Chapter 49: Introduction to the Endocrine System
Which hormone is secreted by the posterior pituitary? a. Vasopressin b. Calcitonin c. Corticosteroids d. Somatostatin
a Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.
A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply. a. Foods high in vitamin D b. Foods high in calories c. Foods high in protein d. Foods high in calcium e. Foods high in sodium
a, c, d Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.
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. Eggs b. Shellfish c. Table salt d. Red meat
c The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: a. Thyroxine b. Phosphorus c. Parathyroid d. Calcitonin
d Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response? a. adrenal medulla b. thyroid gland c. adrenal cortex d. pineal gland
a The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.
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. renin b. erythropoietin c. cholecystokinin d. gastrin
a 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.
Which diagnostic test is done to determine suspected pituitary tumor? a. computed tomography scan b. measurement of blood hormone levels c. radioimmunoassay d. radiographs of the abdomen
a A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
The pharmacology instructor is discussing the endocrine system with a class of pre-nursing students. What would the instructor tell the students is considered to be a hormone? a. Norepinephrine b. Acetylcholine c. Nucleic acid d. Serotonin
a A hormone is secreted directly into the blood stream and travels from the site of production to react with specific receptor sites to cause an action. Norepinephrine, which is a neurotransmitter, is a hormone when it is produced in the adrenal medulla, secreted into circulation, and travels to norepinephrine receptor sites to cause an effect. Acetylcholine and serotonin are neurotransmitters, but are not hormones. Nucleic acid is used to build DNA and RNA.
A client with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in the client's cortisol levels. How should the nurse interpret this finding? a. The client's pituitary function is compromised. b. The client's adrenal insufficiency is not treatable. c. The client has insufficient hypothalamic function. d. The client would benefit from surgery.
a An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated.
A client with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in the client's cortisol levels. How should the nurse interpret this finding? a. The client's pituitary function is compromised. b. The client's adrenal insufficiency is not treatable. c. The client has insufficient hypothalamic function. d. The client would benefit from surgery.
a An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated.
A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications? a. "Do you feel any muscle twitches or spasms?" b. "Do you feel flushed or sweaty?" c. "Are you experiencing any dizziness or lightheadedness?" d. "Are you having any pain that seems to be radiating from your bones?"
a As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.
A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? a. Blood glucose b. Assessment of urine for blood c. Weight d. Oral temperature
a Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are carried out. The client's blood sugar is more likely to be volatile than body weight or temperature. Hematuria is not a common complication.
Following an addisonian crisis, a client's adrenal function has been gradually regained. The nurse should ensure that the client knows about the need for supplementary glucocorticoid therapy in which of the following circumstances? a. Episodes of high psychosocial stress b. Periods of dehydration c. Episodes of physical exertion d. Administration of a vaccine
a During stressful procedures or significant illnesses, additional supplementary therapy with glucocorticoids is required to prevent addisonian crisis. Physical activity, dehydration and vaccine administration would not normally be sufficiently demanding such to require glucocorticoids.
The nurse is assessing a diverse group of clients. What client is at a greater risk for the development of hypothyroidism? a. A 75-year-old female client with osteoporosis b. A 50-year-old male client who is obese c. A 45-year-old female client who uses oral contraceptives d. A 25-year-old male client who uses recreational drugs
a Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women. Younger men and women generally face a lower risk.
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? a. decrease in hormonal levels b. increase in hormonal levels c. hormonal overproduction d. hormonal underproduction
a Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.
Which gland was originally identified as the master gland? a. Pituitary b. Adrenal c. Hypothalamus d. Thyroid
a Originally, the pituitary was identified as the master gland, but currently the hypothalamus is given this title because it is responsible for coordinating the nervous and endocrine responses.
Parathyroid hormone (PTH) has which effects on the kidney? a. Stimulation of calcium reabsorption and phosphate excretion b. Stimulation of phosphate reabsorption and calcium excretion c. Increased absorption of vitamin D and excretion of vitamin E d. Increased absorption of vitamin E and excretion of vitamin D
a 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.
Which glands regulate calcium and phosphorous metabolism? a. Parathyroid b. Thyroid c. Adrenal d. Pituitary
a 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.
While palpating the neck of a client diagnosed with a thyroid disorder, the nurse takes special care to be very gentle. What is the rationale for the nurse's action? a. Deep palpation of the thyroid can result in excessive release of thyroid hormone. b. The nurse must be careful not to risk occluding neck vessels and disrupting circulation. c. Care must be taken to avoid causing a choking sensation and subsequent hormone release as a response. d. The thyroid is likely swollen, and pain must not be compounded by touch that is rough.
a Repeated or forceful palpation of the thyroid in the case of thyroid hyperactivity can result in a sudden release of a large amount of thyroid hormones, which can have serious implications.
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. Fatigue b. Bulging eyes c. Palpitations d. Flushed skin
a 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.
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. adrenal function b. thyroid function c. thymus function d. parathyroid function
a 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 is responsible for producing which substances? a. Glucocorticoids and androgens b. Catecholamines and epinephrine c. Mineralocorticoids and catecholamines d. Norepinephrine and epinephrine
a The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.
A nurse is caring for clients in the emergency department and feels very stressed. What endocrine structure is releasing stress hormones to contribute to the nurse's response? a. Adrenal medulla b. Adrenal cortex c. Thyroid d. Pituitary gland
a The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what is referred to as the physiologic stress response also known as the fight-or-flight response.
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. Addison disease c. Graves disease d. Hashimoto disease
a 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.
The nurse is assessing mental and emotional status in a client about to begin therapy for an endocrine disorder. Which of the following would the nurse test to assess the client's mental and emotional status? a. Ability to respond to questions b. Motor function c. Sleep and awake cycles d. Facial expression
a The client's ability to process information and respond to questions can help the nurse evaluate mental and emotional status.
The pharmacology instructor is diagramming the nervous and endocrine systems. What organ would the instructor diagram as the connector between the nervous and endocrine systems? a. Hypothalamus b. Pituitary gland c. Thyroid gland d. Pineal gland
a The hypothalamus is the coordinating center for the nervous and endocrine responses to internal and external stimuli. The pituitary, thyroid, and parathyroid glands all play an important role in hormones, but do not connect the nervous and endocrine systems.
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. cardiac atria c. brain d. liver
a The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.
The physiology instructor is talking with the class of nursing students. What would the instructor explain to the students is the connecting link between the nervous system and the endocrine system? a. Hypothalamus b. Thalamus c. Medulla oblongata d. Posterior pituitary
a The main connecting link between the nervous system and the endocrine system is the hypothalamus, which responds to nervous system stimulation by producing hormones.
A client with symptoms of Cushing syndrome is admitted to the hospital for evaluation and treatment. The nurse is creating a plan of care for the client. Which is an appropriate nursing diagnosis? a. Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns b. Insomnia related to increased nighttime voiding c. Impaired nutrition: more than body requirements related to polyphagia d. Activity intolerance related to muscle cramps, cardiac dysrhythmias, and weakness
a The major goals for the client include decreased risk of injury, decreased risk of infection, increased ability to perform self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications. The other nursing diagnoses do not apply in Cushing syndrome.
A client is scheduled for a thyroid test. Which of the following findings in the client's history would the nurse bring to the physician's attention before initiating the thyroid test? a. Intravenous pyelogram 2 months ago b. Iron-deficiency anemia 2 years ago c. Surgery in the previous 12 months d. Urinary frequency of 8-week duration
a The nurse reports whether the client has had a diagnostic test that used iodine (e.g., intravenous pyelography, gallbladder series) within the past 3 months. This information is essential before initiating a thyroid test.
A nurse explains the role of the ovaries. Which hormones would be included in that discussion? a. estrogen and progesterone b. estrogen and progestin c. testosterone and progesterone d. estrogen and testosterone
a 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.
Which organ is both an exocrine and an endocrine gland? a. pancreas b. ovaries c. pineal gland d. thymus gland
a The pancreas lies behind the stomach, with the head of the gland close to the duodenum. It is both an exocrine and an endocrine gland.
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 The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
A patient visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Identify the glands and hormones that help in regulating sleep cycles and mood. a. Pineal gland: melatonin b. Thymus gland: thymosin c. Parathyroid glands: parathormone d. Adrenal cortex: corticosteroids
a The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone that increases the level of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.
The primary function of the thyroid gland includes which of the following? a. Control of cellular metabolic activity b. Facilitation of milk ejection c. Reabsorption of water d. Reduction of plasma level of calcium
a The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
A client has had an alteration in the production of T lymphocytes and is undergoing diagnostics. What gland aids in the development of T lymphocytes? a. thymus b. pineal c. parathyroid d. thyroid
a The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity.
A nurse is caring for a client suspected of having a pituitary tumor that is causing panhypopituitarism. During assessment of the client, which clinical manifestation would the nurse expect to find? a. Atrophy of the gonads b. Carpopedal spasm c. Hypertension d. Tachycardia
a Undersecretion (hyposecretion) commonly involves all of the anterior pituitary hormones and is termed panhypopituitarism. In this condition, the thyroid gland, the adrenal cortex, and the gonads atrophy (shrink) because of loss of tropic-stimulating hormones.
During a client education session, a nurse describes the role of endocrine glands to the client. Which homeostatic processes regulated by hormones should the nurse include in the teaching? Select all that apply. a. Pregnancy maintenance b. Blood pressure regulation c. Growth d. Fluid balance e. Sleep
a, c, d, e Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. The hormones play a vital role in regulating homeostatic processes such as metabolism, growth, fluid and electrolyte balance, reproductive processes such as pregnancy maintenance, and sleep and wake cycles. The endocrine glands do not regulate blood pressure.
The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? a. A reduced calorie diet, high in nutrients b. Small, frequent meals, high in protein and calories c. Three large, bland meals a day d. A diet high in fiber and plant-sourced fat
b A client with hyperthyroidism has an increased appetite. The client should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the client's caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? a. Decreased phosphate level b. Adequate vitamin 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.
ADH is secreted by which gland? a. Anterior pituitary b. Posterior pituitary c. Adrenal d. Thyroid
b Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.
A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland? a. Anterior pituitary b. Posterior pituitary c. Adrenal d. Thyroid
b Antidiuretic hormone is secreted by the posterior pituitary gland.
The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic? a. The possibility of precipitous weight gain b. The need for lifelong steroid replacement c. The need to match the daily steroid dose to immediate symptoms d. The importance of monitoring liver function
b Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the client and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
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. "Have you had a recent head injury?" b. "Has your shoe size increased recently?" c. "Do you experience skin breakouts?" d. "Is there any family history of acromegaly?"
b 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.
The nurse is educating a couple who has had difficulty with conception. The client asks about the hormone, which is responsible for the production of eggs. The nurse answers that this hormone is called: a. luteinizing hormone (LH) b. follicle-stimulating hormone (FSH) c. interstitial cell-stimulating hormone (ICSH) d. melanocyte-stimulating hormone
b FSH stimulates the growth and secretion of ovarian follicles in women and the production of sperm in men. LH is not responsible for stimulating the growth and secretion of ovarian follicles in women and the production of sperm in men. In women, LH stimulates ovulation and the formulation of the corpus luteum. In men, LH is called ICSH and it influences the secretion of testosterone and other sex hormones from specialized areas in the testes. Melanocyte-stimulating hormone influences skin pigmentation, and is not responsible for stimulating the growth and secretion of ovarian follicles in women and the production of sperm in men.
While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the client's vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see? a. Hyperthermia and tachypnea b. Hypertension and heart rate changes c. Hypotension and hypothermia d. Hyperthermia and bradycardia
b Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign changes may occur related to surgical complications, the most common changes are related to hypertension and changes in the heart rate.
A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a client with this condition is what? a. Risk for peripheral neurovascular dysfunction b. Excess fluid volume c. Hypothermia d. Ineffective airway clearance
b The priority nursing diagnosis for a client with SIADH is excess fluid volume, as the client retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The client is not at risk for neurovascular dysfunction or a compromised airway.
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? a. Headache b. Hypotension c. Diaphoresis d. Palpitations
b The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.
A group of nursing students are doing a presentation on hormones. What hormone would the presentation show regulates the metabolic rate and influences the growth and development of the body? a. PTH or parathormone b. Thyroid hormone c. Cortisol d. Insulin
b Thyroid hormone regulate the metabolic rate of the body and greatly influence growth and development. Parathormone, cortisol, and insulin do not regulate the metabolic rate or influences growth and development.
The nurse's assessment of a client with thyroidectomy suggests tetany and a review of the most recent blood work corroborates this finding. The nurse should prepare to administer what intervention? a. Oral calcium chloride and vitamin D b. IV calcium gluconate c. STAT levothyroxine d. Administration of parathyroid hormone (PTH)
b When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.
The nurse is caring for a client with a diagnosis of Addison disease. What sign or symptom is most closely associated with this health problem? a. Truncal obesity b. Hypertension c. Muscle weakness d. Moon face
c Clients with Addison disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Clients with Cushing syndrome demonstrate truncal obesity, "moon" face, acne, abdominal striae, and hypertension.
A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? a. Glucose in the urine b. Albumin in the urine c. Highly dilute urine d. Leukocytes in the urine
c Clients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.
The nurse is assessing a client diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find? a. Hair loss b. Moon face c. Bulging eyes d. Fatigue
c 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.
A 30 year-old female client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the client's care? a. Decisional conflict related to treatment options b. Spiritual distress related to changes in cognitive function c. Disturbed body image related to changes in physical appearance d. Powerlessness related to disease progression
c Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerlessness may exist, but disturbed body image is more likely to be present. Cognitive changes take place in clients with Cushing syndrome, but these may or may not cause spiritual distress.
A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response? a. "I can show you how to change your style of dress so that the changes are not so noticeable." b. "I do not think you look bad and I am sure your family loves you very much." c. "If treated successfully, the major physical changes will disappear with time." d. "I can refer you to a support group. Talking to someone may help you feel better."
c If treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationships with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.
A client has returned to the floor after having a thyroidectomy for thyroid cancer. What laboratory finding may be an early indication of parathyroid gland injury or removal? a. Hyponatremia b. Hypophosphatemia c. Hypocalcemia d. Hypokalemia
c Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.
A client newly diagnosed with diabetes is discussing the disease with the nurse. The client asks about the hormones that might affect diabetes. Which is considered client teaching information about somatostatin? a. It releases cortisol to help with stress. b. It stimulates the release of a hormone. c. It inhibits the release of insulin. d. It stimulates the breakdown of fats and proteins.
c Somatostatin inhibits the release of insulin and glucagon. Corticotropin-releasing hormone (CRH) from the hypothalamus causes the release of adrenocorticotropic hormone from the anterior lobe of the pituitary gland, and not somatostatin. Atrial natriuretic peptide (ANP), a hormone produced in the atrium of the heart, stimulates aldosterone release, and not somatostatin. Glucagon stimulates the breakdown of fats and proteins, and not somatostatin.
A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy? a. The client's diet should be low protein with ample fat. b. The client may experience short-term changes in cognition. c. The client is at an increased risk for developing infection. d. The client is at a decreased risk for development of thrombophlebitis and thromboembolism.
c The client is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.
A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? a. Thymus gland, thymosin b. Parathyroid glands, parathormone c. Pineal gland, melatonin d. Adrenal cortex, corticosteroids
c The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? a. Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips. b. Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck. c. Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. d. Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips.
c When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: a. Thyroxine b. Phosphorus c. Parathyroid d. Calcitonin
d Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
Cardiac effects of hyperthyroidism include a. decreased pulse pressure. b. decreased systolic BP. c. bradycardia. d. palpitations.
d Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to do what action? a. Take the drug concurrent with levothyroxine. b. Take each dose of prednisone with a dose of calcium chloride. c. Gradually replace the prednisone with an over-the-counter (OTC) alternative. d. Slowly taper down the dose of prednisone, as prescribed.
d Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no over-the-counter (OTC) substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
A client with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this client? a. Increased body temperature b. Jaundice c. Copious urine output d. Decreased blood pressure
d Decreased blood pressure may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal cortex does not affect the client's body temperature, urine output, or skin tone.
The nurse is caring for a client with hyperparathyroidism. What level of activity would the nurse expect to promote? a. Complete bed rest b. Bed rest with bathroom privileges c. Out of bed (OOB) to the chair twice a day d. Ambulation and activity as tolerated
d Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Bed rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the client to getting out of bed only a few times a day also increases calcium excretion and the associated risks.
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. sodium. b. potassium. c. magnesium. d. phosphorus.
d PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
The student nurse is labeling a diagram of the endocrine system. What organ would the student nurse not include in the diagram because it is not a major organ of the endocrine system? a. Hypothalamus b. Pituitary c. Thyroid d. Gallbladder
d The gallbladder is not part of the endocrine system and does not secrete hormones. All other options are organs of the endocrine system.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: a. iodine and thyroid-stimulating hormone (TSH). b. thyrotropin-releasing hormone (TRH) and TSH. c. TSH, triiodothyronine (T3), and calcitonin. d. T3, thyroxine (T4), and calcitonin.
d 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.
