Endocine - Evolve Questions

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? Dry lips and oral mucosa on examination Nasal drainage that tests negative for glucose Urine specific gravity of 1.016 Client report of a headache and stiff neck

Client report of a headache and stiff neck Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. The finding requires the nurse to immediately notify the primary health care provider.Dry lips and mouth are not unusual after surgery. Nasal drainage that tests negative for glucose is normal, expected, and not significant. A urine specific gravity of 1.016 is within normal limits.

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) Select all that apply. Decreased urine output Hypotension Weigh gain of more than 2.2 lb (1 kg) in 24 hours Persistent headache Hyperglycemia Acute confusion

Decreased urine output Weight gain of more than 2.2 lb (1 kg) in 24 hours Persistent headache Acute confusion Drug therapy for DI can cause a greatly increased kidney reabsorption of water and lead to life-threatening water toxicity. Indications of water toxicity are a relatively rapid onset of acute confusion, rapid weight gain, decreased urine output, persistent headache, and nausea and vomiting.Clients become hypertensive (not hypotensive). Usually blood glucose levels are unaffected but can be diluted below normal levels.

What is the nurse's best first response when a client with a suspected endocrine disorder says, "I can't, you know, satisfy my wife anymore."? "Don't worry. It happens to everyone occasionally." "Do you use any over the counter or recreational drugs?" "Can you please tell me more?" "Would you like to speak with a counselor?"

"Can you please tell me more?" An open-ended question such as, "Can you please tell me more?," is a best first response because it allows the nurse to explore the client's feelings more thoroughly. Clients with endocrine disorders may report issues with infertility, impotence, and changes in sexual function.Telling a client not to worry or that something happens to many others is dismissive and therefore incorrect. Referring the client to a counselor is not an appropriate first step. This action does not allow for assessment of the issue nor allow him to express his concerns. Asking about drug use is not a good first question until the nurse or other health care provider knows more about how long the problem has been present and about the client's general health. Sexual difficulties may also be psychological, as well as be caused by a variety of physical changes.

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? Urine output of 30 to 50 mL/hr Blood glucose level of 110 mg/dL (6.1 mmol/L) Respiratory rate of 20 breaths/min Potassium level of 3.9 mEq/L (mmol/L)

Urine output of 30 to 50 mL/hr With DI, insufficient amounts of vasopressin (antidiuretic hormone [ADH]) prevent reabsorption of water, leading to profound diuresis that can result in dehydration. Desmopressin, a synthetic form of ADH, is the drug of choice to stop fluid loss.A blood glucose result of 110 mg/dL (6.1 mmol/L) is within the range of normal blood glucose levels, as are the respiratory rate and the potassium level.

Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider? Serum sodium increases from 122 mEq/L to 140 mEq/L. Serum potassium decreases from 4.2 mEq/L to 3.8 mEq/L. Serum chloride decreases from 109 mEq/L to 99 mEq/L. Serum calcium increases from 9.5 mg/dL to 10.2 mg/dL.

Serum sodium increases from 122 mEq/L to 140 mEq/L. The purpose of tolvaptan is to restore a normal sodium concentration to the blood and other extracellular fluid. In the case of syndrome of inappropriate antidiuretic hormone, excessive amounts of antidiuretic hormone have caused more water to be absorbed, causing the serum sodium to be diluted. When tolvaptan therapy brings the serum sodium level to normal levels, it must be discontinued to prevent hypernatremia. A serum sodium of 140 mEq/L is within the normal range.

Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)? "Increase the amount of fiber in your diet to prevent the side effect of constipation." "Stop this drug immediately if you discover you are pregnant." "Avoid over-the-counter medications unless prescribed by your primary health care provider." "If you miss a dose, double your next day's dose."

"Avoid over-the-counter medications unless prescribed by your primary health care provider." The amount of drug in synthetic thyroid hormone tablets is very small and many other foods and drugs interfere with its absorption. The client is instructed to not take over-the-counter medications without approval from the primary health care provider. Fiber greatly interferes with the drug's absorption and is not to be taken with or within 4 hours of HRT. In addition, the drug does not cause constipation. Thyroid HRT must continue during pregnancy. The therapy works best when blood levels are maintained. The client is taught to take the forgotten drug as soon as it is remembered and not to double the next day's dose.

Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess? "Do you think if I lost weight my sleep apnea would improve?" "Why do I feel thirsty all the time?" "How can I make my skin less itchy?" "Does everyone's feet get bigger during menopause?"

"Does everyone's feet get bigger during menopause?" Growth hormone is secreted and is needed throughout the life span. When it is secreted in excess in adults, organs can enlarge and bones containing desmoid bone type increase in size, including the facial bones, hands, and feet.The other client questions are reasonable for a client with sleep apnea, hyperglycemia, and menopause to ask.

Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency? "Are you experiencing any pain during sexual intercourse?" "Do you work with or have hobbies that involve exposure to chemicals?" "Have you gained or lost any weight recently?" "How often do you need to shave your face?"

"How often do you need to shave your face?" A gonadotropin deficiency reduces the expression of secondary sexual characteristics and leads to decreased libido and fertility in both male and female clients. Male clients lose facial fair and need to shave less frequently. This change may be the first problem noticed by the client. A deficiency does not result in painful intercourse for men although it can in women from vaginal dryness.

Which statement made by the client alerts the nurse to the possibility of hypothyroidism? "I seem to feel the heat more than other people." "I am always tired, even when I get 10 or 12 hours of sleep." "Food just doesn't taste good without a lot of salt." "My grandmother had thyroid problems."

"I am always tired, even when I get 10 or 12 hours of sleep." Clients with hypothyroidism usually feel tired or weak and often report an increase in time spent sleeping, sometimes up to 14 to 16 hours per day. Thyroid problems are very common among women and do not demonstrate a specific pattern of inheritance. Clients with hypothyroidism have a slow metabolism and have difficulty keeping warm. Salt craving is not a symptom of hypothyroidism.

What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"? "You must learn to control your behavior. Because you are disturbing others, I am going to keep the door to your room closed and restrict your visitors." "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." "I will tell your primary health care provider order a psychiatric consult for you." "You are probably feeling this way because you are frightened about having a chronic disease. Would you like some information about a support group?"

"You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." Changes in blood cortisol levels can cause the client to show neurotic or psychotic behaviors. The client's need to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and more steady blood cortisol levels. Drug therapy to reduce these feelings and behaviors may be appropriate.A psychiatric consult is not likely to be needed. A support group may be indicated depending on why the client has hypercortisolism but the nurse should not make assumptions about the client's feelings and possible fears. Punishing the client for her behavior does not solve the problem or help the client understand her feelings.

For which client will the nurse question the prescription for long-term androgen therapy? A 40 year old who also has syndrome of inappropriate antidiuretic hormone (SIADH). A 52 year old with a history of prostate cancer treatment. A 30 year old who is taking antiviral therapy for HIV disease. A 66 year old with impotence that is resistant to standard erectile dysfunction therapy.

A 52 year old with a history of prostate cancer treatment. Androgen therapy can make any residual prostate cancer cells proliferate and cause a recurrence of the disease.This therapy is often prescribed for impotence. SIADH is not a contraindication for the therapy and neither is HIV disease or its treatment.

Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences? Prolactin and prolactin inhibiting hormone (PIH) Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) Growth hormone (GH) and melanocyte-stimulating hormone (MSH) Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) Deficiencies of (ACTH) or TSH are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands.Deficiencies of the other hormones result in significant changes but these deficiencies are not incompatible with life.

Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min? Increasing the IV infusion rate Initiating the Rapid Response Team Assessing temperature Applying oxygen by mask

Applying oxygen by mask The most common cause of death with severe hypothyroidism is respiratory failure with decreased gas exchange. The nurse would apply oxygen first and then initiate the Rapid Response Team. Although a decreased body temperature would support the findings that a client with severe hypothyroidism is worsening, assessing it would not be helpful in this situation. Increasing the IV flow rate may not even improve cardiac output because the slow heart rate is not related to a volume deficit but to reduced myocardial contractility.

The nurse reviews the vital signs of a client diagnosed with Graves disease and notes that the client's temperature is 99.6° F (37.6° C). After notifying the primary health care provider, what is the nurse's best next action? Administering acetaminophen Observing for the presence of chills Initiating the Rapid Response Team Assessing cardiac status

Assessing cardiac status Graves disease is manifested by symptoms of hyperthyroidism and increased metabolic rate, including fever. The nurse must next assess the client's cardiac status as atrial fibrillation or other dysrhythmias may have developed. If the client has a cardiac monitor, the nurse needs to check for any dysrhythmias.Administering a nonsalicylate antipyretic such as acetaminophen is appropriate, but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time as no instability has been noted. Unlike with infection, temperature elevations in a client with hyperthyroidism are not associated with chills.

Which trends in serum electrolyte values will the nurse expect to find in a client who has untreated hypoparathyroidism? Below normal calcium levels; above normal phosphorus levels Below normal calcium levels; below normal phosphorus levels Above normal calcium levels; above normal phosphorus levels Above normal calcium levels; below normal phosphorus levels

Below normal calcium levels; above normal phosphorus levels With hypoparathyroidism, the lack of parathyroid hormone (PTH) decreases serum calcium levels by increasing kidney calcium excretion and inhibiting calcium absorption from the GI tract. Low levels of calcium cause a corresponding increase in serum phosphorus levels because calcium and phosphorus exist in a balanced reciprocal relationship in which a decrease in one always causes an increase in the other.

Which action in the plan of care for a client who is hospitalized for pituitary function testing would be most appropriate for the nurse to delegate to an experienced assistive personnel (AP)? Checking the client's blood glucose levels every 4 hours Monitoring the client's response to the IV insulin given during a stimulation test Teaching the client about a hormone suppression test Assessing the client for symptoms of hypopituitarism

Checking the client's blood glucose levels every 4 hours Monitoring blood glucose is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.Assessing and teaching are actions that are within only the nurse's scope of practice. When IV insulin is given for a stimulation test, adverse reactions, especially hypoglycemia, are common and the client needs monitoring by a health care worker who knows exactly what the signs and symptoms are. Such a person must be either a registered nurse or an LPN/LVN.

For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm? Chest pain Constipation Headache Increased sleepiness

Chest pain Bromocriptine can cause serious cardiac dysrhythmias and coronary artery spasms. Constipation, increased sleepiness, and headaches are possible side effects of the drug and their degree of discomfort to the client always should be considered; however, their presence does not constitute harm or require immediate attention.

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? Urine output for the past 24 hours has increased. Client reports numbness and tingling around the mouth. Temperature is now elevated. pH is now 7.43.

Client reports numbness and tingling around the mouth. Hyperaldosteronism causes potassium to be excreted excessively. As hypokalemia becomes more severe, paresthesias occur with numbness and tingling around the mouth and of the fingers and toes.Alkalosis is possible, but the pH shown is normal. Temperature elevation and increased urine output are not associated with a worsening of hyperaldosteronism.

Which type of drug therapy will the nurse prepare to teach about to a client who has mild hyperparathyroidism? Antipyretics Opioid analgesics Furosemide diuretics Calcium supplements

Furosemide diuretics High ceiling or loop diuretics, such as furosemide increase calcium excretion and are used to manage calcium levels in clients who have mild hyperparathyroidism. Antipyretics are not routinely prescribed because fever is not associated with the disorder. Opioid analgesics are used only when a problem causing acute pain is present and not for typical management of mild hyperparathyroidism. Calcium supplements are contraindicated because hyperparathyroidism results in chronic hypercalcemia.

Which laboratory findings will the nurse use to validate the statement of a client with diabetes that therapy instructions for glucose control "have been followed to the letter" for the past 2 months? Random blood glucose level. Glycosylated hemoglobin (HbA1c) Fasting blood insulin level Fasting blood glucose level

Glycosylated hemoglobin (HbA1c) The glycosylated hemoglobin (HbA1c) evaluates the average blood glucose level for 2 to 3 months; this is the best indicator of overall blood glucose control.Although fasting blood glucose can be used to monitor daily glucose control, it is not the best method to evaluate blood glucose over a period of time. A random blood glucose level reflects what the client has eaten within the last few hours and provides no real indication of long-term control. Fasting insulin levels are not used to evaluate anything.

For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider? Calf muscle cramping Runny nose Anorexia Hand tremors

Hand tremors Hand tremors are an indication of HRT toxicity with increased central nervous system stimulation. The dose must be decreased to prevent more serious neurologic and cardiac toxicities. Anorexia, runny nose, and muscle cramping are neither side effects of the drug nor indications of toxicity.

Which changes in laboratory values will the nurse expect to see in a client who has tumor causing excess secretion of aldosterone? (Select all that apply.) Hypoglycemia Hyponatremia Hypokalemia Hypernatremia Hyperglycemia Hyperkalemia

Hypokalemia Hypernatremia Aldosterone is the mineralocorticoid that maintains extracellular fluid volume and electrolyte composition. It promotes sodium and water reabsorption and potassium excretion in the kidney. Excessive amounts of this hormone result in hypernatremia and hypokalemia.Increased aldosterone levels do not affect blood glucose levels.

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? Increased facial hair and absent menses in a 28-year-old nonpregnant woman Increased appetite in a 40-year-old man who started an aerobic exercise program 1 week ago Male-pattern baldness in a 32-year-old man Dry skin on the shins of a 70-year-old woman

Increased facial hair and absent menses in a 28-year-old nonpregnant woman Absence of menses when pregnancy is not present is considered abnormal, especially when accompanied by hirsutism. Possible endocrine problems associated with these changes include ovarian, adrenal gland, hypothalamic, or anterior pituitary dysfunction.Male-pattern baldness in a man is usually associated with a genetic predisposition. Dry skin is a normal finding in older women. An increased appetite when physical activity increases is also considered normal.

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? Decreased sodium; decreased glucose Increased sodium; increased glucose Increased sodium; decreased glucose Decreased sodium; increased glucose

Increased sodium; increased glucose Any of the glucocorticoids have some mineralocorticoid activity and increase the reabsorption of sodium from the kidney tubules, thus increasing the serum sodium level. Cortisol also increases liver production of glucose (gluconeogenesis) and inhibits peripheral glucose uptake by the cells. Both these actions increase blood glucose levels.

Which statements regarding hyperthyroidism are accurate? (Select all that apply.) Select all that apply. Has a sudden onset of symptoms. Is much more common among women than among men. Produces symptoms of a hypermetabolic state. Most common form is Graves disease. Can be diagnosed by the presence of a goiter. Often occurs weeks after exposure to ionizing radiation.

Is much more common among women than among men Produces symptoms of a hypermetabolic state Most common form is Graves disease Hyperthyroidism increases the metabolism and function of all systems. The most common cause of hyperthyroidism is Graves disease, which is an autoimmune disorder, often occurring after an episode of thyroid inflammation leading to the production of autoantibodies (thyroid-stimulating immunoglobulins [TSIs]) that attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid gland. The increased stimulation of TSH receptors greatly increases thyroid hormone production. All thyroid problems are from five to ten more common among women than men.The onset is so slow and insidious that clients may not even notice them until severe changes are present. A goiter only indicates a thyroid problem and can occur with both hypothyroidism and hyperthyroidism. Exposure to ionizing radiation can induce hypothyroidism, not hyperthyroidism.

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? High carbohydrate, low potassium, and fluid restriction Low carbohydrate, high calorie, and low sodium Low protein, high carbohydrate, and low calcium High protein, high carbohydrate, and low potassium

Low carbohydrate, high calorie, and low sodium The client with Cushing disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and hypertension. Clients are encouraged to moderately restrict sodium intake.

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? Administering morphine for pain Assessing the wound dressing for bleeding Hyperextending the neck Monitoring oxygen saturation

Monitoring oxygen saturation Airway assessment and management is always the first priority with every client, especially for a client who has had surgery that involves potential bleeding and edema near the trachea.Assessing the wound dressing for bleeding is a high priority, which is performed next after assessing airway and breathing. Pain control is important, but can be addressed after airway assessment. The neck should not be extended or hyperextended because this position puts too much tension on the incision.

Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)? New-onset hypertension. The client reports extreme salt craving. No change in urine output with minimal fluid intake. The client's headache is gradually increasing in intensity.

No change in urine output with minimal fluid intake. DI results from absent or insufficient secretion of antidiuretic hormone (ADH, vasopressin) from the posterior pituitary and can result from a head injury that damages this endocrine gland. With less or absent ADH, the client is unable to reabsorb water even when fluid intake is low. Although headache is usually present with a head injury, it is not associated with DI. The dehydration associated with DI would cause hypotension and an increased serum sodium concentration.

Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) Select all that apply. Goiter Nonpitting edema of hands and feet Warm, moist skin Decreased deep tendon reflexes Agitation and inability to sleep Pulse rate below 60 beats/min

Nonpitting edema of hands and feet Decreased deep tendon reflexes Hypothyroidism slows the metabolism and function of all systems and the ones that are usually first noticed and can lead to life-threatening complications are the cardiac and central nervous systems. Thus, the heart rate is usually slower than 60 beats/min, and the deep tendon reflexes are decreased. Metabolites that are compounds of proteins and sugars called glycosaminoglycans (GAGs) build up inside cells, which increase the mucus and water, forming cellular edema that is nonpitting.The onset is so slow and insidious that clients may not even notice them until severe changes are present. A goiter only indicates a thyroid problem and can occur with both hypothyroidism and hyperthyroidism. The skin reflects the client's overall decreased metabolism and is cool and dry.

Which laboratory finding in a client with a possible pituitary disorder will the nurse report to the health care provider immediately? Blood glucose 148 mg/dL (7.4 mmol/L) Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) Serum sodium 110 mEq/L (110 mmol/L) Serum potassium 3.2 mEq/L (3.2 mmol/L)

Serum sodium 110 mEq/L (110 mmol/L) The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L). A result of 110 mEq/L (110 mmol/L) represents severe hyponatremia, requiring immediate action to prevent increased intracranial pressure, seizures, and death as the intravascular fluid shifts into brain tissue. The most likely cause of the problem is an increased vasopressin level that is increasing water reabsorption and diluting the serum sodium level.Although all the other laboratory values are also out of the normal range, none are close to reaching a critically low or high value.

Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands? 5-lb weight loss Dry, cracked lips Thinning pubic hair Skin darkening

Skin darkening Clients whose adrenal insufficiency is caused by adrenal glands that cannot produce appropriate levels of adrenal hormones have overall skin darkening. When the problem is in the adrenal gland and not either the hypothalamus or pituitary, plasma ACTH and melanocyte-stimulating hormone (MSH) levels are elevated in response to the adrenal-hypothalamic-pituitary feedback system. (Both ACTH and MSH are made from the same prehormone molecule.) Anything that stimulates increased production of ACTH also leads to increased production of MSH. Elevated MSH levels result in areas of increased pigmentation. Skin darkening does not occur when adrenal insufficiency is caused by hypofunction of the hypothalamus or pituitary gland.Although dehydration and weight loss can occur with adrenal insufficiency, they are not specific to problems in the adrenal glands.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A 42 year old with diabetes insipidus who has a dose of desmopressin due. A 35 year old with hyperaldosteronism who has a serum potassium of 3.0 mEq/L (3.0 mmol/L). A 50 year old with pituitary adenoma who is reporting a severe headache. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L). The nurse first attends to the client with adrenal insufficiency who has a blood glucose level of 36 mg/dL (2.0 mmol/L). The client's condition is considered a medical emergency and must be assessed and treated immediately.Although it is important to maintain prescribed drugs on schedule, especially when a client is demonstrating a need for the next dose, the client requiring a dose of desmopressin cannot take priority over treatment of severe hypoglycemia. A serum potassium of 3.0 mEq/L (3.0 mmol/L) in the client with hyperaldosteronism may be considered normal (or slightly hypokalemic) and does not require immediate attention. The client reporting a severe headache needs to be evaluated as soon as possible after the client with acute adrenal insufficiency.

With which client will the nurse be aware of an increased risk for hypoparathyroidism? A 28-year-old woman with pregnancy-induced hypertension A 35-year-old woman who had radiation therapy for Graves disease A 50-year-old man starting on insulin therapy for type 2 diabetes mellitus A 55-year-old man with moderate heart failure after myocardial infarction

A 35-year-old woman who had radiation therapy for Graves disease Hypoparathyroidism is a relatively rare disorder. It is most often caused by treatment for hyperthyroidism that resulted in injury to the parathyroid glands. None of the other client health problems increase the risk for development of hypoparathyroidism.

Which factor or condition does the nurse expect to result in an increase in a client's production of thyroid hormones (TH)? Getting 8 hours of sleep nightly Chronic constipation Protein-calorie malnutrition Cold environmental temperatures

Cold environmental temperatures Cold and stress are two factors that cause the hypothalamus to secrete thyrotropin-releasing hormone (TRH), which then stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH) to increase production of the two major thyroid hormones.Constipation does not affect thyroid hormone production. Stress from inadequate sleep could increase TH production but adequate sleep does not. Protein-calorie malnutrition would decrease production of many hormones, including TH.

Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.) Select all that apply. Elevated temperature Tachycardia Somnolence Elevated systolic blood pressure Abdominal pain and nausea Slow respiratory rate

Elevated temperature Tachycardia Elevated systolic blood pressure Abdominal pain and nausea Symptoms of thyroid storm are caused by excessive thyroid hormone release, which dramatically increases metabolic rate. Key symptoms include fever, tachycardia, and systolic hypertension. Additional symptoms include abdominal pain, nausea, vomiting, diarrhea, tremors, and anxiety.The increased metabolic rate causes the respiratory rate to increase. Clients are agitated, not somnolent.

Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production? Inspecting feet and legs for ulcers Planning for weight-bearing activities Stressing the important of fiber in the diet Encouraging fluids every 2 hours

Encouraging fluids every 2 hours A decrease in ADH production in the older adult causes urine to be more dilute. In this instance, urine might not concentrate when fluid intake is low, allowing for excess water loss. Encouraging fluid intake every 2 hours, even during the night, is important to prevent dehydration.Weight-bearing activities are appropriate for older adults to prevent bone loss, not fluid loss. Development of foot or leg ulcers is not associated with changes in ADH production. Although a client with dehydration may be constipated, the problem is not the priority when ADH production is low.

What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold? Ensuring the phlebotomist wears a facemask while in the client's room Asking the phlebotomist to delay the blood draw Monitoring the client closely for cold-like symptoms Placing a facemask on the client

Ensuring the phlebotomist wears a facemask while in the client's room The nurse needs to make sure the phlebotomist wears a facemask because the client is immunosuppressed and at higher risk for respiratory infection. Anyone with a suspected upper respiratory infection who must enter the client's room needs to wear a mask to prevent the spread of infection.Asking the phlebotomist to delay the blood draw could lead to harm by not providing sufficient information about the client's condition. The phlebotomist, not the client, is exhibiting cold-like symptoms, so monitoring the client for these symptoms is not appropriate. Having the client wear a mask during the blood draw does not protect him or her from any airborne microorganisms that remain in the atmosphere of the room or droplets that may reside on surfaces.

Why is a goiter often present in clients who have Graves disease? The low circulating levels of thyroid hormones stimulates the feedback system and triggers the anterior pituitary gland to secrete more thyroid-stimulating hormone, which increases the numbers and size of glandular cells in the thyroid gland. The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland. The autoantibodies stimulate blood vessel growth and blood storage within the thyroid gland, increasing its overall size. The autoantibodies stimulate the inflammatory and immune responses to increase the number of white blood cells circulating in the thyroid gland, which increases tissue size without increasing the number of glandular cells.

The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland. Graves disease is an autoimmune disorder in which antibodies (thyroid-stimulating immunoglobulins [TSIs]) are made and attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid tissue. The thyroid gland responds by increasing the number and size of glandular cells, which enlarges the gland, forming a goiter and overproduces thyroid hormones (thyrotoxicosis).

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." "I will keep the cat food bowl on my counter so that I do not have to bend over." "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." "If the dressing gets wet, I will wash the incision line and redress it immediately."

"I will keep the cat food bowl on my counter so that I do not have to bend over." After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waste and should not bear down, cough, or lay flat. Wearing dark glasses while outside is not necessary to prevent complications from the surgery.

After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching? "I will not eat any fatty foods when I am collecting urine for this test." "To end the collection, I must empty my bladder and add this urine to the collection." "I need to keep the urine container cool in a separate refrigerator or cooler." "I won't save the first urine sample of the day."

"I will not eat any fatty foods when I am collecting urine for this test." A need for further teaching is needed when the client says that he/she will not eat any fatty foods while collecting urine for a 24-hour urine test to evaluate a hormone level. Eating fatty foods does not interfere with collection or testing of the urine sample. The other statements indicate correct understanding of the client's actions for collection of an accurate 24-hour urine specimen.

Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed? "If I continue to lose weight, I may need an increased dose." "I will have more energy with this medication." "If I often am constipated and feel tired, I may need an increased dose." "I will take the medication every morning."

"If I continue to lose weight, I may need an increased dose." The statement, "If I continue to lose weight, I may need an increased dose," indicates a need for further teaching. Weight loss indicates a need for a decreased dose, not an increased dose.One of the symptoms of hypothyroidism is lack of energy. Thyroid replacement therapy would cause the client to have more energy. The correct time to take thyroid replacement therapy is in the morning. Frequent constipation and continuing to feel tired are indications that the dose may need to be increased.

Which statement made by a client who is undergoing therapy with radioactive iodine (RAI) for Graves disease indicates a lack of understanding about the disorder and its treatment? "Luckily, I have my own bathroom, so I won't be exposing the rest of my family to radiation" "If this treatment works, maybe I will stop sweating all the time" "It will be great to lose my "bug-eyed" appearance" "I hope I don't gain too much weight when my thyroid function is normal."

"It will be great to lose my "bug-eyed" appearance." Although successful radioactive iodine (RAI) therapy for Graves disease results in reducing most physical symptoms, the exophthalmia does not respond to this therapy. Other measures, such as drug therapy targeted to the exophthalmos and not the hyperthyroidism and surgery to remove tissue from behind the eye, are needed to improve the eye appearance. All other client statements demonstrate accurate understanding of the disorder and its treatment.

What is the nurse's best response when family members of a client with hyperthyroidism express concern about the client's frequent mood swings? "Do the client's mood swings make you feel angry?" "The medications will make the mood swings disappear completely." "Your family member is sick. You must be patient." "Mood swings are common should diminish with treatment."

"Mood swings are common should diminish with treatment." Telling the family that the client's mood swings should diminish over time with treatment provides information to the family, as well as reassurance that this behavior is expected.Asking the family if the client's mood swings make them angry is a closed-ended question and could make the family members feel guilty. The response needs to be client-centered. Any medications or treatment may not completely remove the mood swings associated with hyperthyroidism. The family is aware that the client is sick. Telling them to be patient can also cause feelings of guilt and does not address the family's concerns.

What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid? "Corticosteroids are a type of hormone, and once you have been started on a replacement hormone, you must continue the hormone replacement therapy for the rest of your life." "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." "It is possible for your health problem to recur when corticosteroid therapy is halted suddenly." "The drug suppressed your immune system while you were taking it. Slowly decreasing the dose over time prevents your immune system from starting up too quickly and causing allergic reactions."

"The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." One of the most frequent causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of ACTH and adrenal production of cortisol. None of the other statements are completely accurate.

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? Administering an infusion of 150 mL hypertonic saline over the next 3 hours Drawing blood for hemoglobin and hematocrit levels Measuring serial weights at the same daily with the client wearing the same amount of clothing Inserting an indwelling catheter and monitoring urine output

Administering an infusion of 150 mL hypertonic saline over the next 3 hours The first intervention the nurse performs is to administer an infusion of 150 mL hypertonic saline over 3 hours. When the serum sodium level is below 115 mEq/L (115 mmol/L), the client is at increased risk for seizures and coma.Drawing blood for hematocrit and hemoglobin levels, inserting an indwelling catheter for urine monitoring, and weighing the admitted client are not top priority actions.

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) Select all that apply. Bending at the waist Talking Deep breathing Coughing Wearing makeup Using dental floss

Bending at the waist Coughing Coughing early after surgery both increases intracranial pressure (ICP) and also increases pressure in the incision area and may lead to a leak of cerebrospinal fluid. Bending at the waist also increases ICP.The actions of talking and wearing makeup have no harmful effects. In place of coughing, clients are instructed to take deep breaths to promote gas exchange. To prevent harm, clients are taught to avoid toothbrushing (which could injure the incision line) and are encouraged to floss instead.

Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed? Hypoactive bowel sounds Apical pulse of 92 beats/min Bilateral leg muscle twitching Dry mouth

Bilateral leg muscle twitching Clients are at risk for hypocalcemia and seizures after removal of the parathyroid glands. Muscle twitching is an indication of hypocalcemia and requires assessment and intervention. The other findings are abnormal but not associated with complications from the surgery.

Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.) Select all that apply. Hypertonic saline Furosemide Calcium gluconate Oxygen Suction Emergency tracheotomy kit

Calcium gluconate Oxygen Suction Emergency tracheotomoy kit Calcium gluconate needs to be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema occludes the airway. Oxygen always needs to be at the bedside and especially for the thyroidectomy client who may experience respiratory distress from swelling or damage to the laryngeal nerve leading to spasm. It is also important to have suction available at the client's bedside because of the risk for increased secretions.Furosemide is a diuretic used to treat hypercalcemia associated with hyperparathyroidism. However, hypocalcemia from inadvertent parathyroid removal during thyroidectomy is the greater concern. Hypertonic saline is not necessary for this client. This client is not expected to have hyponatremia after surgery.

Which changing trends in a client's serum laboratory values indicate to the nurse that thyroid hormone replacement therapy for hypothyroidism is effective? Declining thyroglobulin (Tg) levels; rising thyrotropin receptor antibody (TRAb) levels Declining thyroid hormone (TH) levels; rising thyroid-stimulating hormone (TSH) levels Rising thyroglobulin (Tg) levels; declining thyrotropin receptor antibody (TRAb) levels Rising thyroid hormone (TH) levels; declining thyroid-stimulating hormone (TSH) levels

Rising thyroid hormone (TH) levels; declining thyroid-stimulating hormone (TSH) levels Drug therapy for hypothyroidism hormone replacement therapy with synthetic thyroid hormones, which would result in rising TH levels. As these levels rise, the negative feedback loop, which tries to stimulate the thyroid gland to produce TH would be suppressed, causes declining TSH levels. Thyroglobulin levels are related to active thyroid tissue. In hypothyroidism, these levels are low and drug therapy does not increase them. TRAbs are not a cause of hypothyroidism and do not develop with drug therapy.