Chapter 45 Prep U Questions- Endocrine
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. tetany c. thyroid storm d. hemorrhage
b
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? a pituitary disorder b thyroid disorder c parathyroid disorder d adrenal disorder
a
For a client with hyperthyroidism, treatment is most likely to include: a. a thyroid hormone antagonist. b thyroid extract. c a synthetic thyroid hormone. d emollient lotions.
a 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. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
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. increase serum calcium level b. inhibit release of calcium into extracellular fluid c. decrease serum calcium level d.promote urinary secretion of calcium
a.
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.
a.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: a. Graves' disease. b. Hashimoto's thyroiditis. c. multinodular goiter. d. thyroiditis.
a.
A patient has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this patient? a. Concentrated urine b. Dilute urine c. Hypernatremia d. Increased serum osmolality
a.
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? a. kidneys b. brain c. cardiac atria d. liver
a.
What test should the nurse provide education on for the client with suspected posterior pituitary gland dysfunction? a. fluid deprivation b, ct scan c. mri d. TSH serum
a.
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. severe hypotension b. excessive thirst c. profound neuromuscular irritability d. acute gastritis
c
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. exophthalmos b. thyroid storm c. myxedema coma d. tibial myxedema
c
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. decrease in the glucose level b. decrease in release in the growth hormone c. a pituitary tumor d. increase in cerebral edema
c.
The nurse provides care for a client, with a history of atherosclerosis, who is hospitalized for the initiation of pharmacotherapy for the treatment of hypothyroidism. Complete the following sentence by choosing from the lists of options. The client is at highest risk for developing ______ evidenced ______.
cardiac dysfunction, angina
Long-term use of antithyroid medication is not generally recommended for elderly clients because of which events? a. Gastrointestinal complications and weight loss b. Renal disease and mental confusion c. Cardiac arrhythmias and fatigue d. Agranulocytosis and hepatic injury
d
The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland? a. Distal to the carotid arteries b. Mid trachea c. The upper neck posterior to the trachea d. The lower neck anterior to the trachea
d
The following clients are scheduled for thyroid testing. Which client would be at greatest risk for inaccurate results? a. a client diagnoised with low blood sugar b. a client who recieved corticosteroids 4 months ago c. a client who avoid kelp d. a client who was given salicylates last month
d.
Cardiac effects of hyperthyroidism include a. decreased pulse pressure. b. decreased systolic blood pressure. c. bradycardia. d. palpitations.
d. Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.
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. Hypothermia b. Hypotension c. Hypoventilation d. Tachycardia e. Hyperactivity
a. b. c.
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? a. Moon face and buffalo hump b. Hand flexing inward c. Cardiac dysrhythmia d. Bulging forehead
b.
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? have regular follow up care
have regular follow up care
The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is: a. tiny in size and difficult to palpate b. hard as a result of hypertrophy c. soft with poorly defined borders d. nodular due to diminished blood flow
c.
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply. a. fetal hypothyroidism b. fetal bradycardia c. goiter d. cretinism e. fetal tachycardia
a. b. c. d.
When caring for a client with diabetes insipidus, the nurse expects to administer: a. vasopressin. b. furosemide. c. regular insulin. d. 10% dextrose.
a. 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.
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? a. the patient may have hypothyroidism b. the patient may have thryoiditis c. the patient may have hyperthyroidism d. the patient may have Cushing disease
c. If palpation discloses an enlarged thyroid gland, both lobes are auscultated using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism and necessitates referral to a physician.
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? a. methimazole b. PTU c. SSKI d. Potassium iodine
b. Propylthiouracil (PTU), rather than methimazole (MMI), is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism due to the teratogenic effects of MMI.
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. retinal detachment b. glaucoma c. pressure on the optic nerve d. corneal abrasions
c
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? a. thickened hard nails b. compliant of sleepiness c. reports of increased appetite d. inability to tolerate cold
c
A nurse should expect a client with hypothyroidism to report: a. thyroid gland swelling b. increased appetite and weight loss c. nervousness and tremors d. puffiness of the face and hands
d. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
Parathyroid hormone (PTH) has which effects on the kidney? a. Stimulation of phosphate reabsorption and calcium excretion b. Stimulation of calcium reabsorption and phosphate excretion c. Increased absorption of vitamin D and excretion of vitamin E d. Increased absorption of vitamin E and excretion of vitamin D
b
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. Acromegaly b. Type 1 diabetes mellitus c. Hypothyroidism d. Deficient growth hormone
a. 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.
The most common type of goiter is caused by lack of which of the following? a. Iodine b. Calcium c. Potassium d. Sodium
a. The most common type of goiter is often encountered in geographic regions where there is lack of iodine. If too little iodine exists, the level of thyroxine will decrease, causing the stimulation of thyroid-stimulating hormone (TSH) from the anterior pituitary.
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. "Jog at least 2 miles per day." d. "Lose weight."
a. 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.
The nurse recognizes that which of the following agents suppress release of thyroid hormones? Select all that apply. a.sodium iodine b. potassium iodine c. proplythiouracil (PTU) d. Saturated solution of potassium iodine (SSKI) e. Methimazole
a. b. d. Sodium iodide, potassium iodide, and SSKI suppress the release of thyroid hormones. Methimazole inhibits the synthesis of thyroid hormone. Propylthiouracil blocks the synthesis of hormones.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? a. serum glucose level b. glucose tolerance test in combination with a GH measurement c. growth hormone levels d. bone radiographs
b
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. adrencotricotropic hormone b. oxytocin c. somatotropin d. prolactin
b
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? a. decreased phosphate level b. adqueate vit d level c. functioning thyroid gland d. increased calcium level
b, Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
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. three b. four c. one d. two
b.
A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults? a. Medullary carcinoma b. Papillary carcinoma c. Follicular carcinoma d. Anaplastic carcinoma
b.
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. "Do you experience skin breakouts?" b. "Has your shoe size increased recently?" c. "Is there any family history of acromegaly?" d. "Have you had a recent head injury?"
b.
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences: a. diastolic hypertension and widened pulse pressure. b. heat intolerance and systolic hypertension. c. weight gain and heat intolerance. d. anorexia and hyperexcitability.
b.
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. Increase in serum calcium b. Inadequate secretion of parathormone c. Increase in the renal excretion of phosphate d. Increase in the renal excretion of phosphate
b.
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 size of the organs and location. b. Detecting information about possible tumor growth. c. Detecting evidence of hormone hypersecretion. d. Determining the presence or absence of testosterone levels.
c
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 needs to learn to accept herself as she is and be compliant during treatment. b. Tell the client that she looks fine and offer to help her with makeup. c. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. d. Tell the client she'll feel better if she consistently takes the thyroid replacement medication.
c.
The most common cause of hypothyroidism is which of the following? a. Thyroidectomy b. Antithyroid medications c. Autoimmune thyroiditis d. Radioiodine therapy
c.
Which intervention is the most critical for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Measuring and recording accurate intake and output c. Maintaining a patent airway d. Warming the client with a warming blanket
c.
A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? a. encourage the client to particapte in outside activites to boost coping strategies b. refer the client to professional counseling c. reassure the client that their emotion reactions are a result of the disorder and symptoms can be controlled with effective treatment d. suggest that the client wear cosmetics to cover any changes in apperance
c. The client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.
A client diagnosed with thyroid cancer has undergone a thyroidectomy and is returning to the unit. When developing the client's plan of care, which action would be a priority? a. Administering analgesics b. Ensuring adequate IV fluid replacement c. Performing frequent vital sign checks d. Having a tracheostomy tray at the bedside
d. Although ensuring adequate hydration with IV fluids, monitoring frequent vital signs, and administering analgesics for pain are important, the priority would be to ensure that a tracheostomy tray is at the bedside. Respiratory difficulties can occur as a result of edema of the glottis, hematoma formation, or injury to the recurrent laryngeal nerve. This complication requires insertion of an airway. It is vital to have a tracheostomy set by the bedside at all times because, in the event of significant edema, placement of an endotracheal tube is unlikely because of narrowing of the airway.
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to a. continue radioactive precautions with all body secretions. b. watch for symptoms of hyperthyroidism to disappear within 1 week. c. discontinue all antithyroid medications. d. monitor for symptoms of hypothyroidism.
d. Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).
