Ch 45: Assessment and Management of Patients with Endocrine Disorders
d) Vitamin D Pg. 1470 The actions of PTH are increased by the presence of vitamin D.
1. The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? a) Vitamin E b) Vitamin C c) Vitamin B d) Vitamin D
a) "Maintain a moderate exercise program" Pg. 1472 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.
10. 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? a) "Maintain a moderate exercise program" b) "Rest as much as possible" c) "Lose weight" d) "Jog at least 2 miles per day"
a) Kidney stones Pg. 1470-1471 Kidney stones occur in 55% of patients with primary hyperparathyroidism. They are caused by renal damage from the precipitation of calcium phosphate in the renal pelvis and parenchyma.
100. One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is: a) Kidney stones b) Pathologic fractures c) Pancreatitis d) Peptic ulcer
c) Closely monitor nasal packing and postnasal drainage d) Assess for neurologic changes Pg. 1451 The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.
101. A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. a) Offer the client a straw when drinking liquids b) Encourage deep breathing and coughing c) Closely monitor nasal packing and postnasal drainage d) Assess for neurologic changes
a) A corticotropin-secreting pituitary adenoma Pg. 1479-1480 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.
102. 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: a) A corticotropin-secreting pituitary adenoma b) An inborn error of metabolism c) Adrenal carcinoma d) An ectopic corticotropin-secreting tumor
b) A pituitary tumor Pg. 1450 When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.
103. A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly? a) A decrease in release in the growth hormone b) A pituitary tumor c) A decrease in the glucose level d) An increase in cerebral edema
a) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Pg. 1452 Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
104. Dilutional hyponatremia occurs in which disorder? a) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) b) Diabetes insipidus (DI) c) Pheochromocytoma d) Addison disease
d) Hydrocortisone Pg. 1477 Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.
105. A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion? a) Insulin b) Hypotonic saline c) Potassium d) Hydrocortisone
a) Alpha Pg. The alpha cells of the pancreas secret the hormone glucagon. It promotes gluconeogenesis, thus increasing the blood glucose level. The beta cells of the pancreas secrete insulin. Delta cells secrete somatostatin, which reduces the rate at which food is absorbed from the gastrointestinal tract.
106. Which type of cell secretes glucagon and promotes gluconeogenesis? a) Alpha b) Omega c) Delta d) Beta
a) "It regulates the function of other endocrine glands" Pg. 1449 The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.
11. A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? a) "It regulates the function of other endocrine glands" b) "It is the gland that is responsible for regulating the hypothalamus" c) "It regulates metabolism" d) "The gland does not have any other function other than to cause secretion of the growth hormones"
a) Thyrotoxic crisis Pg. 1463 Antithyroid medication is given to treat hyperthyroidism. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Therefore, this client is at risk for thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism. Myxedema coma results from severe hypothyroidism. Diabetes insipidus (DI) and SIADH do not correlate with hyperthyroidism or the medication taken for hyperthyroidism.
12. What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking the prescribed antithyroid medication? a) Thyrotoxic crisis b) Diabetes insipidus c) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d) Myxedema coma
c) Palpitations Pg. 1462 Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.
13. Cardiac effects of hyperthyroidism include a) Decreased pulse pressure b) Decreased systolic BP c) Palpitations d) Bradycardia
d) Levothyroxine sodium Pg. 1466 Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.
14. Which of the following would the nurse expect the physician to order for a client with hypothyroidism? a) Methimazole b) Propranolol c) Propylthiouracil d) Levothyroxine sodium
c) Restricting fluids Pg. 1452 To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
15. A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a) Encouraging increased oral intake b) Infusing IV fluids rapidly as ordered c) Restricting fluids d) Administering glucose-containing I.V. fluids as ordered
d) Myxedema coma Pg. 1456-1457 Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.
16. A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? a) Syndrome of inappropriate antidiuretic hormone (SIADH) b) Thyroid storm c) Diabetes insipidus d) Myxedema coma
b) Renin Pg. 1474 Renin is released from the kidneys and initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys secrete erythropoietin, a substance that promotes the maturation of red blood cells. Cholecystokinin released from cells in the small intestine stimulates contraction of the gallbladder to release bile when dietary fat is ingested. Gastrin is released within the stomach to increase the production of hydrochloric acid.
17. A nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume? a) Erythropoietin b) Renin c) Cholecystokinin d) Gastrin
a) Tracheostomy set Pg. 1469 After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.
18. A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? a) Tracheostomy set b) Humidifier c) Indwelling urinary catheter kit d) Cardiac monitor
c) Parathyroid Pg. 1470 Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.
19. Which glands regulate calcium and phosphorous metabolism? a) Thyroid b) Adrenal c) Parathyroid d) Pituitary
b) Pressure on the optic nerve Pg. 1450-1451 Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.
2. A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? a) Glaucoma b) Pressure on the optic nerve c) Retinal detachment d) Corneal abrasions
b) Stimulation of calcium reabsorption and phosphate excretion Pg. 1470-1471 PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.
20. Parathyroid hormone (PTH) has which effects on the kidney? a) Increased absorption of vitamin E and excretion of vitamin D b) Stimulation of calcium reabsorption and phosphate excretion c) Stimulation of phosphate reabsorption and calcium excretion d) Increased absorption of vitamin D and excretion of vitamin E
d) Calcium Pg. 1468 Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.
21. Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. a) Potassium b) Magnesium c) Sodium d) Calcium
a) A decrease in urine output Pg. 1452 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.
22. A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? a) A decrease in urine output b) A decrease in blood glucose levels c) A decrease in appetite d) A decrease in blood pressure
c) "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon" Pg. 1478 Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
23. A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? a) "I'll take my hydrocortisone in the late afternoon, before dinner" b) "I'll take the entire dose at bedtime" c) "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon" d) "I'll take all of my hydrocortisone in the morning, right after I wake up"
b) Potassium of 6.0 mEq/L Pg. 1477 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.
24. The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? a) Glucose of 100 mg/dL b) Potassium of 6.0 mEq/L c) Sodium of 140 mEq/L d) A blood pressure reading of 135/90 mm Hg
a) Iodized table salt Pg. 1467 The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.
25. The nurse is teaching a client that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? a) Iodized table salt b) Soy products c) Red meat d) Eggs
a) Cushing syndrome Pg. 1479 Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.
26. Hypophysectomy is the treatment of choice for which endocrine disorder? a) Cushing syndrome b) Acromegaly c) Hyperthyroidism d) Pheochromocytoma
c) Exophthalmos Pg. 1462 Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
27. Which of the following would the nurse expect to find in a client with severe hyperthyroidism? a) Striae b) Buffalo hump c) Exophthalmos d) Tetany
a) Epinephrine Pg. 1474 The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.
28. A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? a) Epinephrine b) Glucocorticoids c) Glucagon d) Mineralocorticoids
c) Glucagon Pg. 1476 Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.
29. Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? a) Cholecystokinin b) Insulin c) Glucagon d) Somatostatin
c) Bulging eyes Pg. 1461 Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes) and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.
3. The nurse is assessing a client diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find? a) Fatigue b) Hair loss c) Bulging eyes d) Moon face
c) Phosphorus Pg. 1473 PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
30. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: a) Magnesium b) Potassium c) Phosphorus d) Sodium
a) Sensitive to heat Pg. 1462 Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.
31. Patients with hyperthyroidism are characteristically: a) Sensitive to heat b) Calm c) Emotionally stable d) Apathetic and anorexic
a) Diabetes insipidus (DI) Pg. 1451 With diabetes insipidus, 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 excretion. 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 to a pituitary tumor. The thyroid gland does not exhibit these symptoms.
32. A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for? a) Diabetes insipidus (DI) b) Hypothyroidism c) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d) Pituitary tumor
b) Vasopressin Pg. 1452 Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
33. When caring for a client with diabetes insipidus, the nurse expects to administer: a) 10% dextrose b) Vasopressin c) Regular insulin d) Furosemide
b) An irregular apical pulse Pg. 1479 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.
34. A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? a) Pitting edema of the legs b) An irregular apical pulse c) Dry mucous membranes d) Frequent urination
c) Desmopressin (DDAVP) Pg. 1452 DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration. Other medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.
35. Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? a) Diabinese b) Thiazide diuretics c) Desmopressin (DDAVP) d) Ibuprofen
a) Paresthesia Pg. 1483 Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
36. On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: a) Paresthesia b) Bradypnea c) Hypothermia d) Hypotension
d) Increase serum calcium level Pg. 1471 The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
37. A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? a) Decrease serum calcium level b) Promote urinary secretion of calcium c) Inhibit release of calcium into extracellular fluid d) Increase serum calcium level
d) Oxytocin Pg. 1450 The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
38. 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? a) Somatotropin b) Adrenocorticotropic hormone c) Prolactin d) Oxytocin
a) Hypoventilation b) Hypothermia c) Hypotension Pg. 1456 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.
39. 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. a) Hypoventilation b) Hypothermia c) Hypotension d) Hypertension e) Hyperventilation
a) Positive Chvostek's sign Pg. 1473 If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. A positive Trousseau's sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski's sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.
4. The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels? a) Positive Chvostek's sign b) Positive Trousseau's sign c) Positive Babinski's sign d) Positive paresthesias
b) Explain that the client's physical changes are a result of excessive corticosteroids Pg. 1450 The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
40. A nurse should perform which intervention for a client with Cushing's syndrome? a) Offer clothing or bedding that's cool and comfortable b) Explain that the client's physical changes are a result of excessive corticosteroids c) Suggest a high-carbohydrate, low-protein diet d) Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather
a) Acromegaly Pg. 1450 The client with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism. Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.
41. Which disorder results from excessive secretion of somatotropin (growth hormone)? a) Acromegaly b) Cretinism c) Adrenogenital syndrome d) Dwarfism
a) Inadequate secretion of parathormone Pg. 1472 In hypoparathyroidism, there is an increased blood phosphate. Blood calcium is decreased, and there is a decreased renal excretion of phosphate. The secretion of parathormone is inadequate.
42. When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following? a) Inadequate secretion of parathormone b) Lowered blood phosphate c) Increase in serum calcium d) Increase in the renal excretion of phosphate
a) Hypercalcemia Pg. Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hypophosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.
43. Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? a) Hypercalcemia b) Hyperphosphatemia c) Hypocalcemia d) Hypophosphaturia
a) An adrenal adenoma Pg. An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.
44. What is the most common cause of hyperaldosteronism? a) An adrenal adenoma b) Deficient potassium intake c) A pituitary adenoma d) Excessive sodium intake
b) A pulse rate below 60 beats/minute Pg. 1456 Bradycardia, a heart rate below 60 bpm, is associated with hypothyroidism because metabolism is subnormal and the tissues require little oxygen. This is initially tolerated without overt symptoms.
45. Which of the following is a clinical manifestation of hypothyroidism? a) An elevated systolic blood pressure b) A pulse rate below 60 beats/minute c) Systolic murmurs d) Exophthalmos
a) Magnetic resonance imaging (MRI) Pg. 1451 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.
46. 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? a) Magnetic resonance imaging (MRI) b) Radioimmunoassay c) Radioactive iodine uptake test d) A nuclear scan
a) Maintaining room temperature in the low-normal range Pg. 1461-1462 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.
47. For a client with Graves' disease, which nursing intervention promotes comfort? a) Maintaining room temperature in the low-normal range b) Limiting intake of high-carbohydrate foods c) Restricting intake of oral fluids d) Placing extra blankets on the client's bed
d) Hypotension Pg. 1474 The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.
48. The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? a) Diaphoresis b) Headache c) Palpitations d) Hypotension
a) Excessive thirst Pg. 1451 Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.
49. Which is a clinical manifestation of diabetes insipidus? a) Excessive activities b) Weight gain c) Low urine output d) Excessive thirst
b) Muscle twitching Pg. 1473 Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are not associated with hypocalcemia.
5. Hypocalcemia is associated with which of the following manifestations? a) Polyuria b) Muscle twitching c) Bowel hypomotility d) Fatigue
b) 450 pg/mL Pg. 1475 Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.
50. A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? a) 50 pg/mL b) 450 pg/mL c) 100 to 300 pg/mL d) 100 pg/mL
d) Epinephrine @ 450 pg/mL Pg. 1475 A plasma level of epinephrine that is more than 400 pg/mL is diagnostic of a pheochromocytoma. Refer to Table 31-4 in the text.
51. A patient is being evaluated for a diagnosis of pheochromocytoma. He is scheduled for epinephrine and norepinephrine laboratory tests. Which of the following plasma levels is a positive value that is diagnostic for pheochromocytoma? a) Norepinephrine @ 200 pg/mL b) Epinephrine @ 100 pg/mL c) Norepinephrine @ 550 pg/mL d) Epinephrine @ 450 pg/mL
a) Hypotension b) Hypothermia d) Hypoventilation Pg. 1457 The client will experience signs of hypothermia, hypotension, and hypoventilation with myxedema. Clients with myxedema will have bradycardia, not tachycardia, and will have lethargy, not hyperactivity.
52. A client with a 20-year history of hypothyroidism who has not been compliant with taking thyroid replacement therapy is brought into the ED with a diagnosis of myxedema coma. What client symptoms are consistent with this life-threatening event? Select all that apply. a) Hypotension b) Hypothermia c) Tachycardia d) Hypoventilation e) Hyperactivity
d) Sodium level of 150 mEq/L Pg. 1451 Diabetes insipidus (DI) is a rare disorder that occurs due to injury to the hypothalamus or pituitary gland with a deficiency of ADH (vasopressin) that results in excretion of large volumes of dilute urine and extreme thirst. Without the action of ADH on the distal nephron of the kidney, an enormous daily output (greater than 250 mL per hour) of very dilute urine with a specific gravity of 1.001 to 1.005 occurs. The urine contains no abnormal substances such as glucose or albumin. Due to the intense thirst, the client tends to drink 2 to 20 L of fluid daily and craves cold water. In adults, the onset of DI may be insidious or abrupt. The disease cannot be controlled by limiting fluid intake because the high-volume loss of urine continues even without fluid replacement. Attempts to restrict fluids cause the client to experience an insatiable craving for fluid and to develop hypernatremia and severe dehydration. DI does not affect the glucose, potassium, or phosphate levels.
53. A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms? a) Phosphate level of 5.0 mg/dL b) Potassium level of 2.9 mmol/L c) Blood glucose level of 60 mg/dl d) Sodium level of 150 mEq/L
a) Profound neuromuscular irritability Pg. 1473 Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.
54. A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: a) Profound neuromuscular irritability b) Excessive thirst c) Severe hypotension d) Acute gastritis
b) Neurologic function c) Urine and blood chemistry e) Strict intake and output Pg. 1452 Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
55. A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. a) Liver function tests b) Neurologic function c) Urine and blood chemistry d) Signs of dehydration e) Strict intake and output
b) Indicators of dehydration Pg. 1450 A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration. No glucose is lost in the urine. Hypernatremia occurs with dehydration.
56. A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for: a) Indicators of hyponatremia b) Indicators of dehydration c) Serum calcium levels d) Glycosuria
b) Fatigue Pg. 1456 Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.
57. The nurse is caring for a client diagnosed with hypothyroidism secondary to Hashimoto thyroiditis. When assessing this client, what sign or symptom would the nurse expect? a) Flushed skin b) Fatigue c) Bulging eyes d) Palpitations
d) Myxedemic coma Pg. 1455 Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.
58. Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? a) Thyroid storm b) Addison's disease c) Acromegaly d) Myxedemic coma
c) Have regular follow-up care Pg. The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.
95. Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? a) Use nasal desmopressin acetate (DDAVP) b) Keep an accurate record of intake and output c) Have regular follow-up care d) Exercise to improve cardiovascular fitness
d) "Has your shoe size increased recently?" Pg. 1450-1451 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.
96. 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) "Is there any family history of acromegaly?" b) "Have you had a recent head injury?" c) "Do you experience skin breakouts?" d) "Has your shoe size increased recently?"
d) Detecting evidence of hormone hypersecretion Pg. 1450 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.
97. 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? a) Determining the presence or absence of testosterone levels b) Determining the size of the organs and location c) Detecting information about possible tumor growth d) Detecting evidence of hormone hypersecretion
a) Calcitonin Pg. 1453 Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
98. When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: a) Calcitonin b) Thyroxine c) Parathyroid d) Phosphorus
b) The moon face and acne will resolve when the medication is tapered off Pg. 1479 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).
99. 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? a) The symptoms are permanent side effects of the corticosteroid therapy b) The moon face and acne will resolve when the medication is tapered off c) The dose of the medication must be too high and should be lowered d) Those symptoms are not related to the corticosteroid therapy
c) Acromegaly Pg. 1450 Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.
76. A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? a) Deficient growth hormone b) Type 1 diabetes mellitus c) Acromegaly d) Hypothyroidism
d) 4 Pg. 1470 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.
77. 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? a) 1 b) 2 c) 3 d) 4
a) Computed tomography Pg. 1448 CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.
78. Which diagnostic test is done to determine a suspected pituitary tumor? a) Computed tomography b) Radioimmunoassay c) Radiography of the abdomen d) Measuring blood hormone levels
c) Hyperthyroidism Pg. 1462 Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
59. The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? a) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) b) Diabetes insipidus (DI) c) Hyperthyroidism d) Hypothyroidism
d) Estrogen and progesterone Pg. 1449 The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.
6. A nurse explains the role of the ovaries. Which hormones would be included in that discussion? a) Estrogen and progestin b) Testosterone and progesterone c) Estrogen and testosterone d) Estrogen and progesterone
a) In the morning after fasting Pg. 1450 Typically, a vasopressin challenge test is performed in the morning with the client having fasted.
60. A client is suspected of having central diabetes insipidus and is scheduled to undergo a vasopressin challenge test. When preparing the client for this test, the nurse anticipates that the test would be done: a) In the morning after fasting b) In the middle of the afternoon c) Just after breakfast d) Immediately before bedtime
c) T3, thyroxine (T4), and calcitonin Pg. 1453 The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
61. A nurse explains to a client with thyroid disease that the thyroid gland normally produces: a) TSH, triiodothyronine (T3), and calcitonin b) Iodine and thyroid-stimulating hormone (TSH) c) T3, thyroxine (T4), and calcitonin d) Thyrotropin-releasing hormone (TRH) and TSH
a) Dexamethasone (Decadron) b) Propylthiouracil c) Iodine e) Acetaminophen Pg. 1463 Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.
62. What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.) a) Dexamethasone (Decadron) b) Propylthiouracil c) Iodine d) Synthetic levothyroxine e) Acetaminophen
d) Thyroid crisis Pg. 1469 Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
63. Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? a) Hypoglycemia b) Diabetic ketoacidosis c) Tetany d) Thyroid crisis
d) Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion Pg. 1479 Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.
64. A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of: a) Risk for imbalanced fluid volume related to excessive sodium loss b) Decreased cardiac output related to hypotension secondary to Cushing's syndrome c) Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome d) Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion
b) IV calcium gluconate Pg. 1470 Usually tetany is treated with IV calcium gluconate. Methimazole, propylthiouracil, and potassium iodide are agents used to treat hyperthyroidism.
65. Following a thyroidectomy, a client exhibits signs of tetany. The nurse anticipates administering which medication? a) Methimazole b) IV calcium gluconate c) Propylthiouracil d) Potassium iodide
b) A blood pressure of 176/88 mm Hg Pg. 1475 Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
75. When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: a) Bradycardia b) A blood pressure of 176/88 mm Hg c) A blood glucose level of 130 mg/dl d) A blood pressure of 130/70 mm Hg
d) Hypocalcemia Pg. 1473 Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.
66. On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? a) Hypermagnesemia b) Hyponatremia c) Hyperkalemia d) Hypocalcemia
c) Glucagon Pg. Glucagon, a hormone released by alpha islet cells, raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Insulin is released to lower the blood sugar levels. Cortisone and estrogen are not released from the pancreas.
67. The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level? a) Insulin b) Cortisone c) Glucagon d) Estrogen
c) Insulin Pg. 1447 Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.
68. A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? a) Parathormone b) Calcitonin c) Insulin d) Melatonin
d) Adrenal function Pg. 1474 The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.
69. 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? a) Parathyroid function b) Thyroid function c) Thymus function d) Adrenal function
a) Gigantism Pg. 1450 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.
7. 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? a) Gigantism b) Acromegaly c) Dwarfism d) Simmonds' disease
a) Observe stool color Pg. 1479 The nurse should observe the color of each stool and test the stool for occult blood.
70. Which assessment would a nurse perform on a client with Cushing syndrome who is at high risk of developing a peptic ulcer? a) Observe stool color b) Observe urine output c) Monitor bowel patterns d) Monitor vital signs every 4 hours
c) Iodine Pg. 1453 Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
71. The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? a) Calcitonin b) Thyrotropin c) Iodine d) Thyroxine
c) A rise in serum calcium stimulates the release of calcitonin from the thyroid gland Pg. 1471 Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.
72. The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? a) A rise in serum calcium stimulates the release of T lymphocytes b) A rise in serum calcium stimulates the release of erythropoietin c) A rise in serum calcium stimulates the release of calcitonin from the thyroid gland d) A rise in serum calcium inhibits the release of calcitonin
c) Stimulate more hormones using the negative feedback system Pg. 1453 Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.
73. 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? a) Produce a new hormone to try and regulate the thyroid function b) Stimulate more hormones using the positive feedback system c) Stimulate more hormones using the negative feedback system d) Be unable to perform in response to low levels of thyroid hormone
b) Consume adequate amounts of fluid Pg. 1451 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.
74. What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? a) Come to the clinic for IV fluid therapy daily b) Consume adequate amounts of fluid c) Weigh daily d) Limit the fluid intake at night
a) Give fluids to the client with caution c) Monitor the client's oxygen saturation levels d) Measure the client's arterial blood gases e) Turn and reposition the client at regular intervals Pg. 1456 Myxedema requires nursing management measures to maintain the client's vital functions. Oxygen saturation levels and arterial blood gases should be monitored and measured to determine the need for assisted ventilation. Caution should be used when giving fluids because of the risk of water intoxication. The client should be turned and positioned to minimize risks associated with immobility. Active warming should be avoided to prevent the client's oxygen demands from increasing and to prevent hypotension. Instead passive warming with a blanked is recommended.
79. A client has been hospitalized with myxedema. Which of the following actions will the nurse take to care for this client? Select all that apply. a) Give fluids to the client with caution b) Apply heating pads to the client c) Monitor the client's oxygen saturation levels d) Measure the client's arterial blood gases e) Turn and reposition the client at regular intervals
c) Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff Pg. 1473 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. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
8. Trousseau's sign is elicited by which of the following? a) After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery b) The patient complains of pain in the calf when his foot is dorsiflexed c) Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff d) 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
c) Calcium gluconate Pg. 1470 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.
80. Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? a) Synthroid b) Propylthiouracil (PTU) c) Calcium gluconate d) Tapazole
b) Hypotension Pg. 1451 Diabetes insipidus, which causes profound polyuria, may cause clinical signs of volume depletion such as tachycardia and hypotension.
81. Which of the following clinical signs are associated with diabetes insipidus? a) Bradycardia b) Hypotension c) Hypertension d) Oliguria
c) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Pg. 1452 Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia.
82. Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? a) Hyperthyroidism b) Hypothyroidism c) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d) Diabetes insipidus (DI)
a) Cushing syndrome Pg. 1479 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.
83. Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a) Cushing syndrome b) Hashimoto disease c) Graves disease d) Addison disease
d) Serum potassium level of 5.8 mEq/L Pg. 1477 Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
84. A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? a) Blood urea nitrogen (BUN) level of 12 mg/dl b) Blood glucose level of 90 mg/dl c) Serum sodium level of 134 mEq/L d) Serum potassium level of 5.8 mEq/L
c) Hypocalcemia Pg. 1472 Hypoparathyroidism results in hypocalcemia, which triggers a series of physiologic responses, including the choices presented.
85. The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of: a) Cardiac arrhythmias b) Decreased levels of vitamin D c) Hypocalcemia d) Increased serum levels of phosphate
d) Milk Pg. 1470 Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
94. The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? a) Bananas b) Chicken livers c) Hamburger d) Milk
b) Imbalanced nutrition: Less than body requirements related to thyroid hormone excess Pg. 1465 In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
86. Which nursing diagnosis takes highest priority for a client with hyperthyroidism? a) Disturbed body image related to weight gain and edema b) Imbalanced nutrition: Less than body requirements related to thyroid hormone excess c) Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing d) Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
d) Intolerance to heat Pg. 1462 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.
87. The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: a) Fatigue b) Weight gain c) Constipation d) Intolerance to heat
d) Assess vital signs Pg. 1477 Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.
88. During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? a) Weigh the client b) Test urine for ketones c) Administer oral hydrocortisone d) Assess vital signs
b) Myxedema coma Pg. 1456 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.
89. 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? a) Tibial myxedema b) Myxedema coma c) Thyroid storm d) Exophthalmos
b) Those who are allergic to seafood Pg. 1464 Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.
9. Which group of clients should not receive potassium iodide? a) Those who are allergic to corticosteroids b) Those who are allergic to seafood c) Those who are pregnant d) Those taking medications such as cough medicines
b) Glucose tolerance test + GH measurement Pg. 1450 A glucose tolerance test in combination with a growth hormone measurement is the most reliable method of confirming acromegaly.
90. A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What is the most reliable method of confirming the client's condition? a) Skull radiography + glucose level b) Glucose tolerance test + GH measurement c) Skull radiography alone d) MRI + GH measurement
b) Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency Pg. 1460 Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.
91. A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? a) Tell the client she'll feel better if she consistently takes the thyroid replacement medication b) Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency c) Tell the client she needs to learn to accept herself as she is and be compliant during treatment d) Tell the client that she looks fine and offer to help her with makeup
a) Vasopressin Pg. 1450 Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
92. A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: a) Vasopressin b) Furosemide c) Potassium chloride d) Insulin
c) The secretions are released directly into the blood stream Pg. 1446 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.
93. When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? a) The secreted hormones act like target cells b) The glands contain ducts that produce the hormones c) The secretions are released directly into the blood stream d) The glands play a minor role in maintaining homeostasis