Endocrine Problems

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? A antidiuretic hormone (ADH). B thyroid-stimulating hormone (TSH). C follicle-stimulating hormone (FSH). D luteinizing hormone (LH).

A ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A vasopressin (Pitressin Synthetic). B furosemide (Lasix). C regular insulin. D 10% dextrose.

A 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.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? A Fluid intake is less than 2,500 ml/day. B Urine output measures more than 200 ml/hour. C Blood pressure is 90/50 mm Hg. D The heart rate is 126 beats/minute.

A 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.

When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? A sulfisoxazole (Gantrisin) B mexiletine (Mexitil) C prednisone (Orasone) D lithium carbonate (Lithobid)

A Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

A nurse is instructing a client regarding intranasal Vasopressin (Pitressin). The nurse tells the client that which of the following is a side effect specific to the medication? A Runny nose. B Headache. C Flushing. D Nausea.

A Vasopressin administered via intranasal route causes nasal congestion/Runny nose. Options B, C, and D are the side effects of the medication administered intravenously.

A patient presenting with diabetes insipidus (DI) exhibits a. hyperosmolality and hypernatremia. b. hyperosmolality and hyponatremia. c. hypo-osmolality and hypernatremia. d. hypo-osmolality and hyponatremia.

ANS: A In central DI, there is an inability to secrete an adequate amount of antidiuretic hormone (arginine vasopressin) in response to an osmotic or nonosmotic stimuli, resulting in inappropriately dilute urine. Hypernatremia is usually associated with serum hyperosmolality.

Patients with central DI are treated with a. vasopressin. b. insulin. c. glucagon. d. propylthiouracil.

ANS: A Patients with central DI who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH,desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.

After a patient has been diagnosed with SIADH, the nurse would expect the first line of treatment to include a. fluid restriction. b. hypotonic intravenous fluid. c. D5W. d. fluid bolus.

ANS: A Reduction in fluid intake is one component of the treatment plan for SIADH.

The neuroendocrine stress response produces which of the following? (Select all that apply.) a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia d. Heightened pain awareness e. Increased glucose

ANS: A, B, C, E The fight-or-flight response, or sympathetic nervous response, releases catecholamine that causes an increased heart rate and blood pressure. Blood is shunted form nonessential organs such as the stomach, glucose is made available to the brain cells, and pain awareness is decreased.

. During the first 24 hours when the nurse administers hypertonic saline in a patient with SIADH, the serum sodium should be raised no more than a. 5 mEq/day. b. 12 mEq/day. c. 20 mEq/day. d. 25 mEq/day.

ANS: B One recommended regimen is an IV rate that provides sufficient sodium to raise serum sodium levels by up to 12 mEq/day for the first 24 hours (no more than 0.5 mEq each hour), with a total increase of 18 mEq/L in the initial 48 hours.

In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is a. massive diuresis, leading to hemoconcentration. b. dilutional hyponatremia, reducing sodium concentration to critically low levels. c. hypokalemia from massive diuresis. d. serum osmolality greater than 350 mOsm/kg.

ANS: B Patients with SIADH have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.

The major electrolyte disturbances that result from diuresis are a. low calcium and high phosphorus levels. b. low potassium and low sodium levels. c. high sodium and low phosphorus levels. d. low calcium and low potassium levels.

ANS: B Serum sodium may be low as a result of the movement of water from the intracellular space into the extracellular (vascular) space. The serum potassium level is often normal; a low serum potassium level in diabetic ketoacidosis suggests that a significant potassium deficiency may be present.

An older patient presents with a serum glucose level of 900 mg/dL, hematocrit of 55%, and no serum ketones. Immediate attention must be given to a. clotting factors. b. rehydration. c. administration of insulin. d. sodium replacement.

ANS: B The physical examination may reveal a profound fluid deficit. Signs of severe dehydration include longitudinal wrinkles in the tongue, decreased salivation, and decreased central venous pressure, with increases in heart rate and rapid respirations (Kussmaul air hunger does not occur). In older patients, assessment of clinical signs of dehydration is challenging.

A patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium level of 120 mEq/L, a serum osmolality level of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse would suspect a. diuresis. b. DI. c. SIADH. d. hyperaldosteronism.

ANS: C A decreased urine output, hyponatremia, hypoosmolality, and high urine specific gravity are classic signs of SIADH. Oat cell carcinoma is a precipitating factor for SIADH.

. Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing a. type 1 diabetes. b. type 2 diabetes. c. DI. d. myxedema coma.

ANS: C Any patient who has head trauma or resection of a pituitary tumor has an increased risk of developing DI.

A patient is admitted with a long history of mental illness. Her husband states she has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspects a. central diabetes insipidus (DI). b. nephrogenic DI. c. psychogenic (dipsogenic) DI. d. iatrogenic DI.

ANS: C Psychogenic diabetes insipidus (DI) is a rare form of the disease that occurs with compulsive drinking of more than 5 L of water a day. Long-standing psychogenic DI closely mimics nephrogenic DI because the kidney tubules become less responsive to antidiuretic hormone as a result of prolonged conditioning to hypotonic urine.

Characteristics of diabetes insipidus (DI) are a. hyperglycemia and hyperosmolarity. b. hyperglycemia and peripheral edema. c. intense thirst and passage of excessively large quantities of dilute urine. d. peripheral edema and pulmonary crackles.

ANS: C The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.

Which of the following nursing interventions should be initiated on all patients with SIADH? a. Placing the patient on an air mattress b. Forcing fluids c. Initiating seizure precautions d. Applying soft restraints

ANS: C The patient with SIADH has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death.

The patient at risk for developing SIADH may be taking a. adenosine (Adenocard). b. diltiazem (Cardizem). c. heparin sodium. d. acetaminophen.

ANS: D Tylenol increases the release of ADH.

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? A "You must lie flat for 24 hours after surgery." B "You must avoid coughing, sneezing, and blowing your nose." C "You must restrict your fluid intake." D "You must report ringing in your ears immediately."

B After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? A Tetanic contractions B Neck vein distention C Weight loss D Polyuria

B SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

For a male client with hyperglycemia. which assessment finding best supports a nursing diagnosis of Deficient fluid volume? Discuss A. Cool. clammy skin B. Distended neck veins C. Increased urine osmolarity D. Decreased serum sodium level

C In hyperglycemia. urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glycosuria and polyuria. losing body fluids and experiencing fluid volume deficit. Cool. clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess. the opposite imbalance.

Desmopressin acetate (DDAVP) is given to a patient with diabetes insipidus. Which of the following therapeutic response should you expect? A Decreased blood pressure. B Decreased attention span. C Decreased urinary output. D Decreased blood sugar.

C The therapeutic response of this medication is decreased urine output because it promotes renal conservation of water. Options A, B, and D are unrelated effect to this medication.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A Infusing I.V. fluids rapidly as ordered B Encouraging increased oral intake C Restricting fluids D Administering glucose-containing I.V. fluids as ordered

C To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? A Acromegaly B Type 1 diabetes mellitus C Hypothyroidism D Deficient growth hormone

A 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 often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? A Acromegaly B Type 1 diabetes mellitus C Hypothyroidism D Deficient growth hormone

A 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 often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

To assist the nurse in evaluating the patients hydration status, assessment would include a. orthostatic hypotension and neck vein filling. b. pupil checks and Kernig sign. c. Chvostek and Trousseau signs. d. S4 gallop and edema.

ANS: A Assessment for orthostatic hypotension and neck vein filling is an important way to evaluate hydration status.

Decreased urine osmolality is a sign of a. hyperglycemia. b. diabetes insipidus. c. thyroid crisis. d. SIADH.

ANS: B Decreased urine osmolality is a sign of DI.

The onset of seizures in the patient with DI indicates a. increased potassium levels. b. hyperosmolality. c. severe dehydration. d. toxic ammonia levels.

ANS: C This excessive intake of water reduces the serum osmolality to a more normal level and prevents dehydration. In the person with decreased level of consciousness, the polyuria leads to severe hypernatremia, dehydration, decreased cerebral perfusion, seizures, loss of consciousness, and death.

A priority for patient education when discharged with long-term antidiuretic hormone deficiency is a. daily intake and output. b. attention to thirst. c. a low-sodium diet. d. daily weights.

ANS: D Daily weights on the same scale are an excellent assessment of fluid status. A weight gain or loss of 1 kg (2.2 lb) is equal to 1 L of fluid.

While a patient with SIADH is receiving hypertonic saline, the nurse assesses for signs that the saline must be stopped. These signs would include a. decreased CVP and decreased PAP. b. bradycardia and thirst. c. hypotension and wheezing. d. hypertension and lung crackles.

ANS: D Hypertension and lung crackles are signs of fluid overload. The hypertonic solution may pull fluid out of cells and tissues. Whereas weight gain signifies continual fluid retention, weight loss indicates loss of body fluid.

The diagnosis of SIADH is made when which of the following conditions is present? a. Decreased ADH level and hyperkalemia b. Decreased ADH level and hypernatremia c. Increased ADH level and serum ketones d. Increased ADH level and low serum osmolality

ANS: D SIADH occurs when there are increased levels of ADH in the blood compared with a low serum osmolality.

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? A Restricting fluids B Restricting sodium C Forcing fluids D Restricting potassium

C The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

A 67-year-old male 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, nurse Richard would suspect which of the following disorders? A Diabetes mellitus B Diabetes insipidus C Hypoparathyroidism D Hyperparathyroidism

D Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

A client with diabetes insipidus is taking antidiuretic hormone. Which of the following symptoms would alert the need to decrease the dosage? A Alopecia. B Jaundice. C Diarrhea. D Drowsiness.

D One of the side effects of taking antidiuretic hormone is water intoxication which is manifested by a headache, drowsiness, light-headedness, and shortness of breath. This could indicate the need to reduce the dosage. Options A, B, and C are not related signs to this medication.

A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? A It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs. B It interacts with plasma membrane receptors to inhibit enzymatic actions. C It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. D It regulates the threshold for water resorption in the kidneys.

c Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn't decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? A "Administer desmopressin while the suspension is cold." B "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." C "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." D "You won't need to monitor your fluid intake and output after you start taking desmopressin."

c Question 27 Explanation: Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.