Unit 11 Study Guide
Cardiac effects of hyperthyroidism include: a. Decreased pulse pressure b. Palpitations c. Decreased systolic blood pressure d. Bradycardia
b Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.
A nurse is reviewing the laboratory test results of a client and notes that the client serum calcium is elevated. Which hormone with the nurse most likely identify as being involved with this elevation? a. T3 b. Parathormone c. Calcitonin d. T4
b Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates metabolism of calcium and phosphorus.
A nurse is providing care to a client who is experiencing low blood glucose levels. The nurse understands that the body attempts to raise the level by secreting which hormone? a. Insulin b. Glucagon c. Aldosterone d. Somatostatin
b The beta cells of the pancreas secrete insulin, which facilitates glucose transport into body cells, thus lowering the blood glucose levels when they are above normal.
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a. Graves' disease b. Cushing syndrome c. Addison's disease d. Hashimoto's disease
b The client with Cushing's 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's syndrome are primarily as a result of the over secretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.
A client with symptoms of Cushing's syndrome is admitted to the hospital for evaluation and treatment. The nurse is creating a plan of care for the client. Which is an appropriate nursing diagnosis? a. Activity intolerance related to muscle cramps, cardiac dysrhythmias, and weakness b. Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns c. Impaired nutrition: more than body requirements related to polyphagia d. Insomnia related to increased nighttime voiding
b The major goals for the client include decreased risk of injury, decreased risk of infection, increased ability to perform self-care activities, improve skin integrity, improved body image, improved mental function, and absence of complications. The other nursing diagnoses do not apply in Cushing syndrome.
What hormone is secreted by the posterior pituitary? a. Calcitonin b. Vasopressin c. Somatostatin d. Corticosteroids
b Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Cortical steroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.
A client is diagnosed with acute addisonian crisis. When planning the clients care, which action with the nurse most likely include? a. Allowing the client up ad lib b. Performing all activities for the client c. Permitting the client to shower in the bathroom d. Encouraging bed rest with bathroom privileges
b With a cute addisonian crisis, unnecessary activity and stress that could precipitate another hypotensive episode are avoided until the clients condition is stabilized. The nurse assesses for signs of infection or presence of other stressors. Even minor events or stressors may be excessive in clients with adrenal insufficiency. During the acute crisis, the nurse maintains a quiet, non-stressful environment and performs all activities for the client.
A client is diagnosed with Addison's disease. When reviewing the clients laboratory tests, which result with the nurse most likely note? Select all that apply. a. Serum sodium 139 mEq/L b. Serum potassium 6.2 mEq/L c. Blood glucose 70 mg/dL d. Serum calcium 5.0 mEq/L e. Serum chloride 100 mEq/L
b, c Addison's disease is characterized by muscle weakness, anorexia, G.I. symptoms, fatigue, and satiation, skin pigmentation changes, and hypotension as well as low blood glucose, low serum sodium, and high serum potassium levels. The blood glucose level listed is low; the serum potassium level listed as high. The other results are within normal parameters.
Which disorder results from excessive secretion of somatotropin (growth hormone - GH)? a. Cretinism b. Adrenogenital Syndrome c. Acromegaly d. Dwarfism
c The client with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet.
A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the clients concern and promote effective coping strategies? a. Refer the client to professional counseling. b. Suggest that the client wear cosmetics to cover any changes in appearance. c. Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. d. Encourage the client to participate in outside activities to boost coping strategies.
c The client with hyperthyroidism needs reassurance that the emotional reactions being experienced or as a result of the disorder and that with affective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with a client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not over stimulate the client. It is important to balance periods of activity with rest.
Dilutional hyponatremia occurs in which disorder? a. Pheochromocytoma b. Addison's Disease c. SIADH d. DI
c Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
Which is a clinical manifestation of DI? a. Excessive activities b. Low UO c. Excessive thirst d. Weight gain
c UO may be as high as 20 L in 24 hours. Thirst is excessive and constant.
A nurse is assessing a client experiencing a severe anxiety attack. The nurse understands that the clients physiologic response to unknown fear involve secretion of which hormone? a. Hydrocortisone b. Thyroid stimulating hormone c. Aldosterone d. Epinephrine
d Simulation of preganglionic sympathetic nerve fibers, which travel directly to the cells of the adrenal medulla, causes the release of the catecholamine hormones epinephrine and norepinephrine.
A nurse is teaching a client with an endocrine disorder how the nervous system and endocrine system are linked. Which structure with the nurse identify as a link between the two systems? a. Pancreas b. Brain c. Medulla oblongata d. Hypothalamus
d The hypothalamus is the link between the nervous system and the endocrine system. The hypothalamus controls the pituitary gland, which secretes hormones to influence the target clans through the action of the secreting hormones. The brain and medulla oblongata are part of the nervous system. The pancreas is an endocrine organ.
A client with 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? a. Increased oxytocin b. A deficient amount of somatostatin c. Increased antidiuretic hormone d. Deficient production of vasopressin
d 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 ADH. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to non-surgical brain tumors, and traumatic brain injuries.
A nurse is caring for a client who is suspected of having a pituitary tumor that is causing panhypopituitaryism. During assessment of the client, which clinical manifestation with the nurse expect to find? a. Carpopedal spasm b. Tachycardia c. Hypertension d. Atrophy of the gonads
d Under secretion commonly involves all of the anterior pituitary hormones and is termed panhypopituitaryism. In this condition, the thyroid gland, the adrenal cortex, and the gonad atrophy (shrink) because of loss of tropic-stimulating hormones.
What hormones are secreted by the anterior pituitary gland?
growth hormone (GH)* adrenocorticotropic hormone (ACTH) thyroid-stimulating hormone (TSH) follicle-stimulating hormone (FSH) luteinizing hormone (LH)* prolactin
List seizure precautions that may be implicated for a patient with SIADH.
02 and suction ready bed in lowest position with padded side rails up loose clothing on the patient provide privacy patient needs to be side lying pillow under patient's head lay bed flat during seizure
Fill in the blanks regarding clinical manifestations of SIADH: 1. Hyponatremia (Sodium level below _____) 2. _____ serum osmolality (less than 280 mOsm/kg) with inappropriately _____ urine osmolality (greater than 100 mOsm/kg) 3. urine sodium over ___ mEq/L 4. low ___ (below 10 mg/dL) 5. _____ (uric acid below ____ mg/dL)
1. 134 2. decreased, increased 3. 20 4. BUN 5. hypouricemia, 4
Match the following types of DI to their correct characteristics: 1. Neurogenic 2. Nephrogenic 3. Psychogenic a. drug related damage to the renal tubules, resulting in the inability to conserve water b. caused by excessive water intake c. acute onset resulting from destruction of the posterior pituitary
1. c 2. a 3. b
Match the following types of hypothyroidism with their correct causes: 1. Primary 2. Central 3. Secondary 4. Tertiary a. failure of the pituitary gland, the hypothalamus, or both b. entirely a pituitary disorder c. dysfunction of the thyroid gland itself d. disorder or the hypothalamus which results in inadequate secretion of TSH d/t decreased stimulation by TRH
1. c 2. a 3. b 4. d
What diagnostic findings would would the following labs show to indicate DKA? 1. Blood Glucose Levels 2. Serum pH 3. Serum Bicarbonate 4. Ketones (where would we see accumulation) 5. Presence of _____ in the urine
1. high, greater than 250 mg/dL 2. low 3. low 4. accumulation in the blood and urine 5. glucose
Due to intense thirst, the patient with DI tends to drink ___ to ___ L of fluid daily and often prefers ____ water.
2 20 cold
SIADH is a syndrome characterized by excessive secretion of _____, causing significant retention of water.
ADH
Hypersecretion of growth hormone (GH) can lead to what disorders?
Acromegaly or Gigantism
What is the difference between Addison's disease and Cushing syndrome?
Addison's disease involves adrenal insufficiency (the adrenal glands produce too little cortisol). Cushing syndrome, adrenal hypersecretion, involves the over secretion of adrenal hormones.
A pheochromocytoma is a rare tumor of what endocrine gland?
Adrenal medulla
What happens when blood glucose levels are low?
Alpha cells of the pancreas secretes the hormone glucagon. It promotes gluconeogenesis to raise the blood glucose level.
What can prolactinomas cause in women?
Amennorhhea Infertility
What is the most common cause of hypothyroidism in adults?This condition causes the immune system to attack the thyroid gland.
Autoimmune Thyroiditis (Hashimoto's Disease)
As a nurse caring for a patient with acute hypoparathyroidism, what is one thing we always want to make sure we have on hand?
Calcium Gluconate
Hypersecretion of adrenocorticotropic hormone (ACTH) can lead to what syndrome?
Cushing Syndrome
Recall that the post terrier lobe of the pituitary gland secretes antidiuretic hormone (ADH), also known as vasopressin. Too little ADH results in ____ (_____). Too much ADH leads to _____ (_____).
DI (Diabetes Insipidus) SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
What condition is caused by an absence or markedly inadequate amount of insulin?
DKA
What drug is used in patients with DI to control fluid balance and prevent dehydration?
Desmopressin (DDAVP)
Tell whether the following s/s of hypothyroidism are early or late symptoms: fatigue somnolence decreased libido apathy amenorrhea constipation sluggish non-pitting edema hair loss/brittle nails dry skin
Early s/s of hypothyroidism
What differentiates endocrine from exocrine glands?
Endocrine glands secrete their hormones directly into the blood stream, whereas exocrine glands secrete their products through ducts onto epithelial surfaces of the skin or the directly into the digestive tract.
What hormones are secreted by the adrenal medulla?
Epinephrine Norepinephrine
What term refers to thyroid hormone production that is within normal limits?
Euthyroid
In a patient with hyperthyroidism, what is the term for bulging of the eyes caused by excess fluid accumulation behind the eyes?
Exopthalmos
To assess for endocrine dysfunction's, the nurse is going to note the appearance of what?
Facial features Presence of hair Skin condition Overall proportion
T/F: SIADH is often of endocrine origin.
False: SIADH is often of non-endocrine origin.
What can prolactinomas cars in both men and women?
Galactorrhea (sudden, inappropriate flow of milk from male or female breasts in the absence of pregnancy or breastfeeding)
Usually, oversecretion of thyroid hormone is associated with what condition of the thyroid gland?
Goiter (Enlarged Thyroid)
What term refers to enlargements of the thyroid gland?
Goiters
What disease is a common cause of hyperthyroidism? This disease is an autoimmune disease of the thyroid gland that results in the binding of antibodies to TSH, which causes the over production of thyroid hormones T3 and T4.
Grave's Disease
What term refers to chemical messengers that, when released, have specific "target" tissue, where the messenger binds and impacts the cell's functions and reactions?
Hormones
What are the primary clinical features of DKA?
Hyperglycemia Ketosis Dehydration Electrolyte Loss Metabolic Acidosis
What disorder of the parathyroid glands is characterized y having excess parathormone (PTH), leading to markedly increased level of serum calcium that can present as a potentially life-threatening situation?
Hyperparathyroidism
Exophthalmos is associated with which endocrine dysfunction?
Hyperthyroidism
What is the second most prevalent endocrine disorder, after DM?
Hyperthyroidism
What can prolactinomas cause in men?
Hypogonadism Decreased libido Impotence
_____ results from hyposecretion of the parathyroid glands, leading to low levels of PTH that eventually results in hypocalcemia and hyperphosphatemia.
Hypoparathyroidism
What gland is the link between the nervous system and the endocrine system?
Hypothalamus
What condition results from undersecretion of thyroid hormone?
Hypothyroidism
Bradycardia is associated with _____, while tachycardia is associated with _____.
Hypothyroidism Hyperthyroidism
To assess for function of the thyroid, a radioactive iodine uptake test can be done. This test indicates the rate of iodine uptake by the thyroid gland. If the uptake increases, what condition is indicated? What condition is associated with decreased iodine uptake?
If the uptake increases, hyperthyroidism is indicated. If the uptake of iodine decreases, this is associated with hypothyroidism.
Explain how a negative feedback loop in the endocrine system works.
In a negative feedback loop, when the hormone concentration increases, further production of that hormone is inhibited. When the hormone concentration decreases, that rate of production of that hormone increases.
Explain the cascade of events that happens when a patient experiences hypothyroidism.
In hypothyroidism, the decreased production of thyroxine (T4) leads to the stimulation of TSH in the pituitary gland. Subsequently, TSH stimulates the secretion of triiodothyronine (T3) to increase production of T4, leading to hypertrophy of the thyroid gland.
What happens during panhypopituitarism?
In this condition, the thyroid gland, the adrenal cortex, and the gonads atrophy because of loss of the trophic stimulating hormones (influencing the activity of a gland).
What is so important about correction of fluids in patients with SIADH?
It is important not to correct the sodium level too rapidly; the rate of correction aims to increase the serum sodium to 8-10 mEq/L during the first 24 hours since rapid correction can cause demyelination and permanent damage to the CNS.
What is the primary function of thyroid hormone?
It is to control cellular metabolic activity.
Tell whether the following s/s of hypothyroidism are early or late symptoms: slow speech subdued emotional response decreased sweating thickening of the skin weight gain deafness dyspnea
Late s/s of hypothyroidism
What condition refers to the most extreme, severe stage of hypothyroidism in which the patient is hypothermic and unconscious.
Myxedema Coma
1. Optic Chiasm 2. Pars Intermedia 3. Anterior Pituitary 4. Hypothalamus 5. Posterior Pituitary
Name the structure each number on the diagram is pointing to:
What are the three types of diabetes insipidus?
Neurogenic Nephrogenic Psychogenic
Along with I&Os, daily weights, and urine/blood labs, what is pertinent for the nurse to observe for in patients being treated for SIADH?
Neurologic status is important to assess d/t hyponatremia (confusion, seizures, delirium).
How would the nurse assess for a Trousseau sign in a patient? What is considered a positive Trousseau sign?
Occlude the blood flow to the arm for 3 minutes. with a BP cuff, and assess for carpopedal spasm. If carpopedal spasm is present, it is considered a positive Trousseau sign.
Why are visual complaints and headaches common with pituitary tumors?
Often times, these tumors are not usually diagnosed early. This allows them to grow large and create pressure on the optic chiasm. This pressure causes visual complaints and headaches.
What is the most common cause of pituitary disorders?
Oversecretion (Hypersecretion)
What is the function of PTH?
PTH regulates metabolism of calcium and phosphorus.
What hormone is secreted by the parathyroid glands?
Parathormone (PTH, parathyroid hormone)
SIADH may occur in what kind of patients?
Patients with malignancies Those with pulmonary disorders Patients with disorders of the nervous system Medication use
What glands are included in the endocrine system?
Pituitary Thyroid Parathyroids Adrenals Pancreatic Islets Ovaries Testes
What gland is controlled by the hypothalamus?
Pituitary Gland
What characterizes diabetes insipidus?
Polydipsia (excessive thirst) Large volumes of dilute urine
What are the 4 types of hypothyroidism you may see in a patient?
Primary (Thyroidal) Central Secondary (Pituitary) Tertiary (Hypothalamic)
Prolactinomas caused the hypersecretion of what hormone?
Prolactin
What is the most common pituitary tumor?
Prolactinoma
A characteristic response to the acidemia caused by DKA is for the respiratory center to blow off its respiratory acid, leading to what kind of respirations?
Rapid, deep respirations known as Kussmaul respirations
What is the function of ADH? What stimulates its secretion?
Release of this hormone will result in reabsorption of water into the bloodstream rather than excretion by the kidneys. It's secretion is stimulated by an increase in blood osmolality (concentrated blood) or by a decrease in blood pressure as additional water is needed to return to the bloodstream.
What are the 3 objectives of medical therapy of DI?
Replace ADH Ensure adequate fluid replacement Identify/correct underlying intracranial cause
What hormone is secreted by the delta cells of the pancreas? What does this hormone do?
Somatostatin This hormone reduces the rate at which food is absorbed from the G.I. tract.
Often times, what is the only thing we can do with our psychogenic DI patients?
Sometimes, the only help for these patients is to prevent water intoxication by limiting use of drugs that impair free water excretion, such as thiazide diuretics and carbamazepine.
What are some causes or risk factors of hypothyroidism?
Surgical removal of the thyroid Pt. with previous treatment for hypothyroidism with radioiodine or antithyroid medications
What hormones are produced by the thyroid gland?
T3 (Triiodothyrine) T4 (Thyroxine) Calcitonin
Which of the thyroid hormones is most potent?
T3 is about five times as potent as T4 and has a metabolic action that is more rapid.
1. Pineal Body 2. Pituitary Gland 3. Thyroid Gland 4. Parathyroid Glands 5. Thymus Gland 6. Adrenal Glands 7. Pancreatic Islets 8. Ovaries 9. Testes
Tell what endocrine gland corresponds with each number on the diagram.
What is the chief symptom of hypoparathyroidism?
Tetany
What body system consists of groups of organs involves in regulating metabolism, tissue function, reproduction, growth, and development by synthesizing and releasing specific hormones?
The Endocrine System
What is the major effect of epinephrine?
The major effect of this hormone is to prepare to meet a challenge (fight-or-flight response).
Where should the nurse inspect when palpating for the thyroid?
The nurse inspect the lower neck region between the sternocleidomastoid muscles for swelling or asymmetry. The nurse instructs the patient to extend the neck slightly and swallow. Thyroid tissue rises normally with swallowing.
What will happen to the levels of hormones secreted by the adrenal medulla if a patient has a pheochromocytoma?
There will be increased levels of catecholamine and metanephrine in urine and plasma and elevated serum levels epinephrine and norepinephrine.
How do patients with hyperthyroidism usually present?
These patients often present with s/s of nervousness. Often, they are emotionally hyperexcitable, irritable, and apprehensive. They cannot sit quietly.
What is different, in terms of treatment, when it comes to nephrogenic DI?
Thiazide diuretics, mild salt depletion, and prostaglandin inhibitors are used to treat this form of DI.
You are caring for a patient with hyperthyroidism, and you observe the following signs and symptoms in the patient: - High Fever - Extreme Tachycardia - Exaggerated Symptoms of Hyperthyroidism - Change in LOC/Neurologic State What do you suspect is happening to this patient?
Thyroid Storm
What is one of the life-threatening complications of hyperthyroidism, in which profound hypermetabolism involves multiple systems?
Thyrotoxic Crisis or Thyroid Storm
A positive _____ sign or a positive _____ sign on physical assessment suggests late tetany from hypoparathyroidism.
Trousseau Chvostek
T/F: Blood flow to the thyroid is 5x the amount of blood flow to the liver.
True
T/F: Myxedema is a medical emergency. Even when early, vigorous therapy is implicated, mortality rate is high.
True
T/F: SIADH and subsequent dilution hyponatremia have a significant impact on the CNS because of brain edema and increased ICP.
True
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma includes which conditions? Select all that apply. a. Diaphoresis b. Hypotension c. Palpitations d. Headache
a, c, d
What hormones are secreted by the posterior pituitary?
antidiuretic hormone (ADH) oxytocin
ADH is secreted by which gland? a. Adrenal b. Posterior pituitary c. Anterior pituitary d. Thyroid
b Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary gland secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.
Which diagnostic test is done to determine a suspected pituitary tumor? a. Radioimmunoassay b. Computed tomography (CT) c. Measuring blood hormone levels d. Radiography of the abdomen
b CT or magnetic resonance imaging (MRI) is used to diagnose the presence and extent of pituitary tumors.
Prolactin acts directly on the ____ to simulate milk production.
breast
A client who is being tested for syndrome of inappropriate antidiuretic hormone asked the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland? a. Adrenal b. Thyroid c. Posterior pituitary d. Anterior pituitary
c ADH is secreted by the posterior pituitary gland.
A client comes to the emergency department complaining of muscle weakness, cramping, and polyuria. A diagnosis of hyperaldosteronism is suspected. Based on the nurses understanding of the condition, which findings with the nurse most commonly assess? a. bruising b. abdominal striae c. hypertension d. moon face
c Hypertension is the most prominent and almost universal sign of aldosteronism and accounts for 10% of cases of hypertension. Abdominal striae, moon face, and bruising are associated with Cushing syndrome.
A client is being screened for thyroid disorder. The nurse would anticipate that the client would most likely undergo which test? a. T3 b. T4 c. TSH d. Needle aspiration
c Serum TSH is the best screening test for thyroid disorders and helps differentiate between disorders of the thyroid gland itself and disorders of the pituitary and hypothalamus glands.
During an assessment of a clients functional health pattern, which question by the nurse directly addresses the clients thyroid function? a. Do you have to get up at night to empty your bladder? b. Can you describe the amount of stress in your life? c. Do you experience fatigue even when you sleep for a long time? d. Have you experienced any headaches or sinus problems?
c With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full days work or participate in usual activities.
Someone who has lived with hypothyroidism for a long time is likely to have _____-_____ related diseases, such as atherosclerosis and CAD.
coronary-artery
If thyroid deficiency is present at birth, then the hypothyroidism is known as _____.
cretinism
Because the serum level of ionized calcium regulates the output of parathormone, an increased level of serum calcium will lead to a ____ secretion of parathormone. What kind of feedback loop is this termed? What does this mean for the relationship between calcium and parathormone?
decreased negative feedback loop Calcium and Parathormone have an inverse relationship.
Patients with hypoparathyroidism are prescribed a diet high in calcium and low in phosphorous. What foods are NOT recommended for these patients?
egg yolks milk and milk products (although high in Ca, these products are also high in phosphorous) Spinach (contains oxalate that forms insoluble calcium substances)
Because key tones are a volatile acid, as they are exhaled, they may manifest as acetone breath that has a _____ odor similar to over ripe apples.
fruity
The adrenal cortex secretes three types of steroid hormones produced by the adrenal cortex: _____, the prototype of which is hydrocortisone; _____, mainly aldosterone (important in sodium and potassium regulation); and sex hormones, mainly _____ (male sex hormones)
glococorticoids mineralocorticoids androgens
Growth hormone releasing hormone (GHRH) from the hypothalamus stimulates cells in the anterior lobe of the pituitary to secrete _____ _____.
growth hormone (GH)
The beta cells of the pancreas secrete ____.
insulin
What is the primary objective in the medical management of hypothyroidism is to restore a normal _____ state by replacing the missing hormone, _____ (_____ or _____).
metabolic Levothyroxine Synthroid or Levothroid
Causes of DKA include insufficient or ____ doses of insulin, physical or emotional _____, and illness or _____.
missed stress infection
Hyperthyroidism occurs a s result of the _____ of T3, T4, or both from the thyroid gland.
overproduction
While oversecretion of the pituitary may affect a singular hormone, such as growth hormone, undersecretion (hyposecretion) usually involves all of the anterior pituitary hormones and is termed ______.
panhypopituitaryism
Patients with hypoparathyroidism are prescribed a diet high in calcium and low in phosphorous. What foods are recommended for these patients?
rice milk or non-dairy creamer refined white bread green beans, broccoli, cucumber fish
As a result of SIADH, ____ become dilute, and ____ ensues.
sodium hyponatremia
T4 and T3 are collectively referred to as ____ _____.
thyroid hormone
T/F: The actions of PTH are increased by Vitamin D.
True
T/F: There is no effective treatment for psychogenic DI.
True
How would the nurse assess for a Chvostek's sign in a patient? What is considered a positive Chvostek's sign?
Use something sharp to tap over the facial nerve just in front of the parotid gland and anterior to the ear while assessing for spasm or twitching of the mouth, nose, and eye. If the spasms or twitching are present, it is considered a positive Chvostek's sign.
Explain what you would find in a physical assessment of an enlarged thyroid such as with Graves' disease.
When the nurse places the hands on the thyroid, he or she feels increased blood flow to the thyroid (thrills). Often, thrills are described as sensation of a purring cat. Auscultation using a stethoscope assessors for a bruit (blowing or a whooshing sound), which signifies turbulent blood flow and may be found on one side or on the entire gland.
Is it true that the presence of vitamin D may increase the actions of PTH?
Yes, this is true.
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? a. How is your shoe size increased recently? b. Do you experience skin breakouts? c. Is there a family history of acromegaly? d. Have you had a recent head injury?
a Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.
A nurse is developing a teaching plan for a client diagnosed with hyper parathyroidism that explains this condition. When describing the underlying problem, the nurse would most likely include a discussion about which mineral? a. Calcium b. Potassium c. Magnesium d. Sodium
a Hyperparathyroidm is characterized by having excess parathormone (PTH), leading to a markedly increased level of serum calcium that can present as a potentially life-threatening situation.
A nurse is assessing a client thyroid gland. The nurse asked the client to swallow. Which response for the nurse document as a normal finding? a. The clients thyroid rises. b. Thyroid moves downward. c. Thyroid slides to the left. d. Thyroid stays at the current position.
a The nurse instruct the client to extend the neck slightly and swallow. Thyroid tissue rises normally with swallowing. Any other findings would be abnormal.
A nurse is preparing a review class for a group of nurses returning to the workforce. The topic is the endocrine system. When describing the functions of the system, the nurse will discuss the systems role in regulating which body function? Select all that apply. a. Tissue function b. Metabolism c. Reproduction d. Cognition e. Growth
a, b, c, e The endocrine system consists of a group of organs involved in regulating metabolism, tissue function, reproduction, growth, and development by synthesizing and releasing specific hormones. Regulation of cognition is not involved.
A nurse assesses a female client and suspects that the client may be experiencing an excess of adrenal cortical hormones. Which assessment finding would support the nurses suspicion? Select all that apply. a. Facial hair b. Exophthalmos c. Moon face d. truncal obesity e. buffalo hump
a, c, d, e
A nurse is reviewing information about the pituitary gland in preparation for a presentation. The nurse demonstrates understanding of the information when identifying which hormone as being released by the anterior pituitary gland? Select all that apply. a. Luteinizing hormone b. Vasopressin c. Adrenocorticotropic hormone d. Somatotropin (GH) e. Follicle stimulating hormone
a, c, d, e
A client with a history of hyperparathyroidism comes to the emergency department complaining of extreme muscle weakness, vomiting, and bone pain. The client is diagnosed with hypercalcemic crisis. When providing care, the nurse would most likely administer which intervention if ordered? Select all that apply. a. phosphate therapy b. calcium gluconate c. large volumes of IV fluids d. propylthiouracil e. diuretics
a, c, e Acute hypercalcemic crisis can occur with extreme elevation of serum calcium levels. Serum calcium levels greater than 15 mg/dL results in neurologic, cardiovascular, and renal symptoms that can be life-threatening. Treatment involves rehydration with large volumes of IV fluids to keep urine output above 100 mL per hour; diuretic agents; and phosphate therapy.
A client is scheduled to have a 24 hour urine sample collected to evaluate the levels of metanephrine (MN) and vanillylmandelic acid (VMA). When preparing the client for this test, the nurse will instruct the client to avoid consumption of which foods? Select all that apply. a. bananas b. milk c. chocolate d. fish e. decaffeinated coffee
a, c, e In most cases, pheochromocytoma can be diagnosed or confirmed based on a properly collected 24 hour urine sample of free catecholamine, MN, and VMA; are levels as high as twice the normal level may be found. The use of combined serum and urine tests increase the diagnostic accuracy of the testing. A number of medication and food, such as coffee and tea (including decaffeinated varieties), bananas, chocolate, vanilla, and aspirin, may alter the results of the tests. Therefore, the client must be given instructions to avoid such items.
A nurse is providing care to a client who is experiencing a dysfunction of the adrenal cortex. The nurse would anticipate issues involving which hormone? Select all that apply. a. Aldosterone b. Norepinephrine c. Insulin d. Cortisol e. Epinephrine
a, d The adrenal cortex secretes mineralocorticoids (primarily aldosterone) and glucocorticoids (primarily cortisol). The adrenal medulla secretes Epinephrine and norepinephrine. Pancreatic islet cells secrete insulin.
A client is diagnosed with pheochromocytoma. When reviewing the clients history and physical exam, which finding with the nurse most likely note? Select all that apply. a. Tachycardia b. Pathologic fracture c. Tetany d. Prolonged QT interval e. Hypertension
a, e Pheochromocytoma, a tumor of the adrenal medulla that causes excess secretion of catecholamines, results in episodic severe hypertension and tachycardia.
What are some nursing interventions that we can initiate for DI patients?
Daily weights I&Os Fluid volume management Administration of DDAVP Supportive care Educate patient and family about importance of follow up appt. Educate about medication administration Instruct patient to wear ID band with condition on it as well as carrying medications with them
What pituitary disorder is characterized by a deficiency of ADH?
Diabetes Insipidus
What are the 3 Ds of DI?
Diabetes insipidus Diuresis Decreased ADH
What three hormones are secreted by the pancreatic islet cells?
Insulin Glucagon Somatostatin
Why is iodine essential to the thyroid gland?
Iodine aids in synthesis of hormones.
Oxytocin secretion is stimulated during pregnancy and childbirth. What is the function of oxytocin?
It facilitates milk ejection during lactation and increases the force of uterine contractions during labor and delivery. It also aids in bonding.
What is the dose of hormone replacement therapy based upon?
It is based on the concentration of the patient's TSH.
The assessment of the endocrine system is not as straightforward as other systems. What is the reason for this?
It is difficult to inspect and palpate these glands due to their anatomic location, and patients present with a wide variety of general symptoms.
