Endocrine Prep-U easy
What does a positive Chvostek's sign indicate?
- Hypocalcemia
Cardiac effects of hyperthyroidism include: A. palpitations. B. decreased pulse pressure. C. decreased systolic blood pressure. D. bradycardia.
A R:Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have? A. Anemia from the decrease in maturation of red blood cells B. Increase in blood sugar levels due to alteration in insulin levels C. Decrease in blood sugar levels due to alteration in insulin levels D. Development of male sex characteristics SUBMIT ANSWER
A R:The kidneys secrete erythropoietin, which is a substance that promotes the maturation of red blood cells.
A patient has been admitted to an acute medical unit with a diagnosis of diabetes insipidus with a neurogenic etiology. When planning this patient's care, what diagnosis should be the nurse's most likely priority? A. Fluid volume deficit related to increased urine output B. Altered nutrition: less than body requirements related to decreased intake C. Acute confusion related to alterations in electrolytes D. Risk for injury related to decreased level of consciousness
A R:The hallmark of diabetes insipidus, and the primary focus of interventions, is the copious urine output that accompanies the condition. Confusion, injury, and impaired nutrition are less likely to result from diabetes insipidus.
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? A. Frequent urination B. An irregular apical pulse C. Dry mucous membranes D. Pitting edema of the legs
B R: 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.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: A. Phosphorus B. Calcitonin C. Thyroxine D. Parathyroid
B R: Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: A. a blood glucose level of 130 mg/dl. B. a blood pressure of 176/88 mm Hg. C. a blood pressure of 130/70 mm Hg. D. bradycardia.
B R:Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following? A. Disorder of the hypothalamus B. Dysfunction of the thyroid gland itself C. Failure of the pituitary gland D. Inadequate secretion of TSH
B R: Thyroidal hypothyroidism results from thyroid gland dysfunction. The other causes result in central, secondary, or tertiary causes if there is inadequate secretion of TSH.
When caring for a client with diabetes insipidus, the nurse expects to administer: A. furosemide (Lasix). B. regular insulin. C. vasopressin (Pitressin). D. 10% dextrose.
C R:Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? A. Propylthiouracil (PTU) B. Tapazole C. Calcium gluconate D. Synthroid
C R: 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.
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 _________ and ___________
Calcium and Vitamin D R: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. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
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? A. Thyroxine B. Thyrotropin C. Calcitonin D. Iodine
D R:Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
A group of students are reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? A. Glucagon B. Glucocorticoids C. Mineralocorticoids D. Epinephrine
D R:The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.
Vision and visual fields are altered in disorders of which of the following endocrine glands? A. Parathyroid B. Pancreas C. Thyroid D. Pituitary
D R:The pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur.
Which diagnostic test is done to determine suspected pituitary tumor? A. radiographs of the abdomen B. radioimmunoassay C. measurement of blood hormone levels D. computed tomography scan
D R: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? A. The patient may have hypothyroidism. B. The patient may have thyroiditis. C. The patient may have Cushing disease. D. The patient may have hyperthyroidism.
D R: 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 is the most common cause of hyperaldosteronism? A. Deficient potassium intake B. Excessive sodium intake C. A pituitary adenoma D. An adrenal adenoma
D R:An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? A. Monitor vital signs every 4 hours. B. Observe urine output. C. Monitor bowel patterns. D. Observe stool color.
D R:The nurse should observe the color of each stool and test the stool for occult blood.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A. Decreased cardiac output B. Imbalanced nutrition: Less than body requirements C. Risk for infection D. Impaired physical mobility
R:An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?
Vitamin D
A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in: A. serum glucose level. B. hair loss. C. menstrual flow. D. bone mineralization.
A
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? A. Stimulate more hormones using the negative feedback system B. The feedback loop will be unable to perform in response to low levels of thyroid hormone. C. Produce a new hormone to try and regulate the thyroid function D. Stimulate more hormones using the positive feedback system
A R: Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing 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? A. Pineal gland, melatonin B. Adrenal cortex, corticosteroids C. Parathyroid glands, parathormone D. Thymus gland, thymosin
A R: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.
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: A. Protruding eyes and a fixed stare. B. a wide, staggering gait. C. Dry, waxy swelling and abnormal mucin deposits in the skin. D. More than 10 beats/minute difference between the apical and radial pulse rates.
A R: Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? A. pituitary disorder B. parathyroid disorder C. adrenal disorder D. thyroid disorder
A R: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.
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? A. If the client is allergic to seafood B. If the client is allergic to beef C. If the client is allergic to grapefruit D. If the client is allergic to pork
A R: The nurse documents an allergy to iodine, a component of contrast dyes, or seafood, and informs the physician. Pork, beef, and grapefruit do not interact with the contrast dye that the client will receive during testing.
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? A. Weight loss B. Hair loss C. Dyspnea D. Fatigue
A R: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: A. profound neuromuscular irritability. B. severe hypotension. C. acute gastritis. D. excessive thirst.
A R:Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? A. Tachycardia B. Leg cramps C. Dysuria D. Blurred vision
A R:Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? A. The functioning of endocrine glands B. The concentration of a substance in plasma C. The client's blood sugar level D. Details about the size of the organ and its location
A R:Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? A. Myxedemic coma B. Thyroid storm C. Acromegaly D. Addison's disease
A R: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.
The nurse is assisting with the preparation of teaching plan for a client who is to receive methimazole (Tapazole). Which of the following would be most appropriate to include in this plan? A. Urging the client to report any fever or sore throat. B. Advising the client to use a straw when taking the drug. C. Telling the client to take largest dose of the drug in the morning. D. Telling the client to dilute the drug with fruit juice.
A R: 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 assessing a client with hyperthyroidism. What findings should the nurse expect? A. Weight loss, nervousness, and tachycardia B. Weight gain, constipation, and lethargy C. Diaphoresis, fever, and decreased sweating D. Exophthalmos, diarrhea, and cold intolerance
A R: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? A. Adequate vitamin D level B. Decreased phosphate level C. Functioning thyroid gland D. Increased calcium level
A R:Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
A client with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of: A. hyponatremia and hyperkalemia. B. hypernatremia and hypokalemia. C. hypernatremia and hyperkalemia. D. hyponatremia and hypokalemia.
A R:Adrenal crisis may be sudden or gradual. Clients experiencing an adrenal crisis should be monitored for hyponatremia and hypokalemia.
ADH is secreted by which gland? A. Posterior pituitary B. Anterior pituitary C. Adrenal D. Thyroid
A R:Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.
A nurse educator is teaching a chapter on "The Function of the Endocrine System." Which hormone would not be included as one of the six hypothalamic hormones? A. prolactin B. corticotropin-releasing hormone C. thyrotropin-releasing hormone D. gonadotropin-releasing hormone
A R:Hypothalamic dopamine inhibits the release of prolactin from the anterior pituitary gland. Corticotropin-releasing hormone (CRH) causes the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). Thyrotropin-releasing hormone (TRH) stimulates the release of thyroid-stimulating hormone (TSH) from the anterior pituitary gland. Gonadotropin-releasing hormone (GnRH) triggers sexual development at the onset of puberty and continues to cause the anterior pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose? A. Diabetes insipidus B. Goiter C. Diabetes mellitus D. Cushing's syndrome
B R: A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.
A nurse caring for a patient with diabetes insipidus is reviewing the patient's laboratory results. What is an expected urinalysis finding? A. Glucose in the urine B. Urine specific gravity of 1.001 to 1.005 C. Albumin in the urine D. Leukocytes in the urine
B R: 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 caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? A. Tell the client she needs to learn to accept herself as she is and be compliant during treatment. B. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. C. Tell the client that she looks fine and offer to help her with makeup. D. Tell the client she'll feel better if she consistently takes the thyroid replacement medication.
B R: Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.
When caring for a client who's being treated for hyperthyroidism, the nurse should: A. encourage the client to be active to prevent constipation. B. balance the client's periods of activity and rest. C. provide extra blankets and clothing to keep the client warm. D. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy.
B R:A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.
Which of the following glands is considered the master gland? A. Parathyroid B. Pituitary C. Adrenal D. Thyroid
B R:Commonly referred to as the master gland, the pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands. The thyroid, parathyroid, and adrenal glands are not considered the master gland.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? A. Blood pressure is 90/50 mm Hg. B. Urine output measures more than 200 ml/hour. C. Fluid intake is less than 2,500 ml/day. D. Heart rate is 126 beats/minute.
B R:Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
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 pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: A. Hashimoto's thyroiditis. B. myxedema coma. C. thyroid storm. D. cretinism.
B R: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.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? A. Thiazide diuretics B. Desmopressin (DDAVP) C. Ibuprofen D. Diabinese
B R: 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 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: A. sodium and chloride abnormalities. B. calcium and phosphorus abnormalities. C. sodium and potassium abnormalities. D. chloride and magnesium abnormalities.
C R: 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.
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? A. Use nasal desmopressin acetate (DDAVP). B. Exercise to improve cardiovascular fitness. C. Have regular follow-up care. D. Keep an accurate record of intake and output.
C R: 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. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.
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? A. Blood pressure 90/58 mm Hg B. Heart rate of 62 C. Temperature of 102ºF D. Oxygen saturation of 96%
C R: 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 controls secretion of adrenal androgens? A. Parathormone B. Thyroid-stimulating hormone (TSH) C. Adrenocorticotropic hormone (ACTH) D. Calcitonin
C R:ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate: A. hyperkalemia. B. hypercalcemia. C. hypocalcemia. D. hypokalemia.
C R: A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: A. exophthalmos and conjunctival redness. B. systolic murmur at the left sternal border. C. decreased body temperature and cold intolerance. D. flushed, warm, moist skin.
C R: 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.
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? A. increase in hormonal levels B. hormonal underproduction C. decrease in hormonal levels D. hormonal overproduction
C R: Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.
Which group of clients should not receive potassium iodide? A. Those who are allergic to corticosteroids B. Those who are pregnant C. Those who are allergic to seafood D. Those taking medications such as cough medicines
C R: Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.
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? A. Dwarfism B. Simmonds' disease C. Gigantism D. Acromegaly
C R: When oversecretion 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. An absence of pituitary hormonal activity causes Simmonds' disease.
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? A. The secreted hormones act like target cells. B. The glands play a minor role in maintaining homeostasis. C. The secretions are released directly into the bloodstream. D. The glands contain ducts that produce the hormones.
C R:The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? A. Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck. B. Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips. C. Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. D. Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips.
C R:When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? A. Complaints of nausea B. Shivering C. Blood pressure varying between 120/86 and 240/130 mm Hg D. Heart rate of 56-64 bpm
C R: Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.
The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? A. Diet and drug histories are related to the family history. B. An allergy to iodine is inherited. C. Endocrine disorders can be inherited. D. It helps determine the client's general status.
C R:Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history. A complete blood count and chemistry profile are performed to determine the client's general status and to rule out disorders. Obtaining information about an allergy to iodine is important because diagnostic testing may involve the use of contrast dyes. However, an allergy to iodine is not related to endocrine disorders. Diet and drug histories, although important information, are not associated with the family history.
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? A. A decrease in release in the growth hormone B. An increase in cerebral edema C. A pituitary tumor D. A decrease in the glucose level
C R: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.
Trousseau's sign is elicited by which of the following? A. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. B. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. C. The patient complains of pain in the calf when his foot is dorsiflexed. D. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
D R:A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. The radial artery should not be used for an arterial puncture. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? A. Examine extremities for pitting edema. B. Administer prescribed diuretics. C. Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. D. Provide a high-sodium diet.
D R: 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.
A client has suffered from several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. The client's healthcare provider suspects Addison's disease. Which symptom would the nurse not expect to see? A. depression B. hypotension C. hypoglycemia D. weight gain
D R: Weight loss, anemia, anorexia, and gastrointestinal symptoms are signs and symptoms of adrenal insufficiency. The consequences of decreased adrenal cortical function include decreased available glucose and hypoglycemia. Nervousness and periods of depression are often seen in clients with adrenal insufficiency. Weakness, fatigue, dizziness, hypotension, postural hypotension, and hypothermia are often seen in clients with adrenal insufficiency.
A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? A. 50 pg/mL B. 100 pg/mL C. 100 to 300 pg/mL D. 450 pg/mL
D R:Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? A. Related to tetany secondary to a decreased serum calcium level B. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces C. Related to exhaustion secondary to an accelerated metabolic rate D. Related to bone demineralization resulting in pathologic fractures
D R:Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This increase, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? A. promote urinary secretion of calcium B. decrease serum calcium level C. inhibit release of calcium into extracellular fluid D. increase serum calcium level
D R:The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? A. "Do you have to get up at night to empty your bladder?" B. "Have you experienced any headaches or sinus problems?" C. "Can you describe the amount of stress in your life?" D. "Do you experience fatigue even if you have slept a long time?"
D R:With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient? A. Symptoms of pneumonia B. Dietary intake of foods with saturated fats C. Heat intolerance D. Symptoms of acute coronary syndrome
D R: The nurse must monitor for signs and symptoms of acute coronary syndrome (ACS), which can occur in response to therapy in patients with severe, long-standing hypothyroidism or myxedema coma, especially during the early phase of treatment. ACS must be aggressively treated at once to avoid morbid complications (e.g., myocardial infarction).
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? A. "Rest as much as possible." B. "Lose weight." C. "Jog at least 2 miles per day." D. "Maintain a moderate exercise program."
D R: 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. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? A. Test urine for ketones. B. Weigh the client. C. Administer oral hydrocortisone. D. Assess vital signs.
D R: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.
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: A. processed meats. B. cereals and grains. C. dairy products. D. fresh fruits.
D R:Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.
