosteronoma

is a unilateral tumor. The prognosis usually is excellent. The client should be able to return to normal activities and work; however, the client will be receiving hormone replacement until the remaining adrenal gland can produce an adequate amount of hormone. Hormone therapy could last up to two years.

Generalized edema is seen in clients with hypothyroidism due to

mucopolysaccharide accumulation in the tissues.

*Hypokalemia* is evidenced by

nausea, vomiting, muscle weakness, and dysrhythmias.

The *most common* symptoms of *hypoglycemia* are

nervousness weakness perspiration confusion. Bradycardia

Deficiency of glucocorticoids causes hypoglycemia in the client with Addison disease. Clinical manifestations of hypoglycemia include

nervousness; weakness; dizziness; cool, moist skin; hunger; tremors.

Protein metabolism produces

nitrogenous waste, causing elevated blood urea nitrogen (BUN