Endocrine Review

A nurse is caring for a client who has developed agranulocytosis as a result of taking propylthiouracil to treat hyperthyroidism. The nurse should understand that this client is at increased risk for which of the following conditions?

Infection Agranulocytosis is a failure of the bone marrow to make enough white blood cells, causing neutropenia and lowering the body defenses against infection.

A nurse is talking with a client whose thyroid-stimulating hormone (TSH) level will be measured. Which of the following statements by the nurse explains the purpose of this test?

"This test determines whether your thyroid gland is overactive, appropriately active, or underactive." This describes the TSH test, which helps determine thyroid status and helps monitor the effectiveness and dosage of thyroid hormone replacement therapy.

A nurse is reviewing the laboratory results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism?

A client who has a phosphate of 5.7 mg/dL This level is above the expected reference range of 3.0 to 4.5 mg/dL. Phosphorus levels are increased in a client who has hypoparathyroidism.

A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective?

A decrease in urine output The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following data should the nurse identify as the priority to monitor?

Airway patency When using the airway, breathing, circulation approach to client care, the nurse should determine it is the priority to monitor the client's airway. Nerve damage, hypocalcemia induced tetany, and edema can all impair the airway following thyroidectomy.

A nurse is planning care for a client who is postoperative following a thyroidectomy. Which of the following interventions should the nurse include in the plan?

Check the client's voice every 2 hr. The nurse should assess the client's voice every 2 hr to monitor for hoarseness, which is a manifestation of laryngeal nerve damage.

A nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care?

Check urine specific gravity. The nurse should check the client's urine specific gravity to monitor urine concentration in a client who has diabetes insipidus. A client who has diabetes insipidus has a urine specific gravity of less than 1.005.

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

Chvostek's sign The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia.

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?

Dehydration Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.

A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations?

Frequent mood changes Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones that regulate the metabolic rate. Clients experience emotional lability that fluctuates between emotional hyperexcitability and irritability. They often cannot sit quietly.

A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH?

Lung cancer The nurse should ask the client if he has a history of lung cancer because some of the treatment options for small cell lung cancer can cause secretion of antidiuretic hormone. This results in the body retaining water and can cause the syndrome of inappropriate antidiuretic hormone (SIADH).

A nurse in the emergency department (ED) is admitting a client who has Type 1 diabetes mellitus. Vital Signs 1400: Temperature: 37.2° C (99° F) Heart rate: 128/min Respiratory rate: 30/min Blood pressure: 98/58 mm Hg SpO2 saturation: 89% on room air Nurses' Notes 1400 Client reports increased glucose levels and "feeling really bad." States, "I think I may have given myself the wrong dose of insulin." Oriented to person, place, and time; appears lethargic. Skin is warm and moist. Decreased turgor. Dry mucous membranes. Pulse is rapid, S1S2 heard on auscultation. Respirations deep and rapid. Fruity odor noted to breath. Chest is clear on auscultation. Bowel sounds auscultated in 4 quadrants. Reports anorexia and abdominal pain. Reports frequent urination with no difficulty. Diagnostic Results 1430: Sodium: 130 mEq/L (136 to 145 mEq/L) Potassium: 5.4 mEq/L (3.5 to 5 mEq/L) Glucose: 570 mg/dL (74 to 106 mg/dL) BUN: 22 mg/dL (10 to 20 mg/dL) Creatinine: 1 mg/dL (0.5 to 1 mg/dL)

Obtain blood and urinalysis for ketones is an anticipated prescription for a client who has type 1 diabetes mellitus and highly elevated glucose levels. The client also presents with a fruity odor to the breath, which indicates ketosis. Chest x-ray is nonessential as the client shows no indication of respiratory illness. Obtain arterial blood gases is anticipated as clients who have diabetic ketoacidosis are often in metabolic acidosis. CT scan of the head is nonessential as the client is oriented and gives no indication that a head injury has occurred. Repeat potassium level every 2 hr is anticipated as the potassium level is elevated which places the client at risk for cardiac dysrhythmias. Infuse D5½ sodium chloride @ 100 mL/hr is contraindicated as the client is experiencing high glucose levels. The first fluid that should be infused is 0.9 % sodium chloride, followed by ½ sodium chloride. When glucose levels decline to 250 mg/dL, D5½ sodium chloride should then be initiated. Obtain capillary blood glucose every hr is anticipated as therapy is initiated to decrease the glucose levels. Monitoring glucose every hr will direct the fluid and insulin therapy.

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate?

Oliguria The nurse should expect a client who has developed SIADH following a craniotomy to manifest oliguria. The decrease in urine output can be dramatic with output less than 20 mL/hr.

A nurse is caring for a client who is postoperative following a subtotal thyroidectomy. Nurses Notes 1515: Oxygen saturation 95%. The client's voice is hoarse. The client reports tingling around the mouth. Moderate serosanguinous drainage noted on neck dressing. The client has a slight tremor noted in both hands. The client's temperature has increased in 1 hr from 37.5° C (99.5° F) to 38.6° C (101.5° F). The client appears restless.

Oxygen saturation 95% is incorrect. An oxygen saturation of 95% is within the expected reference range of 95% to 100%. The client's voice is hoarse is incorrect. Temporary hoarseness is an expected finding following a subtotal thyroidectomy due to possible laryngeal nerve damage and endotracheal intubation. The nurse should continue to monitor and document this finding. The client reports tingling around the mouth is correct. Tingling around the mouth is a manifestation of hypocalcemia, which can be caused by damage to the parathyroid glands during surgery. The nurse should notify the provider, check the client's calcium level, and prepare to administer calcium gluconate or calcium chloride. Moderate serosanguinous drainage noted on neck dressing is incorrect. A moderate amount of serosanguinous drainage is an expected finding following a subtotal thyroidectomy. The client has a slight tremor noted in both hands is correct. Muscle twitching is a manifestation of hypocalcemia. The nurse should notify the provider, check the client's calcium level, and prepare to administer calcium gluconate or calcium chloride. Tremors can also indicate thyroid storm. The client's temperature has increased in 1 hr from 37.5° C (99.5° F) to 38.6° C (101.5° F) is correct. A rapid increase in temperature can indicate impending thyroid storm. The nurse should notify the provider immediately, and implement interventions to cool the client, provide humidified oxygen, and prepare to administer hydrocortisone and acetaminophen. The client appears restless is correct. Restlessness is a manifestation of thyroid storm. The nurse should notify the provider and monitor the client for tachycardia and systolic hypertension.

A nurse is teaching a client who has a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that the client is at risk for which of the following complications?

Pathologic fractures A client who has hyperparathyroidism is at risk for pathological fractures due to the release of calcium and phosphate into the blood, which reduces bone density and places the client at risk for pathologic fractures.

A nurse is assessing a client who is admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis?

Provide a quiet, low-stimulus environment. Thyroid crisis can occur in response to a stressor, so the nurse should minimize stressful stimuli in the client's environment.

A nurse is caring for a client who is 8 hr postoperative following a subtotal thyroidectomy. In which of the following positions should the nurse keep the client?

Semi-Fowler's with neck in a neutral position Semi-Fowler's is the most comfortable position for a client who has had thyroid surgery. Neck flexion could compromise the airway, and neck extension could place excessive tension on the operative area and the sutures. A neutral position is essential.

Client has a history of bipolar disorder, cholecystitis, and type 2 diabetes mellitus. 1000: Client is admitted to the acute mental health unit. Client was brought to the emergency department by a family member who states that the client has not eaten, slept, or taken their medications in at least 2 days and that the client's behavior is typical of manic episodes in the past. 1200: Client is alert and orientated x 2. Client is pacing the exam room and refuses to sit down. Becomes agitated when asked questions. Client appears to be pale and disheveled with dirty clothes. Able to obtain vital signs, but no other physical assessment as the client becomes severely agitated. 1000: Temperature: 37.3°C (99.1° F) Heart rate: 110/min Respiratory rate: 24/min Blood pressure: 168/89 mm Hg Oxygen saturation: 97% on room air 1200: Temperature: 37.3° C (99.1° F) Heart rate: 115/min Respiratory rate: 24/min Blood pressure: 166/90 mm Hg Oxygen saturation: 98% on room air

Reduce the level of stimuli in the client's environment. The client should be placed in a room with minimal stimuli to decrease the chance of further agitation. Encourage the client to attend group activities is incorrect. The client should be encouraged to participate in structured activities. However, group activities should be limited as one on one activities foster a sense of security. Provide a high-calorie protein shake every hour is correct. The client should be provided with high-calorie options that can be consumed "on the go". This is important so that the client maintains sufficient caloric intake. Monitor vital signs daily is incorrect. During a manic episode, the client's vital signs should be monitored at least every 30 min until return to baseline. Provide frequent rest periods is correct. Clients should be encouraged to rest frequently, especially if they are unable to sleep. Weigh the client daily is correct. The client should be weighed daily to assess their fluid and nutritional status.

The nurse is reviewing the client's medical record. Based on the information, which of the following actions should the nurse take? For each potential action, click to specify if the potential action is anticipated or contraindicated for the client. Medical History Week 1 0830: Type 2 diabetes mellitus Client reports they have been overeating since they were 14 years old. Obesity Week 1 0830: 35-year-old client reports uncontrollable eating since they were a teenager. States, "My eating has gotten worse in the last 2 months since I got engaged. I am so nervous about losing weight and fitting into my dress. Who would want to marry me anyway?" 1030: Client seen by provider and diagnosed with binge-eating disorder. Started client on a 1,800 calories a day diet along with an oral glycemic. Client instructed to keep food diary and obtain weight weekly. Goal is for client to lose 1 to 2 lb per week. Follow-up appointment in 1 week. Week 2 0900: Client presents for 1-week follow-up. Client states, "I tried to adhere to the diet plan, but I am always hungry. I don't think I will ever lose weight before my wedding. I am always going to be fat. When I think about my fitting into my wedding dress, I eat and eat and I'm unable to stop. I have binged at least three times this week." Week 1 0830: Sodium 143 mEq/L (136 to 145 mEq/L) Potassium 4.5 mEq/L (3.5 to 5 mEq/L) Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L) Hgb 16 g/dL (12 to 18 g/dL) Hct 46% (37% to 52%) Fasting blood sugar 132 mg/dL (70 to 110 mg/dL) Week 2 0900: Sodium 141 mEq/L (136 to 145 mEq/L) Potassium 4.2 mEq/L (3.5 to 5 mEq/L) Magnesium 1.7 mEq/L (1.3 to 2.1 mEq/L) Hgb 15 g/dL (12 to 18 g/dL) Hct 45% (37% to 52%) Fasting blood sugar 148 mg/dL (70 to 110 mg/dL)

Request to decrease the dose of oral glycemic medication is contraindicated. The client's fasting blood glucose has increased and is still above the expected reference range; therefore, the oral glycemic medication should not be decreased. Instruct the client to weigh themselves daily is contraindicated. The nurse should identify that the client has an eating disorder. The client is already struggling with their weight and binge eating; therefore, instructing the client to weigh themselves daily would place more emotional stress on the client, which can lead to more binge eating. Encourage the client to eat small, frequent meals is anticipated. The nurse should identify that the client has a binge-eating disorder and reports being hungry on their diet plan; therefore, encouraging the client to consume a small meal at frequent intervals can extend periods of abstinence, which then helps the client to be less hungry and wanting to binge eat. Anticipate a potassium supplement for the client is contraindicated. The client's potassium level is within the expected reference range; therefore, a potassium supplement should be avoided. Teach the client to plan meals ahead is anticipated. The client has an eating disorder; therefore, planning meals ahead of time provides structure for the client's eating and allows the client an opportunity for another choice if desired. Recommend that the client journal about their feelings is anticipated. The client admits struggling the first week on the 1800 ADA diet plan; therefore, the nurse should recommend that the client should journal about their feelings of anxiety that leads them to binge eat, which can then be a tool to modify their behavior.

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following prescriptions should the nurse anticipate?

Restrict fluid intake to 1,000 mL per day. Clients who have SIADH have an increased amount of antidiuretic hormone, which results in excess fluid volume. This excess fluid dilutes the sodium level in the blood, causing dilutional hyponatremia. Oral fluids are restricted in an attempt to restore the fluid balance and the sodium level in the blood. The nurse should offer this client frequent oral care to prevent discomfort and breakdown of the oral mucosa.

A nurse is caring for a client 1 hr following a subtotal thyroidectomy. In which of the following positions should the nurse place the client?

Semi-Fowler's Positioning the client in semi-Fowler's, with the head supported with a pillow, is the appropriate position to decrease pressure on the suture line and prevent edema formation, which could cause respiratory distress.

A nurse is providing teaching to a client who has a new prescription for levothyroxine for hypothyroidism. The nurse should instruct the client to avoid which of the following herbal supplements?

Soy The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine.

A nurse is assessing a client who has diabetes insipidus. Which of the following findings is a manifestation of this diagnosis?

Tachycardia Tachycardia is a manifestation of diabetes insipidus due to dehydration from fluid loss.

A nurse is reviewing the laboratory results for four clients. The nurse should recognize that which of the following clients has a manifestation of primary hyperparathyroidism?

The client who has an increased magnesium level Magnesium level is increased in a client who has primary hyperparathyroidism.

A nurse in a clinic is reviewing the laboratory values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following laboratory values?

Thyroid stimulating hormone (TSH) The nurse should anticipate that TSH will be elevated.

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?

Urine specific gravity 1.002 The nurse should expect a client who has diabetes insipidus to have diluted urine with a specific gravity less than 1.005.

A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which the following laboratory findings indicate a therapeutic effect of the medication?

Urine specific gravity 1.015 A therapeutic effect of the medication would be urine specific gravity within the expected reference range, which is 1.010-1.025.

A nurse is assisting a client who has hypothyroidism with meal planning. Which of the following foods should the nurse recommend that the client add to her diet?

Whole grains Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fluid and fiber intake. Whole grains provide ample amounts of fiber.