PrepU Chapter 52: Endocrine (Exam 1)
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?"
-"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 client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? -Magnetic resonance imaging (MRI) -Radioactive iodine uptake test -Radioimmunoassay -A nuclear scan
-Magnetic resonance imaging (MRI) A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.
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.
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? -kidneys -cardiac atria -brain -liver
-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.
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? -A decrease in blood pressure -A decrease in blood glucose levels -A decrease in urine output -A decrease in appetite
-A decrease in urine output Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? -"Maintain a moderate exercise program." -"Rest as much as possible." -"Lose weight." -"Jog at least 2 miles per day."
-"Maintain a moderate exercise program." The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? -Pitting edema of the legs -An irregular apical pulse -Dry mucous membranes -Frequent urination
-An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
The most common cause of hypothyroidism is which of the following? -Autoimmune thyroiditis -Radioiodine therapy -Antithyroid medications -Thyroidectomy
-Autoimmune thyroiditis The most common cause of hypothyroidism is autoimmune thyroiditis (Hashimoto's disease), in which the immune system attacks the thyroid gland. Hypothyroidism can occur in patient with previous hyperthyroidism that has been treated with radioiodine, antithyroid medication treatment, or thyroidectomy.
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? -Blood pressure varying between 120/86 and 240/130 mm Hg -Heart rate of 56-64 bpm -Shivering -Complaints of nausea
-Blood pressure varying between 120/86 and 240/130 mm Hg Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.
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.
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.
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? -Sodium bicarbonate -Fludrocortisone -Calcium gluconate -Methylprednisolone
-Calcium gluconate Tetany and severe hypoparathyroidismare 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.
Trousseau's sign is elicited by which of the following? -Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. -A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. -After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. -The patient complains of pain in the calf when his foot is dorsiflexed.
-Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. The radial artery should not be used for an arterial puncture. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
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.
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? -Cushing syndrome -Addison disease -Graves disease -Hashimoto disease
-Cushing syndrome The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? -Risk for infection -Decreased cardiac output -Impaired physical mobility -Imbalanced nutrition: Less than body requirements
-Decreased cardiac output 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.
A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau's sign. What does the nurse observe to verify this finding? -hand flexing inward -cardiac dysrhythmia -moon face and buffalo hump -bulging forehead
-hand flexing inward The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward.
A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? -Deficient production of vasopressin -Increased antidiuretic hormone -Increased oxytocin -A deficient amount of somatostatin
-Deficient production of vasopressin The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? -Detecting evidence of hormone hypersecretion. -Detecting information about possible tumor growth. -Determining the presence or absence of testosterone levels. -Determining the size of the organs and location.
-Detecting evidence of hormone hypersecretion. The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.
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? -Diabetes insipidus (DI) -Syndrome of inappropriate antidiuretic hormone secretion (SIADH) -Pituitary tumor -Hypothyroidism
-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.
The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? -An allergy to iodine is inherited. -Endocrine disorders can be inherited. -It helps determine the client's general status. -Diet and drug histories are related to the family history.
-Endocrine disorders can be inherited. Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history. A complete blood count and chemistry profile are performed to determine the client's general status and to rule out disorders. Obtaining information about an allergy to iodine is important because diagnostic testing may involve the use of contrast dyes. However, an allergy to iodine is not related to endocrine disorders. Diet and drug histories, although important information, are not associated with the family history.
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply. -Fetal hypothyroidism -Fetal bradycardia -Goiter -Cretinism -Fetal tachycardia
-Fetal hypothyroidism Antithyroid medications are contraindicated in late pregnancy because the fetus may develop fetal hypothyroidism, fetal bradycardia, goiter, and cretinism.
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 -Fine-needle biopsy of the thyroid gland -Free T4 analysis -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 outcome indicates that treatment of a client with diabetes insipidus has been effective? -Fluid intake is less than 2,500 ml/day. -Urine output measures more than 200 ml/hour. -Blood pressure is 90/50 mm Hg. -Heart rate is 126 beats/minute.
-Fluid intake is less than 2,500 ml/day. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? -Gigantism -Dwarfism -Acromegaly -Simmonds' disease
-Gigantism When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? -Gigantism -Dwarfism -Acromegaly -Simmonds' disease
-Gigantism When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? -Hand flexing inward -Cardiac dysrhythmia -Moon face and buffalo hump -Bulging forehead
-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.
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 -Hysteroscopy -Thyroidectomy -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 has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. -Hypothermia -Hypertension -Hypotension -Hypoventilation -Hyperventilation
-Hypothermia -Hypotension -Hypoventilation Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: -Fatigue -Weight gain -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.
For a client with Graves' disease, which nursing intervention promotes comfort? -Restricting intake of oral fluids -Placing extra blankets on the client's bed -Limiting intake of high-carbohydrate foods -Maintaining room temperature in the low-normal range
-Maintaining room temperature in the low-normal range Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.
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.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? -Exophthalmos -Thyroid storm -Myxedema coma -Tibial myxedema
-Myxedema coma Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
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.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? -Somatotropin -Prolactin -Oxytocin -Adrenocorticotropic hormone
-Oxytocin The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? -Thymus gland, thymosin -Parathyroid glands, parathormone -Pineal gland, melatonin -Adrenal cortex, corticosteroids
-Pineal gland, melatonin The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamicpituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.
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.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms? -hyperpituitarism -hypopituitarism -panhypopituitarism -panhyperpituitarism
-hyperpituitarism Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? -Provide a high-sodium diet. -Examine extremities for pitting edema. -Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. -Administer prescribed diuretics.
-Provide a high-sodium diet. Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water.
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? -Related to bone demineralization resulting in pathologic fractures -Related to exhaustion secondary to an accelerated metabolic rate -Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces -Related to tetany secondary to a decreased serum calcium level
-Related to bone demineralization resulting in pathologic fractures Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This increase, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.
Patients with hyperthyroidism are characteristically: -Apathetic and anorexic -Calm -Emotionally stable -Sensitive to heat
-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 nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see? -Serum potassium level of 6.8 mEq/L -Blood urea nitrogen (BUN) level of 2.3 mg/dl -Serum sodium level of 156 mEq/L -Serum glucose level of 236 mg/dl
-Serum potassium level of 6.8 mEq/L A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion. A BUN level of 2.3 mg/dl is lower than normal. A client in addisonian crisis is likely to have an increased BUN level because the glomerular filtration rate is reduced. A serum sodium level of 156 mEq/L indicates hypernatremia. Hyponatremia is more likely in this client because of reduced aldosterone secretion. A serum glucose level of 236 mg/dl indicates hyperglycemia. This client is likely to have hypoglycemia caused by reduced cortisol secretion, which impairs glyconeogenesis.
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 -Produce a new hormone to try and regulate the thyroid function -The feedback loop will be unable to perform in response to low levels of thyroid hormone.
-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.
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
-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.
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? -Tetany -Hemorrhage -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.
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.
Cardiac effects of hyperthyroidism include -decreased pulse pressure. -decreased systolic blood pressure. -bradycardia. -palpitations.
-palpitations. Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? -The symptoms are permanent side effects of the corticosteroid therapy. -The moon face and acne will resolve when the medication is tapered off. -Those symptoms are not related to the corticosteroid therapy. -The dose of the medication must be too high and should be lowered.
-The moon face and acne will resolve when the medication is tapered off. Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? -The secretions are released directly into the blood stream. -The glands contain ducts that produce the hormones. -The secreted hormones act like target cells. -The glands play a minor role in maintaining homeostasis.
-The secretions are released directly into the blood stream. The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.
Which hormone is secreted by the posterior pituitary? -Vasopressin -Calcitonin -Corticosteroids -Somatostatin
-Vasopressin Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? -Fatigue -Dyspnea -Weight loss -Hair loss
-Weight loss Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: -an ectopic corticotropin-secreting tumor. -adrenal carcinoma. -a corticotropin-secreting pituitary adenoma. -an inborn error of metabolism.
-a corticotropin-secreting pituitary adenoma. A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.
A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? -adrenal function -thyroid function -thymus function -parathyroid function
-adrenal function The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.
Trousseau sign is elicited -by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. -by tapping sharply over the facial nerve just in front of the parotid gland and anterior to the ear, causing spasm or twitching of the mouth, nose, and eye. -after making a clenched fist and opening the hand; the palm remains blanched when pressure is placed over the radial artery. -when the foot is dorsiflexed and there is pain in the calf.
-by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.
Which diagnostic test is done to determine suspected pituitary tumor? -computed tomography scan -measurement of blood hormone levels -radioimmunoassay -radiographs of the abdomen
-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 is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: -exophthalmos and conjunctival redness. -flushed, warm, moist skin. -systolic murmur at the left sternal border. -decreased body temperature and cold intolerance.
-decreased body temperature and cold intolerance. Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
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.
A nurse educator is teaching a chapter on "The Function of the Endocrine System." Which hormone would not be included as one of the six hypothalamic hormones? -prolactin -corticotropin-releasing hormone -thyrotropin-releasing hormone -gonadotropin-releasing hormone
-prolactin Hypothalamic dopamine inhibits the release of prolactin from the anterior pituitary gland. Corticotropin-releasing hormone (CRH) causes the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). Thyrotropin-releasing hormone (TRH) stimulates the release of thyroid-stimulating hormone (TSH) from the anterior pituitary gland. Gonadotropin-releasing hormone (GnRH) triggers sexual development at the onset of puberty and continues to cause the anterior pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH).