Exam 5: Endocrine System

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones would the nurse expect to be decreased as a result? (Select all that apply.) a. Thyroid-stimulating hormone b.Vasopressin c. Follicle-stimulating hormone d. Calcitonin e. Growth hormone

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

A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding would indicate that the medication is effective? a. Heart rate of 92 beats/min b. Respiratory rate of 18 breaths/min c. Oxygenation saturation of 92% d. Blood pressure of 144/69 mm Hg

A. Heart rate of 92 beats/min Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The other vital signs are within normal limits and do not indicate any response to the medication.

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

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

A nurse assesses a client with Cushing disease. Which assessment findings would the nurse expect? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

A. Moon Face D. Petechiae E. Muscle atrophy Clinical manifestations of Cushing disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

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

A. Turn the lights down and shut the patient's door. A temperature increase of 1° F (5/9° C) may indicate the development of thyroid storm, and the primary health care provider or RRT needs to be notified. But before notifying the provider, the nurse should first take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and acetaminophen is not needed because the temperature increase is due to thyroid activity.

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

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

The nurse is caring for a client who is starting on propylthiouracil for hyperthyroidism. What statement by the client indicates a need for further teaching? a. "I will let my provider know if I have weight gain and cold intolerance." b. "I will let my provider know if I have a metallic taste or stomach upset." c. "I will avoid crowds and other people who have infection." d. "I am aware that if the drug changes the color of my urine, I should stop it."

B. "I will let my provider know if I have a metallic taste or stomach upset." If the client's urine turns dark and/or the skin has a yellow appearance, the client may have possible liver toxicity from the drug. This is a serious adverse effect and needs to be reported to the primary health care provider after stopping the drug. If weight gain and cold intolerance occurs, then the client may need a lower dose of the drug. The drug should not cause GI distress or a metallic taste in his or her mouth.

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

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

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

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

A nurse is caring for a patient who has excessive catecholamine release. Which assessment finding would the nurse correlate with this condition? a. Decreased blood pressure b. Increased pulse c. Decreased respiratory rate d. Increased urine output

B. Increased pulse Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication does the nurse prepare to administer? a. Atropine sulfate b. Levothyroxine c. Propranolol d. Epinephrine

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

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate? a. Consult with the dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for repositioning. d. Instruct assistive personnel to measure intake and output.

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

The nurse is planning health teaching for a client starting on levothyroxine. What health teaching about this drug would the nurse include? a. The need to take the drug when the client feels fatigued and weak. b. The need to report chest pain and dyspnea when starting the drug. c. The need to check blood pressure and pulse every day. d. The need to rotate injection sites when giving self the drug.

B. The need to report chest pain and dyspnea when starting the drug. Levothyroxine is a replacement hormone for clients who have hypothyroidism and is taken orally for life. Vital signs do not have to be checked every day, but the client should report any chest pain and dyspnea when first starting the drug.

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

C. "You'll need thyroid pills for life because your thyroid won't start working again." Hashimoto thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy and will not be able to stop taking the medication.

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the first postoperative day before discharge, the client states, "I feel numbness and tingling around my mouth." What action does the nurse take? a. Offer mouth care. b. Loosen the dressing. c. Assess for muscle twitching. d. Ask the client orientation questions

C. Assess for muscle twitching. Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse would assess for muscle twitching and, if present, notify the surgeon or Rapid Response Team to give calcium gluconate or other IV calcium replacement. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

The nurse assesses an older client. What age-related physiologic changes would the nurse expect? a. Heat intolerance b. Rheumatoid arthritis c. Dehydration d. Increased appetite

C. dehydration As people age, the many of the endocrine glands decrease hormone production, including a decrease in antidiuretic hormone production. This change, in addition to less body fluid being present as one ages, can cause dehydration. Older adults usually have cold intolerance and a decrease in appetite. Rheumatoid arthritis is not an age related change; osteoarthritis causes primarily by aging.

The parathyroid gland a. in response to the releasing hormones of the hypothalamus, secrete some tropic hormones that have as their target tissues other endocrine glands. b. secrete mineralocorticoids and glucocorticoids that affect the entire body in helping to control fluid and electrolyte balance. c. secrete digestive enzymes, glucagon, insulin, and somatostatin. d. secrete parathyroid hormone (PTH) which regulates calcium and phosphorus metabolism by acting on bones, the kidneys, and the G

D. secrete parathyroid hormone (PTH) which regulates calcium and phosphorus metabolism by acting on bones, the kidneys, and the GI tract. PTH increases bone resorption (bone release of calcium into the blood from bone storage sites), thus increasing serum calcium. In the kidneys, PTH activates vitamin D, which then increases the absorption of calcium and phosphorus from the intestines. In the kidney tubules, PTH allows calcium to be reabsorbed and put back into the blood. Serum calcium levels determine PTH secretion. Secretion decreases when serum calcium levels are high, and it increases when serum calcium levels are low.

Which assessment finding would the nurse expect to increase in a client with Cushing syndrome?

Glucose level

Which clinical feature is indicative of hypercortisolism?

Increased pigmentation

Which statement regarding calcitonin is correct?

Its actions are opposite to that of parathyroid hormone.

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. Which would the nurse consider when formulating a response?

Less thyroid tissue is available to supply thyroid hormone after surgery.

Assessment findings of a client include fatigue, hair loss, weight gain, and diagnostic tests indicating anemia. The nurse anticipates a prescription for which therapy?

Levothyroxine

Which clinical finding would the nurse expect when assessing a client with Cushing syndrome?

Liability of mood. Slow wound healing.

A nurse educator instructs a new nurse during orientation about the physiological processes of the endocrine system. Which statement made by the new nurse indicates effective learning?

"The hormones of the endocrine system exert their action by 'lock and key' mechanism."

Which discharge instruction would the nurse emphasize when preparing a client with Addison disease for discharge?

"Continue steroid replacement therapy."

Which explanation will the nurse give as to why potassium iodide solution should be taken before a subtotal thyroidectomy?

"It will reduce the risk of hemorrhage during surgery."

Match the descriptor on the left with the most appropriate phrase/term on the right. 1. Testing used when hormone levels are high or in the upper range of normal. Drugs or other substances known to normally suppress hormone production are administered. Failure of suppression of hormone production during testing indicates hyperfunction. 2. Measured amounts of selected hormones are given to stimulate the target gland to maximum production. Hormone levels are then measured and compared with expect

1. c. suppression testing 2. e. provocative testing For the patient who might have an underactive endocrine gland, a stimulus may be used to determine whether the gland is capable of normal hormone production. This method is called provocative testing. Measured amounts of selected hormones are given to stimulate the target gland to maximum production. Hormone levels are then measured and compared with expected normal values. Failure of the hormone level to rise with provocation indicates hypofunction. Suppression tests are used when hormone levels are high or in the upper range of normal. Drugs or other substances known to normally suppress hormone production are administered. Failure of suppression of hormone production during testing indicates hyperfunction.

Match the drug therapy on the left with the most appropriate disease process for which it is utilized on the right. 1. calcimimetic 2. levothyroxine 3. hypocalcemia therapy 4. methimazole

1. hyperparathyroidism 2. hypothyroidism 3. hypoparathyroidism 4. hyperthyroidism

A client has undergone nasal hypophysectomy surgery. During postoperative care, the nurse would monitor the client for which indication of cerebrospinal fluid leakage?

A yellow edge around nasal discharge

A nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) with assistive personnel. What statement by the AP indicates understanding of this client's care? a. "I will weigh the client carefully before breakfast and compare with yesterday's weight." b. "I will encourage plenty of fluids to promote urination and prevent dehydration." c. "I will teach the client not to select high-sodium or salty foods on the menu." d. "I will assess the client's m

A. "I will weight the client carefully before breakfast and compare with yesterday's weight." The client with SIADH usually has a fluid restriction, not an increase in fluids. It is the role of the RN rather than AP to perform assessments and provide health teaching. The AP needs to weigh the client daily and report a significant weight changes.

A client is admitted with a possible diagnosis of diabetes insidious (DI). What assessment findings would the nurse expect? (Select all that apply.) a. Hypotension b. Increased Urinary output c. Concentrated urine d. Decreased thirst e. Poor skin turgor f. Bradycardia

A. Hypotension B. Increased urinary output E. Poor skin turgor The client who has DI has excessive urination and dehydration. Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor. The urine is dilute with a low specific gravity.

The adrenal glands a. secrete mineralocorticoids and glucocorticoids that affect the entire body in helping to control fluid and electrolyte balance b. control metabolism and calcium and phosphorus balance c. regulate calcium and phosphorus metabolism by acting on bones, the kidneys, and the GI tract d. in response to the releasing hormones of the hypothalamus, secretes some tropic hormones that have as their target tissues other endocrine glands

A. secrete mineralocorticoids and glucocorticoids that affect the entire body in helping to control fluid and electrolyte balance. Adrenal hormones affect the entire body. The adrenal cortex makes up about 90% of the adrenal gland. The main hormone types secreted by the cortex are the mineralocorticoids and the glucocorticoids. Mineralocorticoids are produced and secreted by the adrenal cortex to help control fluid and electrolyte balance. Glucocorticoids are produced by the adrenal cortex and are essential for life.

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

A. sodium: 150 mEq/L C. potassium: 2.5 mEq/L E. pH: 7.28 Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

Which intervention would be included in the plan of care for a client diagnosed with hyperthyroidism?

Arrange for sufficient rest periods.

Which instructions would be included when teaching a client with hyperthyroidism who just had radioactive iodine to ablate thyroid tissue?

Avoid holding an infant

A nurse assesses a female client who presents with hirsutism. Which question would the nurse ask when assessing this client? a. "How do you plan to pay for your treatments?" b. "How do you feel about yourself?" c. "What medications are you prescribed?" d. "What are you doing to prevent this from happening?"

B. "How do you feel about yourself?" Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse would inquire into the client's body image and self-perception. Asking about the client's financial status or current medications does not address the client's immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.

A nurse teaches an older woman who has a decreased production of estrogen. Which statement would the nurse include in this client's teaching to decrease injury? a. "Drink at least 2 quarts (2 L) of fluids each day." b. "Walk around the neighborhood for daily exercise." c. "Bathe your perineal area twice a day." d. "You should check your blood glucose before meals."

B. "Walk around the neighborhood for daily exercise." An older female with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse would encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.

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

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

The nurse is teaching a client who underwent a hypophysectomy for hyperpituitarism about self-management. Which actions performed by the client could cause complications on the second postoperative day?

Blowing the nose Brushing teeth Bending forward

Which are neurological manifestations of hyperthyroidism?

Blurred vision and exophthalmos (eyeballs are protruded)

The nurse is teaching assistive personnel (AP) about hormones that are produced by the adrenal glands. Which hormone has the primary responsibility of maintaining fluid volume and electrolyte composition? a. Sodium b. Magnesium c. Aldosterone d. Renin

C. Aldosterone Aldosterone is a hormone secreted by the adrenal cortex that causes water and sodium absorption to maintain body fluid volume. Renin is secreted by the kidney to trigger angiotensinogen converting angiotensin I to angiotensin II to help control blood pressure. Magnesium and sodium are electrolytes and not hormones

Which symptom would the nurse monitor for when caring for a client who has hyponatremia?

Change in level of consciousness

While reviewing the client's laboratory reports, the nurse finds that there is an elevation in the client's growth hormone levels. Which key physical changes would the nurse expect to find if acromegaly is suspected?

Facial shape Chest shape Lip thickness Length of hands

A client reports unexplained weight gain and back pain from a compression fracture of the vertebrae. On assessment, the nurse notes truncal obesity with excessively thin extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. Which disease process would the nurse anticipate incorporating into the plan of care?

Cushing Disease

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

D. "I am always tired, even with 12 hours of sleep." Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Most thyroid problems are not inherited, although they may occur in families. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism. The nurse would assess the client further for hypothyroidism.

A nurse assesses a client who is prescribed levothyroxine for hypothyroidism. Which assessment finding alerts the nurse that drug therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm3 (6 109/L). d. Heart rate is 76 beats/min and regular

D. Heart rate is 76 beats/min and regular Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

The nurse assesses a client who is scheduled to have a laboratory test to determine if the client's adrenal glands are hypoactive. What type of testing would the client likely have? a. Catecholamine testing b. Suppression testing c. Bone marrow testing d. Provocative testing

D. Provocative testing Provocative testing is done to determine if an endocrine gland is capable of producing its normal level of hormone(s), especially when a client is suspected of having a hypoactive endocrine gland.

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy? a. The need to check the client's urinary specific gravity. b. The need to take blood pressure at least twice a day. c. The need to monitor blood glucose every day. d. The need to weigh every day and report weight gain

D. The need to weigh every day and report weight gain. The client with DI who takes lifelong hormone replacement will need to report significant weight gain to monitor for water toxicity. Water toxicity causes headache, vomiting, and acute confusion.

Which finding would the nurse expect for a client who has just developed the syndrome of inappropriate secretion of antidiuretic hormone (ADH)?

Decreased urine volume

When assessing a client with diabetes insipidus, which sign would the nurse anticipate finding?

Excessive thirst Dry mucous membranes Decreased urine specific gravity

Which symptom would the nurse identify when assessing a client with Graves disease?

Exophthalmos

Which medication would the nurse expect to be prescribed for a client who is scheduled for a bilateral adrenalectomy?

Hydrocortisone

Which response would the nurse expect a client to exhibit who is in addisonian crisis?

Hyperkalemia Hyponatremia Postural hypotension

A client is admitted with a head injury and has large amounts of clear, colorless urine draining from the urinary catheter. Which physiological response is possibly causing the increased urine output?

Inadequate antidiuretic hormone (ADH) secretion

Which parameter would the nurse monitor to evaluate the effectiveness of desmopressin acetate (DDAVP) administered to a client with diabetes insipidus?

Intake and Output

Which sign or symptom might the nurse identify when assessing a client with hyperthyroidism?

Menstrual irregularities Flushed appearance Short attention span

Which findings in a client may indicate potential thyrotoxic crisis?

Rapid heartbeat and tremors

Which clinical manifestations would be expected in a client with hypo secretion of growth hormone?

Reduced bone density

Which reason would the nurse provide for the gradual reduction in dosage to a client who recently started receiving oral corticosteroids for a severe allergic reaction and is instructed that the dosage will be reduced gradually until all medication is stopped at the end of 2 weeks?

Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed.

Which assessment finding would indicate the need for atenolol in a client with hyperthyroidism?

Tachycardia Atrial fibrillation Systolic hypertension

The nurse is educating a client with hypothyroidism about the use of levothyroxine. Which information would the nurse provide?

Take dose same time each day. Refrain from switching brands. Have regular bloodwork drawn.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." Which intervention is appropriate for the nurse to take?

Test for Chvostek and Trousseau signs and notify the primary health care provider of the complaints.

Which clinical manifestation exhibited by a client taking levothyroxine for hypothyroidism for 3 months would cause a nurse to suspect that a decrease in dosage is needed?

Tremors Heat Intolerance

Which clinical finding would the nurse expect to see when assessing a client with a primary brain tumor who has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH)?

Vomiting Increased weight Decreased serum sodium Decreased level of consciousness

Which responses would the nurse expect a client to exhibit as a result of decreased levels of triiodothyronine (T3) and thyroxine (T4)?

Weight gain Cold intolerance

A client is scheduled to have a glycosylated hemoglobin (A1C) drawn and asks the nurse why she has to have it. How would the nurse respond? a. "It measures your average blood glucose level for the past 3 months." b. "It determines what type of anemia you may have." c. "It measures the amount of liver glycogen you have." d. "It determines you have some type of leukemia or other blood cancer."

A. "It measures your average blood glucose level for the past 3 months." A1C measures the average blood glucose level to determine if the client is a diabetic or how controlled a diabetic client is.

The organs and tissues of the endocrine system contain ___1___ cells that secrete ____2____, which are natural biochemicals that exert their effects on specific target tissues.

1. glandular 2. hormones The organs and tissues of the endocrine system contain glandular cells that secrete hormones , which are natural biochemicals that exert their effects on specific target tissues. Target tissues have receptors corresponding to different hormones that when bound to the hormones respond by changing their activity. These glands are ductless and have no direct connection between the glands and their target tissues, which may be located some distance from the endocrine gland. Instead, the hormones secreted from endocrine glands are secreted into the blood for transportation to the target tissues.

Match the drug therapy on the left with the most appropriate disease process for which it is utilized on the right. 1. tolvaptan, conivaptan 2. bromocriptine, cabergoline, somatostatin analogs (i.e., lanreotide) 3. desmopressin 4. steroidogenesis inhibitors (i.e., metyrapone, aminoglutethimide, mitotane) 5. hormone replacement therapy (i.e., testosterone, estrogen, progesterone) 6. hydrocortisone, prednisone, fludrocortisone

1. syndrome of inappropriate antidiuretic hormone (SIADH) 2. hyperpituitarism 3. diabetes insipidus 4. hypercortisolism (Cushing disease) 5. hypopituitarism 6. adrenal insufficiency

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

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

The nurse is caring for a client who has acromegaly. What physical change would the nurse expect to observe? a. Large hands and face b. Thin, dry skin c. Short height d. Truncal obesity

A. Large hands and face The client who has acromegaly has an excess of growth hormone as an adult and therefore has a large musculoskeletal structure that is readily observed.

When caring for an older client who has hypothyroidism, what assessment findings will the nurse expect? (Select all that apply.) a. Lethargy b. Diarrhea c. Low body temperature d. Tachycardia e. Slowed speech f. Weight gain

A. Lethargy C. Low body temperature E. Slowed speech F. Weight Gain A client who has an underactive thyroid gland has a decreased metabolic rate, resulting in lethargy and lack of energy, weight gain, slowed speech, and decreased vital signs like a lowered body temperature. The client also typically has constipation (instead of diarrhea) due to slower peristalsis and bradycardia (instead of tachycardia).

The nurse is caring for a client who has possible hypothyroidism. What possible risk factors can cause this health problem? (Select all that apply.) a. Lithium drug therapy b. Thyroid cancer c. Autoimmune thyroid disease d. Iodine deficiency e. Laryngitis f. Pituitary tumors

A. Lithium drug therapy B. Thyroid cancer C. Autoimmune thyroid disease D. Iodine deficiency F. Pituitary tumors All of these factors place a client at risk for hypothyroidism except for laryngitis which is an inflammation of the larynx.

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

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

The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse monitor? a. Hypertension b. Bradycardia c. Dehydration d. Pulmonary embolus

C. Dehydration The client who has DI has fluid loss through excessive urination. Decreased fluid volume, or dehydration, is manifested by tachycardia, hypotension, and possibly elevated temperature. Pulmonary embolism (PE) could possible as a clot in the lower extremity (caused by dehydration) could fragment and travel to the lungs.

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

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

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

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

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor? a. Increased intracranial pressure b. Myocardial infarction c. Rapid-onset hypernatremia d. Bowel perforation

C. Rapid-onset hypernatremia Tolvaptan has a black box warning that rapid increases in serum sodium levels have been associated with central nervous system demyelination that can lead to serious complications and death.

A nurse plans care for a client with a growth hormone deficiency. Which action would the nurse include in this client's plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to reposition the patient. d. Assist the client to dangle before rising.

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

The nurse is caring for a client with acromegaly who is starting bromocriptine. What health teaching by the nurse about drug therapy will the nurse include? a. "Take this drug on an empty stomach first thing in the morning." b. "You will be starting on a high dose of the drug to ensure it will work." c. "You might experience an increase in blood pressure in about a week." d. "Seek medical attention immediately if you have chest pain and dizziness."

D. "Seek medical attention immediately if you have chest pain and dizziness. Bromocriptine should be started on a low dose and taken with food. The drug can cause decreased blood pressure, including orthostatic hypotension. Serious effects such as cardiac dysrhythmias, coronary artery spasms, and cerebrospinal leak can occur. Therefore, the nurse teaches the client should seek medical attention if he or she experiences chest pain, dizziness, and watery nasal discharge.

The nurse reviews the function of thyroid gland hormones. What is the primary function of calcitonin? a. Sodium and potassium balance b. Magnesium balance c. Norepinephrine balance d. Calcium and phosphorus balance

D. Calcium and phosphorus balance Calcitonin is the primary body hormone that is secreted from the thyroid gland and is responsible for maintaining calcium and phosphorus balance.

The nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform? a. Respiratory assessment b. Skin assessment c. Neurologic assessment d. Cardiac assessment

D. Cardiac assessment The client who has adrenal insufficiency has hyperkalemia that can cause cardiac dysrhythmias. Therefore, the nurse would monitor the client's cardiovascular status through frequent assessments.

A nurse assesses a client who is recovering from a subtotal thyroidectomy and observes the development of stridor. What is the priority action for the nurse to take? a. Apply oxygen via nasal cannula at 2 L/min. b. Document the finding and assess the client hourly. c. Place the client in high-Fowler position in the bed. d. Contact the Rapid Response Team and prepare for intubation.

D. Contact the Rapid Response Team and prepare for intubation. Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.

The thyroid gland a. in response to the releasing hormones of the hypothalamus, secretes some tropic hormones that have as their target tissues other endocrine glands. b. regulates calcium and phosphorus metabolism by acting on bones, the kidneys, and the GI tract. c. secretes mineralocorticoids and glucocorticoids that affect the entire body in helping to control fluid and electrolyte balance. d. helps control metabolism and calcium and phosphorus balance.

D. helps control metabolism and calcium and phosphorus balance. Control of metabolism occurs through triiodothyronine (T3) and thyroxine (T4.). Calcium and phosphorus balance occurs partly through the actions of calcitonin (thyrocalcitonin [TCT]), which also is produced in the thyroid gland.

Which purpose would the nurse include when explaining why a client with hyperthyroidism is prescribed potassium iodide solution before a subtotal thyroidectomy is performed?

Decreases the size and vascularity of the thyroid gland

A nurse collaborates with assistive personal (AP) to provide care for a client who is prescribed a 24 hour urine specimen collection. Which statement would the nurse include when teaching the AP about this activity? a. "Note the time of the client's first void and collect urine for 24 hours." b. "Add the preservative to the container at the end of the test." c. "Start the collection by saving the first urine of the morning." d. "It is okay if one urine sample during the 24 hours

A. "Note the time of the client's first void and collect urine for 24 hours." The collection of a 24-hour urine specimen is often delegated to AP. The 24-hour urine collection specimen is started after the client's first urination. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client's first void is noted.

A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine disorder? (Select all that apply.) a. Excessive thyroid-stimulating hormone—increased bone formation b. Excessive melanocyte-stimulating hormone—darkening of the skin c. Excessive parathyroid hormone—synthesis and release of corticosteroids d. Excessive antidiuretic hormone—increased urinary output e. Excessive adrenocorticotropic hormone—increased bone resorption

A. Excessive thyroid-stimulating hormone-increased bone formation B. Excessive melanocyte-stimulating hormone-darkening of the skin Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte-stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.