Endocrine Prep-U (Hard)
The nurse is aware that the best time of day for the total large corticosteroid dose is between:
7 AM -8AM R: 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.
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences: A. heat intolerance and systolic hypertension. B. weight gain and heat intolerance. C. anorexia and hyperexcitability. D. diastolic hypertension and widened pulse pressure.
A R:An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs because of the increased metabolic rate. Diastolic blood pressure decreases because of decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite — not anorexia.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? A. Tachycardia B. Leg cramps C. Dysuria D. Blurred vision
A R:Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A. Decreased cardiac output B. Imbalanced nutrition: Less than body requirements C. Risk for infection D. Impaired physical mobility
A R: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.
Which hormones are secreted by the posterior lobe of the pituitary gland? Select all that apply. A. Vasopressin B. Thyroid-stimulating hormone (TSH) C. Follicle-stimulating hormone (FSH) D. Oxytocin E. Luteinizing hormone (LH)
A,D R:Important hormones secreted by the posterior lobe of the pituitary gland include vasopressin and oxytocin. TSH, FSH, and LH are secreted by the anterior lobe of the pituitary gland.
When caring for a client who's being treated for hyperthyroidism, the nurse should: A. encourage the client to be active to prevent constipation. B. balance the client's periods of activity and rest. C. provide extra blankets and clothing to keep the client warm. D. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy.
B R:A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.
A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer: A. felodipine (Plendil). B. phentolamine (Regitine). C. methyldopa (Aldomet). D. mannitol (Osmitrol).
B R:Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn't effective in treating hypertensive emergencies. Mannitol, a diuretic, isn't used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? A. Weight loss, increased urination, and increased thirst B. Weight gain, decreased appetite, and constipation C. Weight loss, increased appetite, and hyperdefecation D. Weight gain, increased urination, and purplish-red striae
B R:Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? A. "I will avoid friends and family members who are sick." B. "I may stop taking this medication when I feel better." C. "I will see my ophthalmologist regularly for a check-up." D. "I will eat lots of chicken and dairy products."
B R: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.
What is the most common cause of hyperaldosteronism? A. Excessive sodium intake B. A pituitary adenoma C. An adrenal adenoma D. Deficient potassium intake
C R: An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. What is used to treat tetany?
Calcium gluconate R: 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.
A client with pheochromocytomais scheduled for an adrenalectomy. Which of the following would the nurse perform preoperatively? A. Check for the signs of adrenal insufficiency. B. Initiate intravenous access for fluid therapy. C. Begin administering prescribed corticosteroid. D. Monitor blood pressure (BP) frequently.
D R:The nurse should monitor BP frequently before surgery when a client has a pheochromocytoma. When bilateral adrenalectomy is scheduled, the nurse may start IV administration of a solution containing a corticosteroid preparation the morning of surgery. Some surgeons prefer to initiate corticosteroid administration during removal of the adrenals. The nurse monitors for signs of adrenal insufficiency after the surgery.