Ch. 52: Assessment and Management of Patients with Endocrine Disorders PREPU

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? a) "I may stop taking this medication when I feel better." b) "I will eat lots of chicken and dairy products." c) "I will see my ophthalmologist regularly for a check-up." d) "I will avoid friends and family members who are sick."

"I may stop taking this medication when I feel better." The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning.

A nurse is preparing to palpate the thyroid gland. Where would the nurse expect to find this gland? a) In the abdomen, directly above the kidneys b) In the upper part of the chest near the heart c) In the right to left upper quadrant of the abdomen d) In the lower neck, anterior to the trachea

In the lower neck, anterior to the trachea The thyroid gland is located in the lower neck, anterior to the trachea.

A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client? a) Insulin b) Nitroprusside c) Dopamine (Inotropin) d) Lidocaine

Nitroprusside Excess catecholamine release occurs with pheochromocytoma and causes hypertension. The nurse should prepare to administer nitroprusside to control the hypertension until the client undergoes adrenalectomy to remove the tumor

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a) Laryngeal nerve damage b) Hemorrhage c) Thyroid storm d) Tetany

Tetany Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery.

Cardiac effects of hyperthyroidism include which of the following? a) Decreased systolic BP b) Palpitations c) Bradycardia d) Decreased pulse pressure

Palpitations Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations.

Which glands regulate calcium and phosphorous metabolism? a) Thyroid b) Adrenal c) Parathyroid d) Pituitary

Parathyroid Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism.

Which of the following diagnostic tests are done to determine suspected pituitary tumor? a) A computed tomography scan b) Measuring blood hormone levels c) Radiographs of the abdomen d) A radioimmunoassay

A computed tomography scan A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a) Imbalanced nutrition: Less than body requirements b) Risk for infection c) Impaired physical mobility d) Decreased cardiac output

Decreased cardiac output An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse.

A group of students are 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) Glucagon b) Epinephrine c) Mineralocorticoids d) Glucocorticoids

Epinephrine The adrenal medulla secretes epinephrine and norepinephrine.

Wendy Corcoran, a 34-year-old teacher, is being seen at the primary care group where you practice nursing. She is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by her altered thyroid function? a) Growth b) Sleeping, wake cycles c) Metabolic rate d) Fluid, electrolyte balance

Metabolic rate The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.

Which of the following glands is considered the master gland? a) Parathyroid b) Adrenal c) Thyroid d) Pituitary

Pituitary Commonly referred to as the master gland, the pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.

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) Stimulate more hormones using the negative feedback system b) The feedback loop will be unable to perform in response to low levels of thyroid hormone. c) Produce a new hormone to try and regulate the thyroid function d) Stimulate more hormones using the positive feedback system

Stimulate more hormones using the negative feedback system Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

A postpartum client is receiving intravenous oxytocin (Pitocin) after birth. Why will this medication be used for this client after the birth of her child? a) Will prevent lactation for a woman who is bottle feeding her newborn b) Helps treat nausea c) Decreases the postpartum cramping d) Stimulates the contraction of the uterus and prevents bleeding

Stimulates the contraction of the uterus and prevents bleeding Oxytocin (Pitocin) is released from the pituitary gland and stimulates contraction of pregnant uterus and release of breast milk after childbirth.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? a) Weight loss, nervousness, and tachycardia b) Weight gain, constipation, and lethargy c) Exophthalmos, diarrhea, and cold intolerance d) Diaphoresis, fever, and decreased sweating

Weight loss, nervousness, and tachycardia Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: a) decreased body temperature and cold intolerance. b) flushed, warm, moist skin. c) exophthalmos and conjunctival redness. d) systolic murmur at the left sternal border.

decreased body temperature and cold intolerance. Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression.

During an assessment of a patient's functional health pattern, which question by the nurse directly addresses the patient's thyroid function? a) "Do you have to get up at night to empty your bladder?" b) "Do you experience fatigue even if you have slept a long time?" c) "Have you experienced any headaches or sinus problems?" d) "Can you describe the amount of stress in your life?"

"Do you experience fatigue even if you have slept a long time?" With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.

A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? a) "I'll schedule a follow-up visit with my physician as soon as I get home." b) "I will increase my fluid and calcium intake." c) "I'll call my physician if I notice tingling around my lips." d) "I will take my pain medications according to the schedule we developed."

"I will increase my fluid and calcium intake." The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake.

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. Which of the following is being tested? a) Parathyroid functioning b) Adrenal functioning c) Thymus functioning d) Thyroid functioning

Adrenal functioning The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress. The adrenal cortex manufactures and secretes cortisol.

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? a) Propylthiouracil (PTU) b) Synthroid c) Tapazole d) Calcium gluconate

Calcium gluconate Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate.

Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a) Graves' disease b) Addison's disease c) Hashimoto's disease d) Cushing syndrome

Cushing syndrome The patient with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.

A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak and has had an 8-lb weight loss since admission. What should the client be tested for? a) Hypothyroidism b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c) Diabetes insipidus (DI) d) Pituitary tumor

Diabetes insipidus (DI) Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop.

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? a) Endocrine disorders can be inherited. b) An allergy to iodine is inherited. c) It helps determine the client's general status. d) Diet and drug histories are related to the family history.

Endocrine disorders can be inherited. Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history.

Which of the following assessments are done by the nurse when conducting a physical examination? a) Palpate the thyroid gland repeatedly b) Examine outstretched hands for skin breaks c) Examine the shape and color of the nails d) Determine the patient's ability to participate in the test

Examine the shape and color of the nails During physical examination, the nurse examines the shape and color of the nails and determines whether they are thin, thick, or brittle.

A nurse should perform which intervention for a client with Cushing's syndrome? a) Suggest a high-carbohydrate, low-protein diet. b) Explain that the client's physical changes are a result of excessive corticosteroids. c) Offer clothing or bedding that's cool and comfortable. d) Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids.

The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? a) Acromegaly b) Simmonds' disease c) Dwarfism d) Gigantism

Gigantism When over secretion of GH occurs before puberty, gigantism results.

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) Hyperkalemia c) Hyponatremia d) Hypocalcemia

Hypocalcemia 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.

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) Diabetes insipidus c) Myxedema coma d) Thyroid storm

Myxedema coma 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. (less)

Lydia Kranston, a 3-year-old female, is being seen by a healthcare provider in the endocrinology group where you practice nursing. She has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of her disorder? a) Thyroid disorder b) Adrenal disorder c) Pituitary disorder d) Parathyroid disorder

Pituitary disorder Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood. Dwarfism occurs when secretion of growth hormone from the pituitary gland is insufficient during childhood.

A nurse educator is teaching a chapter on, "The Function of the Endocrine System." Which of the following hormones would she not include as one of the six hypothalamic hormones? a) Corticotropin-releasing hormone b) Thyrotropin-releasing hormone c) Prolactin d) Gonadotropin-releasing hormone

Prolactin Hypothalamic dopamine inhibits the release of prolactin from the anterior pituitary gland.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? a) Tetany b) Thyroid crisis c) Diabetic ketoacidosis d) Hypoglycemia

Thyroid crisis 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.

For a client with hyperthyroidism, treatment is most likely to include: a) a thyroid hormone antagonist. b) a synthetic thyroid hormone. c) thyroid extract. d) emollient lotions.

a thyroid hormone antagonist. Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production.

What is the most common cause of hyperaldosteronism? a) An adrenal adenoma b) Excessive sodium intake c) A pituitary adenoma d) Deficient potassium intake

An adrenal adenoma An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause.

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) excessive thirst. b) acute gastritis. c) severe hypotension. d) profound neuromuscular irritability.

profound neuromuscular irritability. Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany)

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? a) Weight loss, increased appetite, and hyperdefecation b) Weight gain, decreased appetite, and constipation c) Weight loss, increased urination, and increased thirst d) Weight gain, increased urination, and purplish-red striae

Weight gain, decreased appetite, and constipation Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea.