Chapter 52 Endocrine (ATI, Study guide, Notes, practice questions) Pt. 1

A patient has undergone a complete thyroidectomy. What statement by the client indicates that further instruction is needed?

"After surgery, I won't need to take thyroid medication"

During an assessment of a patient's functional health pattern, what question by the nurse directly addresses the patient's thyroid function?

"Do you experience fatigue even if you have slept a long time"?

A nurse is completing an assessment of a patient with suspected acromegaly. To assist in making the diagnosis, which of the following questions should the nurse ask?

"Have you increased your shoe size lately"?

A client with hypothyroidism as a result of Hashimoto's thyroiditis asks the nurse how long she will have to take thyroid medication. What is the nurses best response?

"You'll need thyroid pills for life because your thyroid wont start working again"

A patient is receiving methimazole (Tapazole). What statement form the patient indicates good understanding of teaching regarding this medication?

"if i become pregnant, I need to notify my health care provider immediately"

A patient with Cushing's syndrome is admitted to the hospital. During the initial assessment, the patient 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." What is the best response by the nurse?

"if treated successfully, the major changes will disappear in time"

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing's syndrome in a patient who works at night from 11:00 pm to 7:00 am and normally sleeps from 8:00 am to 4:00 pm. The patient has been given the dexamethasone; to ensure the most reliable test results, the nurse arranges for the plasma cortisol level to be drawn at what time?

5:00 pm

A patient with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find?

A deficient production of vasopressin

A patient has been diagnosed with hypothyroidism. What medication is the nurse prepared to administer to treat the client's bradycardia?

levothyroxine (synthroid)

Which dietary alterations does the nurse make for a client with Cushing's disease?

low carbohydrate, low sodium

Steroid hormones secreted by the adrenal cortex.

Mineralocorticoids

The nurse is completing discharge teaching with a patient with hyperthyroidism who has been treated with radioactive iodine (RAI) at an outpatient clinic. The nurse instructs the patient to do which of the following?

Monitor for symptoms of hypothyroidism

A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal thyroid stimulating hormone (TSH) levels. What is the nurse's priority intervention?

monitor the apical pulse

Released from the pituitary gland; causes stimulation of the thyroid resulting in release of T3 and T4.

Thyroid stimulating hormone (TSH)

Severe life threatening hyperthyroidism precipitated by stress; characterized by high fever, extreme tachycardia, and altered mental status.

Thyroid storm

What is the best instruction for the nurse to give a client scheduled for a thyroid scan?

no special radiation precautions are needed

Which disorder results from excessive secretion of somatotropin (growth hormone)?

Acromegaly

Following a thyroidectomy, a patient develops carpopedal spasm while the nurse is taking a BP reading on the left arm. What action by the nurse is appropriate?

Administer the IV calcium gluconate ordered

Long-term use of antithyroid medication is not generally recommended for elderly patients because of which of the following events?

Agranulocytosis and hepatic injury

A client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking corticosteroids. Which is the nurse's best response?

once you start corticosteroids, you have to be weaned off them

Cardiac effects of hyperthyroidism include?

palpitations

What symptom of thyroid disease is seen in older adults?

Atrial fibrillation

A nurse is caring for a patient suspected of having a pituitary tumor causing panhypopituitarism. During the assessment of the patient, what clinical manifestations would the nurse expect to find?

Atrophy of the gonads

What diagnostic test is done to determine a suspected pituitary tumor?

CT scan

Which disorder is characterized by a group of symptoms produced by a group of symptoms produced by an excess of free circulating cortisol form the adrenal cortex?

Cushing's Syndrome

A hypophysectomy is the treatment of choice for which endocrine disorder?

Cushing's syndrome

A female client has a decrease in all pituitary hormones. What assessment question by the nurse elicits the best information?

Do you have any biological children?

While recording a health history of a patient who is scheduled for a thyroid test, the nurse is informed by the patient about an allergy to shellfish. what is the nurse's most appropriate response?

Document the allergy and inform the physician

Generalized limited growth resulting from insufficient secretion of growth hormone during childhood

Dwarfism

Secreting internally; hormonal secretion of a ductless gland

Endocrine

State of normal thyroid hormone production

Euththyroid

What is a clinical manifestation of diabetes insipidus?

Excessive thirst

Secreting externally; hormonal secretion from excretory ducts

Exocrine

Abnormal protrusion of one or more eyeballs

Exopthalmos

Steroid hormones secreted by the adrenal cortex in response to adrenocorticotropic hormone; produces a rise in liver glycogen and blood glucose.

Glucocorticoids

Enlargement of the thyroid gland.

Goiter

A form of hyperthyroidism; characterized by a diffuse goiter and exopthalmus.

Graves disease

Chemical transmitter substances produced in one organ or part of the body and carried by the blood stream to other cells or organs on which they have a specific regulatory effect; produced mainly by endocrine glands.

Hormones

What may occur in the postoperative patient because of sudden withdraw of excessive amounts of catecholamines?

Hypoglycemia

Removal or destruction of all or part of the pituitary gland

Hypophysectomy

A client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment?

I hope I can go back to a size 8 shoe instead of a 12

A client is going home after an endoscopic transnasal hypophysectomy. What statement by the client indicates an adequate understanding of discharge instructions?

I will keep food on upper shelves so i do not have to bend over

What patient statement indicates the need for clarification regarding the instructions for collecting a 24 hour urine specimen for assessment of endocrine function?

I will start the collection by saving the first urine of the morning

A female client with an endocrine problem has hirsutism. What question or statement by the nurse is most appropriate?

Im interested in knowing how you feel about yourself

Severe hypothyroidism; can be with or without coma.

Mxedema

Regulatory mechanism in which an increase or decrease in the level of a substance decreases or increases the function of the organ producing the substance.

Negative feed back

Adrenal medulla tumor

Pheochromocytoma

A patient who is being tested for syndrome of inappropriate antidiuretic hormone (SIADH) secretion asks the nurse to explain the diagnosis. The nurse explains that there is an excessive secretion of anidiuretic hormone (ADH) from which gland?

Posterior pituitary

Which medication is the treatment of choice for patients with hyperthyroidism who become pregnant?

Propylthiouracil (PTU)

A patient with hypothyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the patient's concern and promote effective coping strategies?

Reassure the patient that emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment

Which serum laboratory values alert the nurse to the possibility of hyperaldosteronism?

Sodium 150 mEq, Potassium 2.5 mEq, and pH 7.28

A client is brought to the emergency department via rescue squad in acute adrenal crisis. What is the nurses priority?

Start an IV line if the client doesnt already have one

Excessive secretion of antidiuretic hormone from the pituitary gland despite low serum osmolality level.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

A patient has a hypofunctioning anterior pituitary gland. Which hormones does the nurse expect to be affected by this?

TSH, FSH, GH

A patient has abnormal calcium levels. Which hormone does the nurse anticipate testing for?

Thyrocalcitonin (calcitonin)

When teaching a patient diagnosed with hypothyroidism regarding medical intervention, what is important to communicate>

Thyroid hormone (TH) may increase the effect of digiralis preparation

A patient has a hormone deficiency. What deficiency has the highest priority?

Thyroid stimulating hormone

Inflammation of the thyroid gland may lead to chronic hypothyroidism or may resolve spontaneously.

Thyroiditis

Condition produced by excessive endogenous or exogenous thyroid hormones.

Thyrotoxicosis

Thyroid hormone; active iodine compound formed and stored in the thyroid; deiodinated in peripheral tissues to form triiodothyronine; maintains body metabolism in a steady state.

Thyroxine (T4)

Thyroid hormone; formed and stored in the thyroid; released in smaller quantities; biologically more active, and with faster onset of action than T4; widespread effect on cellular metabolism.

Triiodothyronine (T3)

Carpopedal spasm induced when blood flow to the arm is occluded when using a blood pressure cuff or tournaqette, causing ischemia to the distal nerves; latent sign in hypocalcemia.

Trousseu's sign

A client has hyperparathyroidism. What intervention is the priority for the nurse to add to the client's plan of care?

Use a lift sheet to assist the client with positioning because of the increased reabsorption from the bones there is an increased risk of pahtological fractures

Which safety measure is most important for the nurse to institute for a client who has Cushing's disease?

Use a lift sheet to change the patients position

Anitdiuretic hormone secreted by the posterior pituitary.

Vasopressin

A client asks why a 24 hour urine collection is necessary to measure excreted hormones instead of a random voided specimen. What response by the nurse is most accurate?

We are testing for a hormone secreted on a circadian rhythm

The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy" What is the nurses best response?

You feel this way because of your hormone levels

A client thought to have a problem with the pituitary gland is given a stimulation test using insulin. A short time later, blood analysis reveals elevated levels of growth hormone and adrnocorticotropic hormone. What is the nurses interpretation of this finding?

a normal pituitary response to insulin

A male patient reports fluid secretion from his breasts. What does the nurse asses next in this patient?

anterior pituitary hormones

When performing personal care on a middle-aged woman, the nurse observes that the client has very little pubic and axillary hair. What is the nurses best action?

ask if she has less pubic hair now than 5 years ago. Loss of pubic hair is related to gonadotropin deficiency.

On the second post operative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around his mouth. What is the nurse's priority intervention?

assess Chvostek's sign

A client has bilateral patchy areas of skin depigmentation on the arms and the face. What action by the nurse is best?

assess the clients mucous membranes

A client with hypercortisolism has an irregular pulse. Which is the nurse's priority intervention?

assessing the telemetry reading

The new nurse is assessing a client with suspected pheochromocytoma. Which action by the nurse requires the precepting nurse to intervene?

auscultating, palpating, and percussing the abdomen, doing this causes intense release of catecholamines

A female client is beginning treatment with bromocriptine (parlodel). The nurse has initiated teaching sessions about potential side effects. What is the most important point of instruction?

be sure to eat 20 to 30 grams of fiber daily

Which conditions may cause hypopituitarism?

benign pituitary tumors, anorexia nervosa, hypotension, shock

A patient has been admitted with hypoparathyroidism. The client's serum lab values are; Calcium 7.2, Sodium 144, Magnesium 1.2, and potassium 5.7. What medications does the nurse anticipate administering?

calcium chloride IV, 50% magnesium sulfate

What situation or condition is likely to result in increased production of thyroid hormones?

cold environmental temperature

What is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone?

darkening of the skin

A patient is taking a drug that blocks a hormone's receptor site. What is the effect on the patient's hormone response?

decreased hormone activity

A client has hypothyroidism. What problem does the nurse address as a priority for this client?

depression and withdraw

A patient has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. What is the nurses best action?

document the finding and monitor the client

A patient being treated for hypothyroidism has been admitted for pneumonia. What activity does the nurse include as a priority in the is client's care plan?

ensure that working suction equipment is in the room

An adult patient has been diagnosed with a deficiency of gonadotropin and growth hormone. What fact reported in the patient's history could have contributed to this problem?

experienced head trauma 5 years ago

What is indicative of a carpopedal spasm in a patient with hypoparathyroidism?

hand flexing forward

The typical triad of manifestations seen in a patient diagnosed with pheochromocytoma includes?

headache, diaphoresis, and hypotension

A client has hypothyroidism and has been started on Synthroid. What assessment finding leads the nurse to conclude that the treatment is effective?

heart rate is 70 bpm and regular

A client has cortisol deficiency and is being treated with prednisone. Which instruction by the nurse is most appropriate?

if you work outside when its hot, you may need another drug

Which dietary modification does the nurse provide for a client with hyperthyroidism?

increased calories, proteins, and carbohydrates

A patient has a condition of excessive catecholamine release. What assessment finding does the nurse correlate with this condition?

increased pulse

A patient with hyperthyroidism is taking lithium carbonate. Which finding indicates that the client is having side effects of this therapy?

increased thirst and urination

A patient has a deficiency of aldosterone. What finding does the nurse correlate with this condition?

increased urine output

A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. What is the nurses best response?

it will prevent excessive bleeding during surgery

Twelve hours after a total thyroidectomy, the client develops stridor. What is the nurses priority intervention?

prepare for emergency tracheostomy and call the health care provider

What physical characteristics are indicative of anterior pituitary hyperfunction?

protrusion of the lower jaw, enlarged hands and feet, kyhposis, barrel shaped chest, excessive sweating

A patient with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. What precautions does the nurse teach this client?

read the label before using salt substitutes

A patient is admitted to the hospital with exacerbation of heart failure, which had been stable for several years. What findings does the nurse associate with the patient's current condition?

recent prescription for thyroid hormone replacement medication

The nurse is caring for a client who has undergone a hypophysectomy. What is the nurse's priority postoperative intervention?

report clear or yellow drainage from the nose or incision site

A patient with suspected syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 114 mEq/L. What action by the nurse is best?

restrict the patients fluid intake to 900 ml/24 hours

A client who had a trans-phenoidal hypophysectomy 2 days ago now has nuchal rigidity. What is the nurses priority action?

take the clients temperature and other vital signs

A new nurse is palpating a client's thyroid gland. What action requires intervention from the nurse's mentor?

the nurse palpates the right lobe with his or her left hand

What are common key features of hormones?

they can travel long distances to their target tissues, continued hormone activity requires continued production and secretion, control of hormone activity is caused by negative feedback mechanisms

Surgical removal of all or part of the thyroid gland

thyroidectomy

How does a tropic hormone differ from other hormones?

tropic hormones stimulate other endocrine glands to secrete hormones.

The nurse is assessing a patient with graves disease and finds that the client's temperature has risen 1 degree F. Before notifying the doctor, what action by the nurse takes priority?

turn the lights down in the patient's room and shut the door

A client has received vasopressin for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy?

urine output is decreased; specific gravity is increased

What is a safety measure the nurse uses for the adult client who has growth hormone deficiency?

using a lift sheet when repositioning the client

The client has chronic hypercotisolism. What intervention is the highest priority for the nurse?

wash the hands when entering the room, excess cortisol reduces the circulating lymphocytes, and reduces antibody synthesis

The nurse is teaching a client about self-care after menopause. Which teaching topic is the priority?

weight bearing exercise

The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. What would be the nurses best response?

when your beard thickens and your voice deepens, the dose will then be decreased, but treatment will continue forever

A client on medication after a bilateral adrenalectomy calls the clinic asking to be seen for "stomach flu" with nausea and vomiting. Which response by the nurse is best?

you need to go to the emergency room