Endocrine + Diabetes (Brunner 45, uWorld)
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. - Truncal obesity - "Buffalo hump" - Thin extremities - "Moon face" - Purple striae
"Buffalo hump" Thin extremities "Moon face" Truncal obesity Purple striae Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? - Deficient growth hormone - Acromegaly - Type 1 diabetes mellitus - Hypothyroidism
Acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.
Long-term use of antithyroid medication is not generally recommended for elderly clients because of which events? - Cardiac arrhythmias and fatigue - Agranulocytosis and hepatic injury - Renal disease and mental confusion - Gastrointestinal complications and weight loss
Agranulocytosis and hepatic injury Long-term use of certain antithyroid medications, such as propylthiouracil (PTU), is not recommended for treatment of toxic nodular goiter in older clients because of the risk of side effects. Although rare, evidence indicates that PTU can result in agranulocytosis and hepatic injury. However, use of antithyroid medications versus radioactive iodine or surgery may be the client's preferred choice or the option for some older clients and other ill clients with "limited longevity" who can be monitored at least every 3 months.
Which of the following is the primary hormone for the long-term regulation of sodium balance? - Calcitonin - Thyroxin - Antidiuretic hormone (ADH) - Aldosterone
Aldosterone Aldosterone is the primary hormone for the long-term regulation of sodium balance. Vasopressin (ADH) release will result in reabsorption of water into the bloodstream, rather than excretion by the kidneys. Calcitonin is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone. Thyroxin is important in brain development and is necessary for normal growth.
When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? - Depression - Mental confusion - Angina - Hypoglycemia
Angina Angina or dysrhythmias can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines.
Which symptom of thyroid disease is seen in older adults? - Hyperactivity - Restlessness - Atrial fibrillation - Weight gain
Atrial fibrillation Symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.
What dietary modifications should be recommended to a client with hyperthyroidism? - Restrict calorie intake. - Consume a high-protein diet. - Limit intake of nutritionally dense foods such as milk products, eggs, and cheese. - Increase calorie intake by 70%.
Consume a high-protein diet. A high protein intake helps replenish losses from muscle catabolism. Metabolism is increased with hyperthyroidism. Calorie needs increase between 10% and 50% above normal to replenish glycogen stores and correct weight loss. Encourage frequent meals and the intake of nutritionally dense foods (fortified milkshakes, foods fortified with skim milk powder, eggs, cheese, butter, or milk).
A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? - Maintains blood pressure - Helps the body adjust to stress - Regulates metabolism - Slows the body's response to inflammation
Helps the body adjust to stress Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress.
Which of the following clinical signs are associated with diabetes insipidus? - Hypotension - Oliguria - Hypertension - Bradycardia
Hypotension Diabetes insipidus, which causes profound polyuria, may cause clinical signs of volume depletion such as tachycardia and hypotension.
Which nursing diagnosis takes highest priority for a client with hyperthyroidism? - Imbalanced nutrition: Less than body requirements related to thyroid hormone excess - Disturbed body image related to weight gain and edema - Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing - Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
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? - Calcitonin - Iodine - Thyroxine - Thyrotropin
Iodine Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of: - Bone fractures - Heart palpitations - Kidney Stones - Gastric esophageal reflex
Kidney Stones The formation of stones in one or both kidneys is caused by the increased urinary excretion of calcium and phosphorus. It occurs in more than 50% of patients with primary hyperparathyroidism. Renal damage causes the kidney stones.
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? - Radioactive iodine uptake test - Radioimmunoassay - Magnetic resonance imaging (MRI) - A nuclear scan
Magnetic resonance imaging (MRI) A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.
A client with diabetes insipidus is extremely dehydrated and is unable to take oral fluids. Fluid therapy is prescribed. Which intervention would be most important for the client? - Weighing the client daily. - Measuring the fluid intake. - Monitoring the rate of IV infusions. - Measuring the urine output every 30 minutes.
Measuring the urine output every 30 minutes. The nurse must measure the urine output every 30 minutes when administering prescribed fluid and drug therapy when the client is acutely ill or extremely dehydrated, fails to take oral fluids, or is beginning to receive medical treatment. Doing so ensures adequate kidney function. Although monitoring the rate of IV infusions, measuring fluid intake, and weighing the client daily are important, measuring the urine output every 30 minutes is the priority.
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones? - Dexamethasone - Potassium Iodide - Methimazole - Propranolol
Methimazole Propylthiouracil (PTU) and methimazole are commonly used. They both act by blocking the synthesis of hormones. The other choices suppress the release of the thyroid hormones, except for propranolol which is a beta-adrenergic blocking agent.
Which nursing diagnosis is most appropriate for a client with Addison's disease? - Excessive fluid volume - Risk for infection - Hypothermia - Urinary retention
Risk for infection Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.
Because there is no one cause for Graves disease, treatment is relegated to the management of symptoms, or in severe cases, surgery to remove the thyroid gland. Which is not a symptom of Graves disease? - fine hand tremors - increased appetite - constipation - blurred vision
constipation Clients with Graves disease commonly experience diarrhea, increased appetite, weight loss, visual changes such as blurred or double vision, and fine tremors of the hands, causing unusual clumsiness.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: - flushed, warm, moist skin. - systolic murmur at the left sternal border. - decreased body temperature and cold intolerance. - exophthalmos and conjunctival redness.
decreased body temperature and cold intolerance. Hypothyroidism markedly decreases the metabolic rate, causing a reduced 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.
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences: - weight gain and heat intolerance. - heat intolerance and systolic hypertension. - diastolic hypertension and widened pulse pressure. - anorexia and hyperexcitability.
heat intolerance and systolic hypertension. An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs because of the increased metabolic rate. Diastolic blood pressure decreases because of decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite — not anorexia.
Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside: - in 1 to 2 weeks. - in 3 to 4 months. - immediately. - in a few days.
in 1 to 2 weeks. Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol (Inderal).
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? - promote urinary secretion of calcium - inhibit release of calcium into extracellular fluid - increase serum calcium level - decrease serum calcium level
increase serum calcium level The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to - watch for symptoms of hyperthyroidism to disappear within 1 week. - discontinue all antithyroid medications. - monitor for symptoms of hypothyroidism. - continue radioactive precautions with all body secretions.
monitor for symptoms of hypothyroidism. Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).
Cardiac effects of hyperthyroidism include - decreased systolic BP. - bradycardia. - palpitations. - decreased pulse pressure.
palpitations. Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.
A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer: - mannitol (Osmitrol). - methyldopa (Aldomet). - phentolamine (Regitine). - felodipine (Plendil).
phentolamine (Regitine). Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn't effective in treating hypertensive emergencies. Mannitol, a diuretic, isn't used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: - sodium and potassium abnormalities. - chloride and magnesium abnormalities. - calcium and phosphorus abnormalities. - sodium and chloride abnormalities.
sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: - vasopressin. - furosemide. - insulin. - potassium chloride.
vasopressin. Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
A group of students are reviewing information about the relationship between the hypothalamus and the pituitary gland. The students demonstrate the need for additional study when they state: - "The hypothalamus, a portion of the brain between the cerebrum and brain stem, creates a pathway for neurohormones." - "The hypothalamus secretes releasing hormones that stimulate or inhibit pituitary gland secretions." - "Corticotropin-releasing hormone from the hypothalamus triggers ACTH secretion by the pituitary gland." - "The pituitary gland, as the master gland, controls the secretion of hormones by the hypothalamus."
"The pituitary gland, as the master gland, controls the secretion of hormones by the hypothalamus." Although the pituitary gland is considered the "master gland" because it regulates the function of other glands, the hypothalamus influences the pituitary gland. The hypothalamus creates a pathway for neurohormones also known as releasing hormones or factors that stimulate and inhibit secretions from the anterior and posterior lobes of the pituitary gland. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. For example, corticotropin-releasing hormone from the hypothalamus causes the anterior pituitary gland to secrete ACTH.
(uWorld) The nurse in the outpatient clinic is caring for assigned clients with type 1 diabetes mellitus. Which client should the nurse recognize as having the highest risk of developing hypoglycemia? - 29yro with new-onset influenza - 40yro who is a cyclist and is training for an upcoming race - 65yro with cellulitis of the right leg - 72yro with emphysema who is receiving prednisone
- 40yro who is a cyclist and is training for an upcoming race Hypoglycemia (blood glucose <70 mg/dL [3.9 mmol/L]) is an acute and potentially life-threatening complication of diabetes mellitus. It occurs when the proportion of insulin exceeds glucose in the blood. Counterregulatory hormones (eg, epinephrine) are then released, and the autonomic nervous system is activated, causing symptoms of hypoglycemia such as sweating, tremor, and hunger to occur. Aerobic exercise typically lowers blood glucose levels. As muscles use up glucose, the liver is unable to produce enough glucose to keep up with the demand. An experienced exerciser should always check blood glucose levels before, during, and after exercise, and carry a carbohydrate drink or snack in case of a hypoglycemic episode (Option 2). (Options 1 and 3) Clients with an acute illness (eg, influenza, cellulitis) are more likely to experience hyperglycemia rather than hypoglycemia. Increased glucose levels occur due to the physiological stress response caused by the infection. (Option 4) Glucocorticoids (eg, prednisone) can cause hyperglycemia in clients with diabetes mellitus. Clients receiving these medications should be closely monitored to avoid complications such as diabetic ketoacidosis. Educational objective: Aerobic exercise typically lowers blood glucose levels as glucose production in the liver fails to keep up with elevated glucose uptake by the muscles, placing a client at increased risk for hypoglycemia. Clients who participate in any amount of physical activity should closely monitor blood glucose levels and keep a carbohydrate source available during activities. Acute infection and glucocorticoids can cause hyperglycemia in clients with diabetes mellitus.
(uWorld) The nurse is assessing a client who has primary adrenal insufficiency (Addison disease). Which of the following findings is consistent with the condition? - Bronze Pigmentation of the skin - Increased body and facial hair - Purple or red striate on the abdomen - Supraclavicular fat pad
- Bronze Pigmentation of the skin Primary adrenal insufficiency (Addison disease) is also described as hypofunction of the adrenal cortex. The adrenal gland is responsible for secretion of glucocorticoids, androgens, and mineralocorticoids. Bronze hyperpigmentation of the skin in sun-exposed areas is caused by an increase in adrenocorticotropic hormone by the pituitary gland in response to low cortisol (ie, glucocorticoid) levels (Option 1). Clients with Addison disease may also have vitiligo, or patchy/blotchy skin, which is usually present when the etiology of the disease is an autoimmune problem. The immune cells are thought to destroy melanocytes which produce melanin (or brown pigment), resulting in a patchy appearance. Other common manifestations of Addison disease include: Slow, progressive onset of weakness and fatigue Anorexia and weight loss Hyponatremia and hyperkalemia Nausea and vomiting (Options 2, 3, and 4) Hirsutism (increased facial and body hair), purple or red striae on the abdomen, and a supraclavicular fat pad are characteristics of Cushing syndrome, a condition associated with excess corticosteroid production. In contrast, Addison disease is a condition associated with hyposecretion of glucocorticoids. Educational objective: Primary adrenal insufficiency (Addison disease) is a condition caused by hyposecretion of glucocorticoids and mineralocorticoids. Manifestations include bronze skin pigmentation, hypovolemia, hypotension, hyponatremia, hyperkalemia, and vitiligo.
(uWorld) A client with type 1 diabetes is prescribed NPH insulin before breakfast and dinner. Although the client reports feeling well, the 6 AM blood glucose level has averaged 60 mg/dL (3.3 mmol/L) over the past week. Which action is appropriate for the nurse to recommend to the client? - Collect urine sample to check for urine ketones - Consume a snack of milk and cereal at bedtime - Increase carbohydrate intake at each meal - Take only the prebreakfast dose of NPH
- Consume a snack of milk and cereal at bedtime NPH insulin is intermediate-acting with an onset of 1-2 hours, peak of 4-12 hours, and duration of 12-18 hours. Due to its long peak, hypoglycemia (blood glucose <70 mg/dL [<3.9 mmol/L]) can result from use of NPH, especially because the overnight hours (during sleep) typically represent the longest interval between meals. To prevent hypoglycemia related to an evening dose of NPH, the client should eat a bedtime snack consisting of protein and complex carbohydrates (eg, cereal with milk, crackers with peanut butter) (Option 2). Complex carbohydrates paired with protein provide sustained, slow release of glucose, thereby preventing hypoglycemia. (Option 1) Testing for urine ketones should be done as part of a sick-day plan or when evaluating for diabetic ketoacidosis. Ketosis occurs in hyperglycemia, especially when blood glucose is >180 mg/dL (>10 mmol/L). (Option 3) Increasing the client's carbohydrate intake at each meal may disrupt glycemic control and lead to a persistent elevation of blood glucose. Elevated blood glucose can cause complications, such as diabetic ketoacidosis. (Option 4) The client may require an adjustment to the prescribed insulin regimen; however, it is dangerous for the client to drastically alter the prescribed dose. In addition, it is outside the nurse's scope of practice to recommend a change in the prescribed dose. Educational objective: NPH insulin is an intermediate-acting insulin that peaks in 4-12 hours. In asymptomatic clients, the best intervention to prevent low blood glucose levels related to an evening dose of NPH is to consume a bedtime snack of protein and complex carbohydrates.
The nurse cares for a client admitted to the hospital due to confusion. The client has a nonmetastatic lung mass and a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Which action(s) should the nurse expect to implement? Select all that apply. - Fluid bolus (NS) - Fluid restriction - Salt restriction in diet - Seizure precautions - Strict record of fluid intake and output
- Fluid restriction - Seizure precautions - Strict record of fluid intake and output SIADH is an endocrine condition in which antidiuretic hormone overproduction leads to water retention, increased total body water, and dilutional hyponatremia (low serum sodium). Hyponatremia can cause confusion, seizures, or other neurologic complications. It is important for the nurse to anticipate these problems and institute seizure precautions. SIADH treatment includes: Fluid restriction to <1000 mL/day Oral salt tablets to increase serum sodium (Option 3) Hypertonic saline (3%) during the first few hours for clients with markedly decreased serum sodium and severe neurologic manifestations Vasopressin receptor antagonists (eg, conivaptan) The nurse should also maintain a strict fluid intake and output chart and daily weights and carefully monitor neurologic status to evaluate for improvement or deterioration. (Option 1) Normal saline fluid bolus would worsen the hyponatremia as the client already has excess fluid volume. Symptoms are caused by a low sodium level. If the sodium level must be raised, the client will need hypertonic (3%) saline or salt tablets as these contain mainly sodium and little free fluid. Educational objective: SIADH can occur due to lung cancer and is characterized by water retention, increased total body water, and dilutional hyponatremia. Hyponatremia may cause neurologic complications (eg, confusion, seizures). SIADH treatment includes fluid restriction, oral salt tablets, and administration of 3% saline IV and/or vasopressin receptor antagonists.
The nurse assesses a client with Cushing syndrome. Which of the following clinical manifestations should the nurse expect? Select all that apply. - Hyperglycemia - Hypertension - Hyponatremia - Truncal obesity - Weight loss
- Hyperglycemia - Hypertension - Truncal obesity Cushing syndrome is the result of prolonged exposure to excess corticosteroids, especially glucocorticoid steroids. The most common cause is the administration of corticosteroids, such as prednisone or hydrocortisone, for other conditions. However, pituitary adenomas can secrete adrenocorticotropic hormone (ACTH), which in turn causes the adrenal glands to produce too much cortisol. Clinical manifestations of Cushing syndrome include: Androgen excess from adrenal gland stimulation can result in acne, hirsutism, and menstrual irregularities (eg, oligomenorrhea). Metabolic complications include truncal obesity (subsequently causing peripheral insulin resistance), hypertension, and hyperglycemia (ie, excess cortisol stimulating gluconeogenesis). Fat accumulation in the face (ie, moon face) and the back of neck (ie, dorsocervical fat pad) is common (Options 1, 2, and 4). Dermatological changes are possible and include easy bruising, purple striae, and skin atrophy; these result from loss of collagen. Proximal muscle weakness and bone loss (ie, osteoporosis) due to steroid catabolism on muscles and bone can develop in untreated clients. (Options 3 and 5) Hyponatremia and weight loss are associated with adrenocortical insufficiency, or Addison disease. Educational objective: Clinical manifestations of Cushing syndrome include weight gain, truncal obesity, moon face, skin atrophy, easy bruising, purple striae on the abdomen, muscle weakness, hypertension, and hyperglycemia. Associated androgen excess can result in acne, hirsutism, and menstrual irregularities.
(uWorld) In the intensive care unit, the nurse cares for a client who has been admitted with diabetic ketoacidosis. The client is on a continuous infusion of regular insulin at 5 units/hr via IV pump. Which action should the nurse expect to implement? - Check serum BUN and Cr levels every hour - Discontinue insulin infusion when BG is <350mg/dL (19.4mmol/L) - Increase insulin infusion rate when BG decreases - Initiate potassium IV when serum potassium is 3.5-5.0 mEq/L (3.5-5.0 mmol/L)
- Initiate potassium IV when serum potassium is 3.5-5.0 mEq/L (3.5-5.0 mmol/L) Diabetic ketoacidosis (DKA) is an acute, serious complication generally due to lack of insulin in clients with type 1 diabetes. DKA is characterized by hyperglycemia, ketosis, and acidosis. Hyperglycemia causes osmotic diuresis, resulting in profound dehydration. Clients with DKA may initially develop hyperkalemia as a compensatory response to acidosis despite having a total body potassium deficit from urinary loss. Management of DKA includes fluid resuscitation, IV insulin, and hourly blood glucose monitoring. When serum glucose is <250 mg/dL (13.9 mmol/L), D5W is administered to prevent hypoglycemia until ketoacidosis is resolved. Hypokalemia often occurs with resolution of acidosis and administration of IV insulin, which shifts potassium from the intravascular to the intracellular space. Therefore, potassium is administered even when the client is normokalemic (3.5-5.0 mEq/L [3.5-5.0 mmol/L]) to prevent hypokalemia and subsequent life-threatening arrhythmias (Option 4). (Option 1) Serum potassium, glucose, and anion gap or bicarbonate levels are regularly monitored in DKA to monitor treatment effectiveness. Although serum creatinine and BUN levels may be elevated due to dehydration and may be monitored, hourly monitoring is not indicated. (Option 2) IV insulin infusion may be discontinued on resolution of acidosis and ketosis, which generally occurs with a blood glucose level of <200 mg/dL (11.1 mmol/L). (Option 3) As blood glucose is reduced, the insulin infusion rate is decreased to prevent a hypoglycemic event. Educational objective: Hypokalemia often occurs with resolution of diabetic ketoacidosis and administration of IV insulin, which shifts potassium from the intravascular to the intracellular space. Potassium is administered even when the client is normokalemic (3.5-5.0 mEq/L [3.5-5.0 mmol/L]) to prevent life-threatening arrhythmias.
(uWorld) The nurse is caring for a 72-year-old client with hypothyroidism admitted to the emergency department for altered mental status. The client lives alone but has not taken medications or seen a health care provider for several months. Which action is the priority? Click on the exhibit button for additional information. Temperature 95F (35C) Blood pressure 90/50 mmHg Heart rate 50/min Respirations 10/min SaO2 83% - Administer IV levothyroxine - Check serum TSH, triiodothyronine, and thyroxine - Place a warming blanket on the client - Prepare for ET intubation
- Prepare for ET Myxedema coma refers to a state of severe hypothyroidism causing decreased level of consciousness (eg, lethargy, stupor) that may progress to a comatose state. Myxedema coma is characterized by hypothermia, bradycardia, hypotension, and hypoventilation. Hypoventilation may occur as a result of respiratory muscle fatigue and mechanical obstruction by an edematous tongue. Clients with signs of respiratory failure (eg, slow or shallow breathing, low oxygen saturation) require emergency endotracheal intubation and mechanical ventilation. The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation (Option 4). (Option 1) Clients with myxedema coma require thyroid hormone replacement with IV levothyroxine to correct the hypothyroid state but only after respiratory status is secured. Improvement in clinical status may not occur for up to a week after initiation of hormone replacement. (Option 2) A serum thyroid panel (eg, TSH, triiodothyronine, thyroxine) is required to confirm hypothyroidism, and these measurements should be monitored during treatment; however, the nurse should ensure that the client is stable before reviewing laboratory values. (Option 3) A warming blanket should be placed on the client to treat hypothermia; however, respiratory support is the priority. Educational objective: Myxedema coma is a state of severe hypothyroidism and decreased level of consciousness that may progress to coma and respiratory failure. The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation.
A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly? - An increase in cerebral edema - A pituitary tumor - A decrease in release in the growth hormone - A decrease in the glucose level
A pituitary tumor When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.
The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? - A rise in serum calcium stimulates the release of T lymphocytes. - A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. - A rise in serum calcium inhibits the release of calcitonin. - A rise in serum calcium stimulates the release of erythropoietin.
A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? - Decreased phosphate level - Adequate vitamin D level - Increased calcium level - Functioning thyroid gland
Adequate vitamin D level Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? - Continue to take his usual dose of hydrocortisone. - Perform capillary blood glucose monitoring four times daily. - Administer hydrocortisone I.M. - Drink 8 oz of fluids.
Administer hydrocortisone I.M. Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.
The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply. - Intravenous isotonic saline solution in large quantities - Administration of calcium carbonate - Administration of a bronchodilator - Administration of calcitonin - Monitoring the patient for fluid overload
Administration of calcitonin Intravenous isotonic saline solution in large quantities Monitoring the patient for fluid overload Acute hypercalcemic crisis can occur in patients with hyperparathyroidism with extreme elevation of serum calcium levels. Serum calcium levels greater than 13 mg/dL (3.25 mmol/L) result in neurologic, cardiovascular, and kidney symptoms that can be life threatening (Fischbach & Dunning, 2009). Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of 100 to 150 mL per hour is combined with administration of calcitonin (Shane & Berenson, 2012). Calcitonin promotes renal excretion of excess calcium and reduces bone resorption. The saline infusion should be stopped and a loop diuretic may be needed if the patient develops edema. Dosage and rates of infusion depend on the patient profile. The patient should be monitored carefully for fluid overload.
What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply. - A pulse rate slower than 90 bpm - Muscular fatigability - An elevated systolic blood pressure - Weight loss. - Intolerance to cold
An elevated systolic blood pressure Muscular fatigability Weight loss. Manifestations of hyperthyroidism include an increased appetite and dietary intake, weight loss, fatigability and weakness (difficulty in climbing stairs and rising from a chair), amenorrhea, and changes in bowel function. Atrial fibrillation occurs in 15% of in older adult patients with new-onset hyperthyroidism (Porth & Matfin, 2009). Cardiac effects may include sinus tachycardia or dysrhythmias, increased pulse pressure, and palpitations. These patients are often emotionally hyperexcitable, irritable, and apprehensive; they cannot sit quietly; they suffer from palpitations; and their pulse is abnormally rapid at rest as well as on exertion. They tolerate heat poorly and perspire unusually freely.
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? - Pitting edema of the legs - Dry mucous membranes - Frequent urination - An irregular apical pulse
An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. - Offer the client a straw when drinking liquids. - Closely monitor nasal packing and postnasal drainage. - Assess for neurologic changes. - Encourage deep breathing and coughing.
Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage. The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? - Assess vital signs. - Weigh the client. - Administer oral hydrocortisone. - Test urine for ketones.
Assess vital signs. Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.
The most common cause of hypothyroidism is which of the following? - Autoimmune thyroiditis - Radioiodine therapy - Antithyroid medications - Thyroidectomy
Autoimmune thyroiditis The most common cause of hypothyroidism is autoimmune thyroiditis (Hashimoto's disease), in which the immune system attacks the thyroid gland. Hypothyroidism can occur in patient with previous hyperthyroidism that has been treated with radioiodine, antithyroid medication treatment, or thyroidectomy.
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? - Above-normal urine and serum osmolality levels - Above-normal urine osmolality level, below-normal serum osmolality level - Below-normal urine osmolality level, above-normal serum osmolality level - Below-normal urine and serum osmolality levels
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. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: - Calcitonin - Thyroxine - Phosphorus - Parathyroid
Calcitonin Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
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. - Sodium - Magnesium - Potassium - Calcium
Calcium Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.
A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of: - Magnesium sulfate - Sodium phosphate - Calcium gluconate - Potassium chloride
Calcium gluconate Inadvertent removal of the parathyroid may occur during neck dissection surgery, resulting in hypocalcemia. This condition is treated with the IV administration of calcium gluconate.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? - Calcium gluconate - Synthroid - Tapazole - Propylthiouracil (PTU)
Calcium gluconate Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.
Which of the following is considered a late symptom of hypothyroidism? - Brittle nails - Loss of libido - Physical sluggishness - Cold intolerance
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.
A patient has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this patient? - Concentrated urine - Hypernatremia - Dilute urine - Increased serum osmolality
Concentrated urine Because SIADH patients do not excrete dilute urine, the urine osmolality will be increased. Also, serum sodium levels will show low levels because of the retention of urine. There is a decreased serum osmolality with an inappropriately increased urine osmolality.
Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following? - Myxedema - Hypothyroidism - Cretinism - Diabetes insipidus
Cretinism During fetal and neonatal development, undersecretion of thyroid hormone may cause cretinism (stunted growth and mental development). In adults, hyposecretion of thyroid hormone causes myxedema or hypothyroidism. Diabetes insipidus is caused by undersecretion of antidiuretic hormone (ADH/vasopressin).
Hypophysectomy is the treatment of choice for which endocrine disorder? - Acromegaly - Cushing syndrome - Pheochromocytoma - Hyperthyroidism
Cushing syndrome Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? - E - C - D - B
D The actions of PTH are increased by the presence of vitamin D.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following would the nurse expect to find? - Elevated serum sodium levels - Decreased serum osmolarity - Elevated urine calcium levels - Decreased urine sodium levels
Decreased serum osmolarity With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? - Elevated serum sodium levels - Decreased urine sodium levels - Elevated urine calcium levels - Decreased serum osmolarity
Decreased serum osmolarity With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? - Diabinese - Thiazide diuretics - Ibuprofen - Desmopressin (DDAVP)
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.
A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for? - Hypothyroidism - Pituitary tumor - Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - Diabetes insipidus (DI)
Diabetes insipidus (DI) With diabetes insipidus, urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine excretion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not to a pituitary tumor. The thyroid gland does not exhibit these symptoms.
Which is a clinical manifestation of diabetes insipidus? - Excessive thirst - Low urine output - Weight gain - Excessive activities
Excessive thirst Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.
A nurse should perform which intervention for a client with Cushing's syndrome? - Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather. - Offer clothing or bedding that's cool and comfortable. - Explain that the client's physical changes are a result of excessive corticosteroids. - Suggest a high-carbohydrate, low-protein diet.
Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
A patient comes to the clinic with complaints of severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the physician will order for diagnosis? - TSH test - Urine specific gravity - Fluid deprivation test - Complete blood count (CBC)
Fluid deprivation test Diabetes insipidus (DI) is the most common disorder of the posterior obe of the pituitary gland and is characterized by a deficiency of ADH (vasopressin). Excessive thirst (polydipsia) and large volumes of dilute urine are manifestations of the disorder. The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI.
A client with Addison disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which action would the nurse take next? - Inform the physician immediately. - Instruct the client to remain in bed. - Check the client's blood glucose level before each meal. - Give the client milk and graham crackers.
Give the client milk and graham crackers. Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? - Insulin - Glucagon - Somatostatin - Cholecystokinin
Glucagon Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.
Antithyroid medications are not generally recommended for elderly patients because of which side effect? - Fatigue - Weight loss - Mental confusion - Granulocytopenia
Granulocytopenia Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? - Moon face and buffalo hump - Cardiac dysrhythmia - Bulging forehead - Hand flexing inward
Hand flexing inward Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client? - Furosemide - Bumetanide - Hydrochlorothiazide - Metolazone
Hydrochlorothiazide The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment. Reference:
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion? - Insulin - Potassium - Hydrocortisone - Hypotonic saline
Hydrocortisone Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.
An older adult female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should suspect which disorder? - Diabetes mellitus - Diabetes insipidus - Hypoparathyroidism - Hyperparathyroidism
Hyperparathyroidism Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone. Clients also exhibit hypercalciuria-causing polyuria. Although clients with diabetes mellitus and diabetes insipidus have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than by polyuria.
A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for: - Indicators of dehydration. - Serum calcium levels. - Glycosuria - Indicators of hyponatremia.
Indicators of dehydration. A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration. No glucose is lost in the urine. Hypernatremia occurs with dehydration.
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: - Weight gain - Constipation - Fatigue - Intolerance to heat
Intolerance to heat With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism.
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? - Bananas - Milk - Chicken livers - Hamburger
Milk Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client's care plan? Select all that apply. - Monitor gait, balance, and fatigue level with ambulation. - Encourage intake of dairy products, seafood, nuts, broccoli, and spinach. - Monitor for fluid overload. - Monitor for signs and symptoms of diarrhea.
Monitor gait, balance, and fatigue level with ambulation. Monitor for fluid overload. Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet.
A patient who has had a total parathyroidectomy has returned to the unit from PACU. The nurse caring for the patient knows to assess for what complication following this surgery? - Muscle twitching - Hypercalcemia - Hemorrhage - Fatigue
Muscle twitching Loss of parathyroid function can result in complaints of paresthesias (perioral, extremities) and fasciculations (muscle twitching), therefore the nurse asks the patient about neuromuscular manifestations. Hemorrhage, fatigue, and hypercalcemia are not associated with the loss of the parathyroid gland.
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? - Monitor laboratory values daily for elevated thyroid-stimulating hormone. - Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. - Observe for swelling of the neck, tracheal deviation, and severe pain. - Evaluate the quality of the client's voice postoperatively, noting any drastic changes.
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.
Which glands regulate calcium and phosphorous metabolism? - Thyroid - Parathyroid - Adrenal - Pituitary
Parathyroid 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.
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: - Paresthesia - Bradypnea - Hypothermia - Hypotension
Paresthesia Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
Nursing care for a client in addisonian crisis should include which intervention? - Offering extra blankets and raising the heat in the room to keep the client warm - Encouraging independence with activities of daily living (ADLs) - Placing the client in a private room - Allowing ambulation as tolerated
Placing the client in a private room The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.
A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? - Potassium chloride - Hydrocortisone (Cortef) - Normal saline solution - Fludrocortisone (Florinef)
Potassium chloride The nurse should question an order for potassium chloride because addisonian crisis results in hyperkalemia. Administering potassium chloride is contraindicated. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? - Propranolol - Spironolactone - Propylthiouracil - Levothyroxine
Propylthiouracil Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.
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? - Insomnia related to increased nighttime voiding - Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns - Activity intolerance related to muscle cramps, cardiac dysrhythmias, and weakness - Impaired nutrition: more than body requirements related to polyphagia
Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns 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.
Patients with hyperthyroidism are characteristically: - Apathetic and anorexic - Emotionally stable - Calm - Sensitive to heat
Sensitive to heat Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? - Blood urea nitrogen (BUN) level of 12 mg/dl - Blood glucose level of 90 mg/dl - Serum potassium level of 5.8 mEq/L - Serum sodium level of 134 mEq/L
Serum potassium level of 5.8 mEq/L Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is: - Soft with poorly defined borders. - Hard as a result of hypertrophy. - Tiny in size and difficult to palpate. - Nodular due to diminished blood flow.
Soft with poorly defined borders. In hyperthyroidism, the thyroid gland is soft to the touch, may pulsate, and sometimes is not clearly defined on ultrasound. This appears due to increased blood flow through the gland.
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 positive feedback system - Produce a new hormone to try and regulate the thyroid function - Be unable to perform in response to low levels of thyroid hormone. - Stimulate more hormones using the negative feedback system
Stimulate more hormones using the negative feedback system Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.
Parathyroid hormone (PTH) has which effects on the kidney? - Stimulation of phosphate reabsorption and calcium excretion - Increased absorption of vitamin E and excretion of vitamin D - Stimulation of calcium reabsorption and phosphate excretion - Increased absorption of vitamin D and excretion of vitamin E
Stimulation of calcium reabsorption and phosphate excretion 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.
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. - Liver function tests - Neurologic function - Urine and blood chemistry - Signs of dehydration - Strict intake and output
Strict intake and output Neurologic function Urine and blood chemistry Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? - Sympathetic - Respiratory effects - Parasympathetic - Gastrointestinal effects
Sympathetic Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.
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? - Oxygen saturation of 96% - Heart rate of 62 - Blood pressure 90/58 mm Hg - Temperature of 102ºF
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.
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? - Hemorrhage - Tetany - Laryngeal nerve damage - Thyroid storm
Tetany Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? - The patient may have thyroiditis. - The patient may have hypothyroidism. - The patient may have Cushing disease. - The patient may have hyperthyroidism.
The patient may have hyperthyroidism. If palpation discloses an enlarged thyroid gland, both lobes are auscultated using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism and necessitates referral to a physician.
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking the prescribed antithyroid medication? - Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - Diabetes insipidus - Thyrotoxic crisis - Myxedema coma
Thyrotoxic crisis Antithyroid medication is given to treat hyperthyroidism. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Therefore, this client is at risk for thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism. Myxedema coma results from severe hypothyroidism. Diabetes insipidus (DI) and SIADH do not correlate with hyperthyroidism or the medication taken for hyperthyroidism.
The nurse is assisting with the preparation of a teaching plan for a client who is to receive methimazole (Tapazole). Which of the following would be most appropriate to include in this plan? - Advising the client to use a straw when taking the drug. - Urging the client to report any fever or sore throat. - Telling the client to take largest dose of the drug in the morning. - Telling the client to dilute the drug with fruit juice.
Urging the client to report any fever or sore throat. Methimazole (Tapazole) can cause agranulocytosis which occurs most often in the first 2 months of therapy and requires discontinuation of the drug. Thus, the client should be instructed to report sore throat, fever, chills, headache, malaise, weakness, or unusual bleeding or bruising. Diluting the drug with fruit juice or using a straw are appropriate instructions for a client taking iodine solution. Methimazole is given in equal doses every 8 hours around the clock.
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. Serum sodium level of 149 mEq/L Serum ADH level of 2.3 pg/mL Serum osmolality of 310 mOsm/kg Urine specific gravity of 1.001 Urine osmolality of 800 mOsm/kg
Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 149 mEq/L A urine specific gravity of 1.001, serum osmolality of 310 mOsm/kg, and serum sodium level of 149 mEq/L are all indicative of diabetes insipidus.
A nurse caring for a patient with diabetes insipidus is reviewing the patient's laboratory results. What is an expected urinalysis finding? - Leukocytes in the urine - Glucose in the urine - Urine specific gravity of 1.001 to 1.005 - Albumin in the urine
Urine specific gravity of 1.001 to 1.005 Patients with diabetes insipidus experience profound polyuria. Consequently, the patient's urine will have a water-like specific gravity (close to 1.000). The urine would not contain 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.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: - thick, coarse skin. - deposits of adipose tissue in the trunk and dorsocervical area. - weight gain in arms and legs. - hypotension.
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 with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with: - hyperthyroidism. - depression. - hypoglycemia. - neuropathy.
depression. Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload? - confusion and diarrhea - hypertension and weight gain without edema - pulmonary congestion and muscle cramps - dyspnea and hypertension
dyspnea and hypertension Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: - Hashimoto's thyroiditis. - myxedema coma. - thyroid storm. - cretinism.
myxedema coma. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
A nurse should expect a client with hypothyroidism to report: - puffiness of the face and hands. - increased appetite and weight loss. - thyroid gland swelling. - nervousness and tremors.
puffiness of the face and hands. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in: - hair loss. - bone mineralization. - menstrual flow. - serum glucose level.
serum glucose level. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.
