endocrine ch 52 prep U

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability?

Stimulate more hormones using the negative feedback system

Which of the following is considered a late symptom of hypothyroidism?

Cold intolerance Late symptoms of hypothyroidism include cold intolerance, weight gain, apathy, slow speech, and constipation. Early symptoms include physical sluggishness, loss of libido, and brittle nails.

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

Computed tomography CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?

"I may stop taking this medication when I feel better."

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?

"Maintain a moderate exercise program." The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?

"You must avoid hyperextending your neck after surgery." To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia.

The nurse is aware that the best time of day for the total large corticosteroid dose is between:

7:00 AM and 8:00 AM

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?

A decrease in urine output Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.

Which type of cell secretes glucagon and promotes gluconeogenesis?

Alpha The alpha cells of the pancreas secret the hormone glucagon. It promotes gluconeogenesis, thus increasing the blood glucose level. The beta cells of the pancreas secrete insulin. Delta cells secrete somatostatin, which reduces the rate at which food is absorbed from the gastrointestinal tract.

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus?

Below-normal urine osmolality level, above-normal serum osmolality level In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level.

Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?

Bulging forehead Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet.

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy.

Calcium Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.

Trousseau's sign is elicited by which of the following?

Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?

Desmopressin (DDAVP) DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration. Other medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.

Which of the following would the nurse expect to find in a client with severe hyperthyroidism?

Exophthalmos Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism

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

Gigantism When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly.

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect:

Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

Hypocalcemia.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?

Have regular follow-up care. The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early.

The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?

Hyperthyroidism

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply.

Hypothermia Hypotension Hypoventilation

A client is admitted to the hospital and will be undergoing tests to determine if he has an abdominal mass. What should the nurse be sure to document when asking about allergies?

If the client is allergic to seafood

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this?

Iodine Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.

Which of the following would the nurse expect the physician to order for a client with hypothyroidism?

Levothyroxine sodium Hypothyroidism is treated with thyroid replacement therapy, in the form of dessicated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit?

Moon face Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.

When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include?

Most disorders result from over- or underproduction of the hormone.

A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate?

Myxedema coma Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism?

Myxedemic coma Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer?

Observe stool color. The nurse should observe the color of each stool and test the stool for occult blood.

A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction?

Parathyroid gland

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?

Pineal gland, melatonin The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamicpituitary 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.

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following?

Positive Chvostek's sign If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.

The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?

Potassium of 6.0 mEq/L Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L.

A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care?

Provide a high-sodium diet. Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water.

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find?

Reports of increased appetite Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids.

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency?

Temperature of 102ºF Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.

Which of the following hormones would the nurse identify as being secreted by the thyroid gland?

Thyroxine The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?

Weight loss, nervousness, and tachycardia Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism

Trousseau sign is elicited

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted?

decrease in hormonal levels

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:

decreased body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:

deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function?

metabolic rate

A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and:

vitamin D. Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D.