Exam 5 Endocrine

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. Forcing fluids Explanation: 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.

The nurse is aware that the following is the most common cause of hyperaldosteronism? A. Excessive sodium intake B. A pituitary adenoma C. Deficient potassium intake D. An adrenal adenoma

D. An adrenal adenoma Explanation: 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 as well as of pituitary stimulation.

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifestation of this disorder? 1. Edema 2. Obesity 3. Hirsutism 4. Hypotension

4. Hypotension Rationale: Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea and vomiting, abdominal cramps, weight loss, depression, and irritability. IGGY

A client who had intracranial surgery is experiencing diabetes insipidus. The nurse plans care, knowing that the client is experiencing which problem? 1. Water intoxication 2. Excess production of dopamine 3. Excess production of angiotensin II 4. Insufficient production of antidiuretic hormone (ADH)

4. Insufficient production of antidiuretic hormone (ADH) Rationale: In diabetes insipidus there is insufficient ADH production, which causes the kidneys to excrete large volumes of urine. Water intoxication occurs when there is excess ADH production, resulting in water retention. IGGY

A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg/dL. Which medication should the nurse anticipate to be prescribed for the client? 1. Calcitonin 2. Calcium chloride 3. Calcium gluconate 4. Large doses of vitamin D

1. Calcitonin Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcitonin (Calcimar), a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. Calcium chloride and calcium gluconate are medications used for the treatment of tetany that occurs from acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided.

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1. Fever and tachycardia 2. Pallor and tachycardia 3. Agitation and bradycardia 4. Restlessness and bradycardia

1. Fever and tachycardia Rationale: Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever with temperatures greater than 100° F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur. IGGY

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1. Hypotension and fever 2. Mental status changes and hypertension 3. Subnormal temperature and hypotension 4. Complaints of weakness and hypertension

1. Hypotension and fever Rationale: The nurse should be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. IGGY

The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

1. Insomnia 2. Weight loss 5. Mild heat intolerance Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client has been hospitalized for an endocrine system dysfunction of the pancreas. The nurse providing care for the client anticipates that he or she will exhibit impaired secretion of which substances? 1. Insulin 2. Lipase 3. Trypsin 4. Amylase

1. Insulin Rationale: The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organ secretes insulin as a key endocrine hormone to regulate the blood glucose level. Other pancreatic endocrine hormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin. IGGY

A nurse notes that a client's serum calcium level is 6.0 mg/dL. Which assessment findings should be anticipated in this client? Select all that apply. 1. Tetany 2. Constipation 3. Renal calculi 4. Hypotension 5. Prolonged QT interval 6. Positive Chvostek's sign

1. Tetany 4. Hypotension 5. Prolonged QT interval 6. Positive Chvostek's sign IGGY

The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions? 1. "I expect to experience some tingling of my toes, fingers, and lips after surgery." 2. "I will definitely have to continue taking antithyroid medications after this surgery." 3. "I need to place my hands behind my neck when I have to cough or change positions." 4. "I need to turn my head and neck front, back, and laterally every hour for the first 12 hours after surgery."

3. "I need to place my hands behind my neck when I have to cough or change positions." Rationale: The client is taught that tension needs to be avoided on the suture line, otherwise hemorrhage may develop. One way of reducing incisional tension is to teach the client how to support the neck when coughing or being repositioned. Likewise, during the postoperative period the client should avoid any unnecessary movement of the neck. That is why sandbags and pillows frequently are used to support the head and neck. Any postoperative tingling in the fingers, toes, and lips probably is due to injury to the parathyroid gland during surgery, resulting in hypocalcemia. These signs and symptoms need to be reported immediately. Removal of the thyroid does not mean that the client will be taking antithyroid medications postoperatively. Thyroid replacement medications are necessary. IGGY

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone

3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone Rationale: SIADH is characterized by inappropriate continued release of antidiuretic hormone (ADH). This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality. IGGY

The nurse is caring for a client who is receiving growth hormone replacement therapy. The nurse monitors the client for which option as an adverse effect of this therapy? 1. Hypocalciuria 2. Hypoglycemia 3. Hyperglycemia 4. Hyperthyroidism

3. Hyperglycemia Rationale: Hyperglycemia can occur as a result of the administration of growth hormone, particularly in a client with diabetes mellitus. Hypercalciuria can occur, particularly during the first 2 to 3 months of therapy. Growth hormone therapy is associated with a decline in thyroid function.

The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the medication at which time? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

3. On an empty stomach Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign/symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1. Bradycardia 2. Flaccid paralysis 3. Tingling around the mouth 4. Absence of Chvostek's sign

3. Tingling around the mouth Rationale: After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. IGGY

The nurse is preparing to discharge a client who has had a parathyroidectomy. The discharge instructions include medication administration of oral calcium supplements that the client will need daily. Which statement by the nurse would be most appropriate regarding the oral calcium supplement therapy? 1. Take the tablets following a meal. 2. Store the tablets in the refrigerator to maintain potency. 3. Avoid sunlight because the medication can cause skin color changes. 4. Check the pulse daily; if it is less than 60 beats/min, do not take the tablets.

1. Take the tablets following a meal. Rationale: Oral calcium supplements can be administered with food to enhance its absorption as well as decrease gastrointestinal irritation. The remaining options are unrelated to oral calcium therapy.

A client's serum calcium level is high. The nurse plans care knowing that which hormones are directly responsible for maintaining the free or unbound portion of the serum calcium within normal limits? 1. Thyroid hormone 2. Parathyroid hormone 3. Follicle-stimulating hormone 4. Adrenocorticotropic hormone

2. Parathyroid hormone Rationale: Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Thyroid hormone is responsible for maintaining a normal metabolic rate in the body. Follicle-stimulating hormone and adrenocorticotropic hormone are produced by the anterior pituitary gland. They are responsible for growth and maturation of the ovarian follicle and stimulation of the adrenal glands, respectively. IGGY

The nurse provides medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the health care provider (HCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur.

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? 1. The hoarseness is permanent. 2. It indicates nerve damage. 3. It is normal during this time and will subside. 4. It will worsen before it subsides, which may take 6 months.

3. It is normal during this time and will subside. Rationale: Hoarseness in the postoperative period usually is the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. IGGY

The health care provider prescribes a 24-hour urine collection for vanillylmandelic acid (VMA). The community health nurse visits the client at home and instructs the client in the procedure for the collection of the urine. Which statement, if made by the client, would indicate a need for further instruction? 1. "I can take medication if I need to during the collection." 2. "When I start the collection, I will urinate and discard that specimen." 3. "I will pour the urine in the collection bottle each time I urinate and refrigerate the urine." 4. "I will start the collection in 2 days. Starting now, I cannot eat or drink any tea, chocolate, vanilla, or fruit until the test is completed."

1. "I can take medication if I need to during the collection." Rationale: Clients are reminded not to take medications for 2 to 3 days before a 24-hour urine collection for vanillylmandelic acid (VMA). Because a 24-hour urine collection is a timed quantitative determination, it is essential that the client start the test with an empty bladder. Therefore the client is instructed to void, discard the first urine, note the time, and start the test. The 24-hour urine specimen collection bottle must be kept on ice or refrigerated. For a VMA determination, the client is instructed to avoid tea, chocolate, vanilla, and all fruits for 2 days before urine collection begins.

A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side/adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1. Administer methimazole with food. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side/adverse effects such as sore throat, fever, or headaches. Rationale: Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the health care provider (HCP) should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

Propylthiouracil (PTU) is prescribed for a client with hyperthyroidism. The nurse provides instructions to the client regarding the medication and informs the client to notify the health care provider if which sign/symptom occurs? 1. Fever 2. Dry mouth 3. Drowsiness 4. Increased urination

1. Fever Rationale: An adverse effect of PTU is agranulocytosis. The client needs to be informed of the early signs of this adverse effect, which include fever and sore throat. Drowsiness is an occasional side effect of the medication. Dry mouth and increased urination are unrelated to this medication.

When teaching the client with adrenal insufficiency about cortisone (Cortone Acetate) the nurse should include which items? Select all that apply. 1. Increase intake of sodium. 2. Take the medication with food. 3. Increase intake of potassium-rich foods. 4. Stay away from people with active infections. 5. Discontinue the medication when symptoms subside. 6. Notify the health care provider if illness occurs or surgery is anticipated

2. Take the medication with food. 3. Increase intake of potassium-rich foods. 4. Stay away from people with active infections. 6. Notify the health care provider if illness occurs or surgery is anticipated Rationale: Glucocorticoids should not be abruptly discontinued because acute adrenal insufficiency could occur. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection, therefore the client should avoid contact with clients who are ill. Taking the medication with food helps prevent stomach upset. Individuals may need an increase in dosage during illness or times of stress (surgery). Kee Hayes Book

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2. Test the drainage for glucose. Rationale: After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. The head of the bed should not be lowered to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication. IGGY

Which findings should raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply. 1. Ketones are present in the urine. 2. Urine specific gravity is 1.001. 3. Jugular venous distention is observed. 4. Serum osmolality is 320 mOsm/kg of water. 5. Blood glucose levels are greater than 200 mg/dL. 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

2. Urine specific gravity is 1.001. 4. Serum osmolality is 320 mOsm/kg of water. 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours. Rationale: Signs of diabetes insipidus include low urine specific gravity (<1.005), high serum osmolality (>300 mOsm/kg of water), and increased urine output from a deficiency of antidiuretic hormone (ADH). IGGY

A nurse is providing home care instructions to a client with a diagnosis of Addison's disease. Which statement by the client indicates a need for further instruction? 1. "I need to wear a Medic-Alert bracelet." 2. "I need to purchase a travel kit that contains cortisone." 3. "I will need to take daily medications until my symptoms decrease." 4. "I need an increased dose of glucocorticoid medication during stressful minor illnesses."

3. "I will need to take daily medications until my symptoms decrease." Rationale: Client teaching includes the need for lifelong daily medications. The client also is instructed to carry or wear a medical identification card or bracelet. A travel kit will need to be purchased. It should contain oral cortisone along with intramuscular preparations for self-injection and intravenous vials for emergency injection by a health care provider. Increased glucocorticoid dosage during stressful minor illnesses will be necessary.

A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse providing care for the client anticipates that he or she may exhibit altered secretion of which hormones? 1. Growth hormone (GH) 2. Luteinizing hormone (LH) 3. Antidiuretic hormone (ADH) 4. Follicle-stimulating hormone (FSH)

3. Antidiuretic hormone (ADH) Rationale: ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. The anterior pituitary gland produces GH, LH, and FSH. IGGY

A nurse is assigned to the care of a client who has an altered production of cortisol. The nurse anticipates that the client is experiencing difficulty with synthesis of which type of substance? 1. Androgens 2. Catecholamines 3. Glucocorticoids 4. Mineralocorticoids

3. Glucocorticoids Rationale: Cortisol is a glucocorticoid, which is produced by the adrenal cortex. Androgens and mineralocorticoids are other substances produced by the adrenal cortex. Catecholamines (epinephrine and norepinephrine) are produced by the adrenal medulla. IGGY

A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit signs of thyroid storm. Which is an early indicator of this complication? 1. Constipation 2. Bradycardia 3. Hyperreflexia 4. Low-grade temperature

3. Hyperreflexia Rationale: Clinical manifestations of thyroid storm include a fever as high as 106° F, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation, hypotension, atrial fibrillation, and cardiovascular collapse. IGGY

A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse should include which priority intervention in the plan of care? 1. Restrict fluids to 1000 mL per day. 2. Describe the use of loperamide (Imodium). 3. Walk down the hall for 15 minutes three times a day. 4. Describe the administration of aluminum hydroxide gel.

3. Walk down the hall for 15 minutes three times a day. Rationale: Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids should not be restricted. Discussing the use of medications is not the priority with this client.

Potassium iodide (SSKI) is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and complains of a brassy taste in the mouth. Which instruction should the nurse provide the client? 1. Continue with the medication. 2. Take half of the prescribed dose for the next 24 hours. 3. Withhold the medication and notify the health care provider (HCP). 4. Withhold the medication for the next 24 hours and then continue as prescribed.

3. Withhold the medication and notify the health care provider (HCP). Rationale: Chronic ingestion of iodine can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain. The client needs to be instructed to notify the HCP if these symptoms occur.

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A coagulation time of 5 minutes 2. A urinary output of 50 mL/hour 3. A blood urea nitrogen level of 20 mg/dL 4. A heart rate that is 90 beats/minute and irregular

4. A heart rate that is 90 beats/minute and irregular Rationale: The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A coagulation time of 5 minutes is normal. A urinary output of 50 mL/hour is an adequate output. A blood urea nitrogen level of 20 mg/dL is a normal finding. IGGY

A client is diagnosed with pheochromocytoma. The nurse understands that pheochromocytoma is a condition that has which characteristic? 1. Causes profound hypotension 2. Is manifested by severe hypoglycemia 3. Is not curable and is treated symptomatically 4. Causes the release of excessive amounts of catecholamines

4. Causes the release of excessive amounts of catecholamines Rationale: Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamine also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. Pheochromocytoma is curable. The primary treatment is surgical removal of one or both of the adrenal glands, depending on whether the tumor is unilateral or bilateral.

A hospitalized client is diagnosed with dysfunction of the adrenal medulla. The nurse monitors for changes in client status related to altered production and secretion of which substance? 1. Cortisol 2. Androgens 3. Aldosterone 4. Epinephrine

4. Epinephrine Rationale: Epinephrine and norepinephrine are produced by the adrenal medulla. The other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex. IGGY

The nurse is caring for a client with a diagnosis of Addison's disease. The nurse is monitoring the client for signs of Addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2. Diaphoresis 3. Restlessness 4. Severe abdominal pain

4. Severe abdominal pain Rationale: Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in Addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. IGGY

A client with hyperthyroidism is scheduled for a subtotal thyroidectomy, and potassium iodide (SSKI) is prescribed. The nurse prepares to administer the medication, knowing that which is the therapeutic effect of this medication? 1. Replaces thyroid hormone 2. Prevents the oxidation of iodide 3. Increases thyroid hormone production 4. Suppresses thyroid hormone production

4. Suppresses thyroid hormone production Rationale: Potassium iodide is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours. Peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil (PTU) before potassium iodide therapy is initiated. Then potassium iodide, along with PTU, is administered for the last 10 days before surgery. Therefore, the remaining options are incorrect.

A nurse provides instructions to a client taking fludrocortisone acetate (Florinef acetate). The nurse instructs the client to notify the health care provider (HCP) if which manifestation occurs? 1. Nausea 2. Fatigue 3. Weight loss 4. Swelling of the feet

4. Swelling of the feet Rationale: Excessive levels of fludrocortisone acetate cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the HCP needs to be notified

A client is receiving somatropin (Humatrope). The nurse should monitor which most significant laboratory study during therapy with this medication? 1. Lipase level 2. Amylase level 3. Blood urea nitrogen level 4. Thyroid-stimulating hormone level

4. Thyroid-stimulating hormone level Rationale: it is used to stimulate linear growth in pediatric patients who lack adequate normal human growth hormone. An adverse effect of somatropin (Humatrope) is hypothyroidism. Therefore, thyroid function is monitored throughout therapy. Options 1 and 2 would evaluate pancreatic function, and blood urea nitrogen level evaluates renal function.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? A. Increased appetite and weight loss B. Puffiness of the face and hands C. Nervousness and tremors D. Thyroid gland swelling

B. Puffiness of the face and hands Explanation: 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).

The nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the health care provider immediately? 1. Laryngeal stridor 2. Abdominal cramps 3. Difficulty in voiding 4. Mild to moderate incisional pain

1. Laryngeal stridor Rationale: During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which causes swelling and compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration; stridor is caused by compression of the trachea, leading to respiratory distress. Stridor is an acute emergency situation that requires immediate attention to avoid complete obstruction of the airway. IGGY

During physical examination of a client, which finding is characteristic of hypothyroidism? 1. Periorbital edema 2. Flushed warm skin 3. Hyperactive bowel sounds 4. Heart rate of 120 beats/min

1. Periorbital edema Rationale: Because cellular edema occurs in hypothyroidism, the client's appearance is changed. Nonpitting edema occurs, especially around the eyes and in the feet and hands. Knowing this should direct you to option 1. Options 2, 3, and 4 are clinical manifestations of hyperthyroidism, which occurs as a result of excess thyroid hormone secretion, resulting in a hypermetabolic state. IGGY

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which item in the preoperative period? 1. Vital signs 2. Fluid balance 3. Anxiety level 4. Creatinine levels

1. Vital signs Rationale: Hypertension is the hallmark symptom of pheochromocytoma. Severe hypertension can precipitate a stroke (brain attack) or sudden blindness. Although all of the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure IGGY

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority? 1. Vital signs 2. Intake and output 3. Blood urea nitrogen results 4. Urine for glucose and ketones

1. Vital signs Rationale: Pheochromocytoma is a catecholamine-producing tumor. Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all the options are accurate nursing interventions for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs, particularly the blood pressure.

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? 1. "Do you have tremors in your hands?" 2. "Are you experiencing pain in your joints?" 3. "Do you notice swelling in your legs at night?" 4. "Have you had problems with diarrhea lately?"

2. "Are you experiencing pain in your joints?" Rationale: Hyperparathyroidism is associated with oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and, sometimes, pathological fractures. Options 1 and 4 relate to assessment of hypoparathyroidism. Option 3 is unrelated to hyperparathyroidism. IGGY

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? 1. Diarrhea 2. Polyuria 3. Polyphagia 4. Weight gain

2. Polyuria Rationale: Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Options 1, 3, and 4 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting,and, constipation. IGGY

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The nurse plans care, understanding that, as part of this response, the endocrine system will increase production and secretion of which mineralocorticoid? 1. Cortisol 2. Glucagon 3. Aldosterone 4. Adrenocorticotropic hormone

3. Aldosterone Rationale: Aldosterone is the primary mineralocorticoid that is produced and secreted in response to lowered blood volume. Cortisol is a glucocorticoid. Glucagon is produced by the pancreas and functions to oppose the action of insulin in regulating blood glucose levels. Adrenocorticotropic hormone is produced by the pituitary gland and stimulates the adrenal cortex to produce glucocorticoids and mineralocorticoids. IGGY

The clinic nurse is caring for an infant who has been diagnosed with primary hypothyroidism. The nurse is reviewing the results of the laboratory tests for a T4 and thyroid-stimulating (TSH) hormone. Which laboratory finding indicates a diagnosis of primary hypothyroidism? 1. A normal T4 level 2. An elevated T4 level 3. An elevated TSH level 4. A decreased TSH level

3. An elevated TSH level Rationale: Diagnostic findings in primary hypothyroidism include a low T4 level and a high TSH level.

A client with diabetes insipidus asks the nurse about the purpose of a new medication, vasopressin (Pitressin). The nurse explains that this medication works by which mechanism? 1. Decreasing peristalsis 2. Producing vasodilation 3. Decreasing urinary output 4. Inhibiting contraction of smooth muscle

3. Decreasing urinary output Rationale: Vasopressin is a vasopressor and an antidiuretic. It increases reabsorption of water by the renal tubules, resulting in a decreased urinary flow rate. It also directly stimulates contraction of smooth muscle, causing vasoconstriction and stimulating peristalsis.

A nurse collects urine specimens for catecholamine testing from a client with suspected pheochromocytoma. The results of the catecholamine test are reported as 20 mcg/100 mL urine. The nurse should make which interpretation about this result? 1. Insignificant and unrelated to pheochromocytoma 2. Lower than normal, ruling out pheochromocytoma 3. Higher than normal, indicating pheochromocytoma 4. Normal results for a client with pheochromocytoma

3. Higher than normal, indicating pheochromocytoma Rationale: Assays of catecholamines are performed on single-void urine specimens, 2- to 4-hour specimens, and 24-hour urine specimens. The normal range of urinary catecholamines is up to 14 mcg/100 mL of urine, with higher levels occurring in pheochromocytoma. IGGY & Pagana, Pagana

A medication has been prescribed for a client with hypoparathyroidism for management of hypocalcemia. The client arrives at the clinic for follow-up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation and determines that the client needs additional information when the client makes which statement? 1. "I will increase my daily fluid intake." 2. "I will increase my activity level as tolerated." 3. "I will increase my daily intake of high-fiber foods." 4. "I will add ½ ounce of mineral oil to my daily diet."

4. "I will add ½ ounce of mineral oil to my daily diet." Rationale: Clients taking medications to treat hypocalcemia should be instructed to avoid the use of mineral oil as a laxative because mineral oil decreases vitamin D absorption, and vitamin D is needed to assist in the absorption of calcium. Options 1, 2 and 3, are basic measures to alleviate constipation. Kee Hayes Book

Octreotide acetate (Sandostatin) is prescribed for a client with acromegaly. The nurse monitors the client, knowing that which side effect is associated with the administration of this medication? 1. Polyuria 2. Hypotension 3. Constipation 4. Abdominal pain

4. Abdominal pain Rationale: Octreotide (Sandostatin) is used to reduce growth hormone levels in clients with acromegaly. The most common side effects of octreotide are diarrhea, nausea, gallstone formation, and abdominal discomfort. Kee Hayes Book

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine (Synthroid) is prescribed. What is an expected outcome of the medication? 1. Alleviate depression 2. Increase energy levels 3. Increase blood glucose levels 4. Achieve normal thyroid hormone levels

4. Achieve normal thyroid hormone levels Rationale: Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.

Vasopressin (Pitressin) is prescribed for a client with diabetes insipidus. The nurse should be particularly cautious in monitoring a client receiving this medication if the client has which preexisting condition? 1. Depression 2. Endometriosis 3. Pheochromocytoma 4. Coronary artery disease

4. Coronary artery disease Rationale: Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if administered to clients with coronary artery disease. In addition, vasopressin may cause vascular problems by decreasing blood flow in the periphery. The remaining options are not conditions of concern with the use of this medication.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? A. Diabetic ketoacidosis B. Thyroid crisis C. Hypoglycemia D. Tetany

B. Thyroid crisis Explanation: Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness.

A client who has had intracranial surgery is experiencing diabetes insipidus. The nurse understands that the diabetes insipidus resulted from which problem? 1. Water intoxication 2. Excess production of dopamine 3. Excess production of angiotensin II 4. Insufficient production of antidiuretic hormone (ADH)

4. Insufficient production of antidiuretic hormone (ADH) Rationale: Diabetes insipidus results from insufficient ADH production, which in this case was because of head injury. This causes the kidneys to excrete large volumes of urine. Water intoxication represents the opposite problem of that experienced with diabetes insipidus. Options 2 and 3 are not associated with diabetes insipidus. IGGY

The nurse has a prescription to obtain a 24-hour urine collection in a client with a renal disorder. Which actions should the nurse take when collecting this specimen? Select all that apply. 1. Explain the procedure to the client. 2. Save all subsequent voidings after the first void during the 24-hour period. 3. During the collection period, place the main container on ice or in a refrigerator. 4. Have the client void at the end time, and place this specimen in the main container. 5. Have the client void at the start time, and place this specimen in the main container.

1. Explain the procedure to the client. 2. Save all subsequent voidings after the first void during the 24-hour period. 3. During the collection period, place the main container on ice or in a refrigerator. 4. Have the client void at the end time, and place this specimen in the main container. Rationale: The nurse should first explain the procedure to the client and ask the client to void at the beginning of the collection period and to discard this urine sample. All subsequent voided urine is saved in a container, which is placed on ice or refrigerated. The client is asked to void at the finish time, and this sample is added to the collection. The container is labeled, placed on fresh ice, and sent to the laboratory immediately. IGGY

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply. 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care 5. A reminder to read the labels on over-the-counter medications before purchase

1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care Rationale: The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the health care provider (HCP) before purchasing any over-the-counter medications, and maintaining regular outpatient follow-up care. The nurse also should instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism. IGGY

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? 1. "I will need to limit the amount of protein in my diet." 2. "I should eat foods that have a lot of potassium in them." 3. "I am fortunate that I can eat all the salty foods I enjoy." 4. "I am fortunate that I do not need to follow any special diet."

2. "I should eat foods that have a lot of potassium in them." Rationale: A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue. IGGY

The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1. A client with hypothyroidism 2. A client with Graves' disease who is having surgery 3. A client with diabetes mellitus scheduled for a diagnostic test 4. A client with diabetes mellitus scheduled for débridement of a foot ulcer

2. A client with Graves' disease who is having surgery Rationale: Thyrotoxicosis usually is seen in clients with Graves' disease in whom the symptoms are precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, delivery, or major surgery. It also must be recognized as a potential complication after thyroidectomy IGGY

The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 1. Maintain an endotracheal tube for 24 hours. 2. Administer a continuous mist of room air or oxygen. 3. Place in a flat position with the head and neck immobilized. 4. Use only a rectal thermometer for temperature measurement.

2. Administer a continuous mist of room air or oxygen. Rationale: Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucus secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required. IGGY

A client visits the health care provider's office for a routine physical examination and reports a new onset of intolerance to cold. Since hypothyroidism is suspected, which additional information would be noted during the client's assessment? 1. Weight loss and tachycardia 2. Complaints of weakness and lethargy 3. Diaphoresis and increased hair growth 4. Increased heart rate and respiratory rate

2. Complaints of weakness and lethargy Rationale: Weakness and lethargy are the most common complaints associated with hypothyroidism. Other common symptoms include intolerance to cold, weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss. IGGY

A client is diagnosed with Cushing's syndrome. The nurse plans care, knowing that this client has an excess of which substances? 1. Calcium 2. Cortisol 3. Epinephrine 4. Norepinephrine

2. Cortisol Rationale: Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium is unrelated to this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla. IGGY

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition? 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2. Graves' disease Rationale: Propylthiouracil (PTU) inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin (DDAVP) is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1. It relieves the headaches. 2. It increases water reabsorption. 3. It stimulates the production of aldosterone. 4. It decreases the production of the antidiuretic hormone.

2. It increases water reabsorption. Rationale: Desmopressin is an antidiuretic hormone used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which on assessment of the client? 1. Unresponsive pupils 2. Positive Trousseau's sign 3. Negative Chvostek's sign 4. Hyperactive bowel sounds

2. Positive Trousseau's sign Rationale: Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany.

A female client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution (Lugol's solution). The client complains to the nurse that she experiences a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client? 1. Dilute the medication in 8 ounces of water. 2. Report the symptom to the health care provider (HCP). 3. Continue to take the medication because the symptoms are normal. 4. Take one half dose of the prescribed medication for the next 2 days.

2. Report the symptom to the health care provider (HCP). Rationale: The client should be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client should be instructed to withhold the medication and notify the HCP if these symptoms are noted.

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would monitor for which problems associated with this disease? Select all that apply. 1. Obesity 2. Syncope 3. Hirsutism 4. Hypotension 5. Muscle weakness

2. Syncope 4. Hypotension 5. Muscle weakness Rationale: Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea and vomiting, abdominal cramps, weight loss, depression, and irritability. IGGY

The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse should ensure that which piece of medical equipment is at the client's bedside? 1. Cardiac monitor 2. Tracheotomy set 3. Intermittent gastric suction device 4. Underwater seal chest drainage system

2. Tracheotomy set Rationale: Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a paramount concern for the nurse managing the care of a postoperative client who has had a parathyroidectomy. An emergency tracheotomy set is always routinely placed at the bedside of the client who has undergone this type of surgery, in anticipation of this complication. IGGY

Thyroid replacement therapy is prescribed for the client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which is the appropriate nursing response? 1. "It depends on the results of the laboratory tests." 2. "Most clients require medication for about 1 year." 3. "The medication will need to be continued for life." 4. "You will need to ask your health care provider."

3. "The medication will need to be continued for life." Rationale: For most hypothyroid clients, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will cause symptoms to improve, these improvements do not constitute a reason to interrupt or discontinue the medication. The outcome of the laboratory results does not bear influence on the length of time the client will need the medication. The statement that indicates that most clients need the medication for about a year implies that the disease is curable, so this option should be eliminated. Referring the client to the health care provider (HCP) places the client's question on hold.

Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin (Coumadin). Which modification to the plan of care should the nurse review with the client's health care provider? 1. A decreased dosage of levothyroxine 2. An increased dosage of levothyroxine 3. A decreased dosage of warfarin sodium 4. An increased dosage of warfarin sodium

3. A decreased dosage of warfarin sodium Rationale: Levothyroxine (Synthroid) accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin (Coumadin) are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which health care provider's (HCP) prescriptions, if noted on the record, would indicate the need for clarification? 1. Assess vital signs and neurological status. 2. Instruct the client to avoid blowing his nose. 3. Apply a loose dressing if any clear drainage is noted. 4. Instruct the client about the need for a Medic-Alert bracelet.

3. Apply a loose dressing if any clear drainage is noted. Rationale: The nurse should observe for clear nasal drainage; constant swallowing; and a severe, persistent, generalized, or frontal headache. These signs and symptoms indicate cerebrospinal fluid leak into the sinuses. If clear drainage is noted after this procedure, the HCP needs to be notified. Options 1, 2, and 4 indicate appropriate postoperative interventions. IGGY

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? 1. Fatigue 2. Diarrhea 3. Polydipsia 4. Weight gain

3. Polydipsia Rationale: Diabetes insipidus is characterized by hyposecretion of antidiuretic hormone, and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Anorexia and weight loss occur.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2. Level of hoarseness 3. Respiratory distress 4. Edema at the surgical site

3. Respiratory distress Rationale: Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status as any swelling to the surgical site could cause respiratory distress. Although all the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for in the client's focused assessment? 1. Peripheral edema 2. Bilateral exophthalmos 3. Signs and symptoms of hypovolemia 4. Signs and symptoms of hypocalcemia

3. Signs and symptoms of hypovolemia Rationale: Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. Thus, a deficiency can cause hypovolemia.

Growth hormone is prescribed for the client with pituitary dwarfism. Which statement is accurate related to the expected outcome of this medication? 1. Growth begins in 4 to 5 years. 2. Growth spurts will occur every 2 years. 3. There will be an immediate increase in growth. 4. An increase in height will begin in late adulthood.

3. There will be an immediate increase in growth. Rationale: Growth hormone may be used in the treatment of dwarfism. When treatment is started, height may be increased by as much as 6 inches. The increase is immediate and continual. To monitor treatment, height and weight should be measured monthly. Kee Hayes book

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1. To treat thyroid storm 2. To prevent cardiac irritability 3. To treat hypocalcemic tetany 4. To stimulate release of parathyroid hormone

3. To treat hypocalcemic tetany Rationale: Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit. IGGY

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which most important statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate after surgery." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery."

4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." Rationale: Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site. IGGY

A client with aldosteronism is being treated with spironolactone (Aldactone). Which finding indicates to the nurse that the medication is effective? 1. A decrease in body metabolism 2. A decrease in sodium excretion 3. A decrease in potassium excretion 4. A decrease in aldosterone production

4. A decrease in aldosterone production Rationale: Aldactone antagonizes the effect of aldosterone and decreases circulating volume by inhibiting tubular reabsorption of sodium and water. Thus, it produces a decrease in blood pressure. It increases the excretion of sodium and plasma potassium.

The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 1. Infertility 2. Gynecomastia 3. Sexual dysfunction 4. Body image changes

4. Body image changes Rationale: Because of the location of the incision in the neck area, many clients are afraid of thyroid surgery for fear of having a visible large scar postoperatively. Having all or part of the thyroid gland removed will not cause the client to experience gynecomastia or hirsutism. Sexual dysfunction and infertility could occur if the entire thyroid is removed and the client is not placed on thyroid replacement medications. IGGY

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 1. Glycosuria 2. Diaphoresis 3. Weight loss 4. Hypertension

4. Hypertension Rationale: Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms. IGGY

A client has begun medication therapy with propylthiouracil (PTU). The nurse should assess the client for which condition as an adverse effect of this medication? 1. Joint pain 2. Renal toxicity 3. Hyperglycemia 4. Hypothyroidism

4. Hypothyroidism Rationale: PTU is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. IGGY

A nurse is performing an assessment on a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate? 1. Check for signs of bleeding. 2. Administer calcium gluconate. 3. Notify the health care provider (HCP) immediately. 4. Reassure the client that this is usually a temporary condition.

4. Reassure the client that this is usually a temporary condition. Rationale: After thyroidectomy, weakness and hoarseness of the voice can occur as a result of trauma from the surgery. If this develops, the client should be reassured that the problem will subside in a few days. Unnecessary talking should be discouraged. These signs do not indicate bleeding or the need to administer calcium gluconate. The nurse does not need to notify the HCP immediately. IGGY

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 1. Serum glucose 2. Blood pressure 3. Respiratory rate 4. Urine specific gravity

4. Urine specific gravity Rationale: After hypophysectomy, temporary diabetes insipidus can result from antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess urine specific gravity, and notify the health care provider if the result is less than 1.005. Although options 1, 2, and 3 may be components of the assessment, the nurse would next assess urine specific gravity. IGGY

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 Explanation: 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.

A female adult 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 bone demineralization resulting in pathologic fractures B. Related to exhaustion secondary to an accelerated metabolic rate C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces D. Related to tetany secondary to a decreased serum calcium level

A. Related to bone demineralization resulting in pathologic fractures Explanation: Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, 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.

Nurse Ruth 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? A. Tetany B. Hemorrhage C. Thyroid storm D. Laryngeal nerve damage

A. Tetany Explanation: 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.

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. vasopressin (Pitressin Synthetic). Explanation: 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.

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. "You must avoid coughing, sneezing, and blowing your nose." Explanation: 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. Neck vein distention Explanation: 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).

A patient adrenal insufficiency is to be discharged and is given Prednisone as a home medication. The nurse instruct the patient the following, except? A. To avoid aspirin-containing products. B. To avoid foods rich in potassium. C. To avoid caffeinated drinks. D. To avoid individuals with respiratory infections.

B. To avoid foods rich in potassium. Explanation: One of the side effects of taking prednisone is hypokalemia so a potassium rich food should be included in the diet.

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug A. Dysuria B. Leg cramps C. Tachycardia D. Blurred vision

C. Tachycardia Explanation: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren't associated with levothyroxine.

During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement? A. "The head of your bed must remain flat for 24 hours after surgery." B. "You should avoid deep breathing and coughing after surgery." C. "You won't be able to swallow for the first day or two." D. "You must avoid hyperextending your neck after surgery."

D. "You must avoid hyperextending your neck after surgery." Explanation: To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

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 Explanation: Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-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.

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect: A. a blood pressure of 130/70 mm Hg. B. a blood glucose level of 130 mg/dl. C. bradycardia. D. a blood pressure of 176/88 mm Hg.

D. a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss.

During an assessment of a patient's functional health pattern, which question by the nurse directly addresses the patient's thyroid function? a) "Do you experience fatigue even if you have slept a long time?" b) "Have you experienced any headaches or sinus problems?" c) "Do you have to get up at night to empty your bladder?" d) "Can you describe the amount of stress in your life?

a) "Do you experience fatigue even if you have slept a long time?" Explanation: 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.

A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer: A. phentolamine (Regitine). B. methyldopa (Aldomet). C. mannitol (Osmitrol). D. felodipine (Plendil).

A. phentolamine (Regitine). Explanation: Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent 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 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. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." 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.

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: A. Hypotension. B. Thick, coarse skin. C. Deposits of adipose tissue in the trunk and dorsocervical area. D. Weight gain in arms and legs.

C. Deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), 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 nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? a) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. b) Monitor laboratory values daily for elevated thyroid-stimulating hormone. c) Evaluate the quality of the client's voice postoperatively, noting any drastic changes. d) Observe for swelling of the neck, tracheal deviation, and severe pain.

a) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Explanation: 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.

A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 1. Laryngeal stridor 2. Difficulty voiding 3. Mild incisional pain 4. Absence of bowel sounds

1. Laryngeal stridor Rationale: During the early postoperative period, the nurse carefully observes the client for signs of bleeding, which may cause swelling and compression of adjacent tissues. Laryngeal stridor results from compression of the trachea and is a harsh, high-pitched sound heard on inspiration and expiration. Laryngeal stridor is an acute emergency, necessitating immediate attention to avoid complete obstruction of the airway. IGGY

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1. Obtain dark glasses for the client. 2. Lubricate the eyes with tap water every 2 to 4 hours. 3. Administer methimazole (Tapazole) every 8 hours around the clock. 4. Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.

1. Obtain dark glasses for the client. Rationale: Because photophobia (light intolerance) accompanies this disorder, wearing dark glasses is helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client would be at risk for developing an eye infection because the solution is not sterile. Methimazole is a thyroid inhibitor, but medication therapy for Graves' disease does not help to alleviate the clinical manifestation of exophthalmos. There is no need to avoid straining or heavy lifting with exophthalmos.

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). The nurse plans care for the client, anticipating that he or she may have a deficiency of which dietary elements? 1. Iodine 2. Calcium 3. Phosphorus 4. Magnesium

1. Iodine Rationale: Adequate dietary iodine is needed to produce T3 and T4. The other requirements for adequate T3 and T4 production are an intact thyroid gland and a functional hypothalamus-pituitary-thyroid feedback system. IGGY

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

2. Maintain a patent airway. Rationale: The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route. IGGY

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs should the nurse monitor for? Select all that apply. 1. Anorexia 2. Dizziness 3. Hypertension 4. Weight loss 5. Moon facies 6. Truncal obesity

3. Hypertension 5. Moon facies 6. Truncal obesity Rationale: A client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon facies, truncal obesity, and a buffalo hump fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain. IGGY

A nurse is monitoring the client for hypocalcemia. Which are indicative of this imbalance? Select all that apply. 1. Irritability 2. Muscle cramps 3. Tingling sensations 4. Hyperactive reflexes 5. Memory impairment 6. Severe muscle weakness

1. Irritability 2. Muscle cramps 3. Tingling sensations 4. Hyperactive reflexes 5. Memory impairment Rationale: Signs of hypocalcemia include tingling sensations, hyperactive reflexes, and a positive Trousseau or Chvostek sign. Other signs include increased neuromuscular excitability, muscle cramps, tetany, seizures, insomnia, irritability, memory impairment, and anxiety. Severe muscle weakness is seen in hypercalcemia not hypocalcemia. IGGY

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 1. Polyuria 2. Polydipsia 3. Concentrated urine 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

1. Polyuria 2. Polydipsia 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005 Rationale: A triad of clinical symptoms including polyuria, polydipsia, and excessive thirst often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L). IGGY

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors

1. Dry skin Rationale: Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features, dry skin, and dry, coarse hair and eyebrows. Options 2, 3, and 4 are noted in the client with hyperthyroidism. IGGY

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Bulging eyeballs 3. Periorbital edema 4. Coarse facial features

2. Bulging eyeballs Rationale: Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance. IGGY

The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention should the nurse include in the plan of care? 1. Maintain a supine position. 2. Monitor neck circumference every 4 hours. 3. Maintain a pressure dressing on the operative site. 4. Encourage deep breathing exercises and vigorous coughing exercises.

2. Monitor neck circumference every 4 hours. Rationale: After thyroidectomy neck circumference is monitored every 4 hours to assess for the occurrence of postoperative edema. The client should be placed in an upright position to facilitate air exchange. A pressure dressing is not placed on the operative site because it may restrict breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. The nurse should assist the client with deep breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision. IGGY

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 cells/mm3 2. A blood glucose level of 110 mg/dL 3. A potassium (K+) level of 3.1 mEq/L 4. A white blood cell (WBC) count of 6000 cells/mm3

3. A potassium (K+) level of 3.1 mEq/L Rationale: The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body.

A nurse is assisting in the care of a client with pheochromocytoma who has been experiencing clinical manifestations of hypermagnesemia. When evaluating the client, the nurse should determine that the client's status is returning to normal if which is no longer exhibited? 1. Tetany 2. Tremors 3. Areflexia 4. Muscular excitability

3. Areflexia Rationale: Signs of hypermagnesemia include neurological depression, drowsiness and lethargy, loss of deep tendon reflexes (areflexia), respiratory paralysis, and loss of consciousness. Tetany, muscular excitability, and tremors are seen with hypomagnesemia. IGGY

A nurse has a prescription to collect a 24-hour urine specimen from a client. The nurse is demonstrating correct procedure when which technique is performed? 1. Ask the client to void, save the specimen, and note the start time. 2. Place the specimen in various containers as necessary for the test. 3. Ask the client to save a sample voided at the end of the collection time. 4. Remove urine from the collection container for other prescribed specimens.

3. Ask the client to save a sample voided at the end of the collection time. Rationale: Because the 24-hour urine test is a timed quantitative determination, the test must be started with an empty bladder; therefore the first urine is discarded. Fifteen minutes before the end of the collection time, the client should be asked to void, and this specimen is added to the collection. The urine sample should be placed in the appropriate container and may be refrigerated or placed on ice to prevent changes in the urine. Because this is a quantitative determination of constituents in the urine, no urine should be removed from the container. IGGY

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible thyroid surgery complication? 1. Increased serum sodium level 2. Increased serum glucose level 3. Decreased serum calcium level 4. Decreased serum albumin level

3. Decreased serum calcium level Rationale: Hypocalcemia may occur if the parathyroid glands are removed, damaged, or their blood supply is impaired during thyroid surgery, resulting in decreased parathyroid hormone (PTH) levels and lead to decreased serum calcium levels. IGGY

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur. Rationale: The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the HCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide (Lasix) and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction? 1. "I need to eat foods high in potassium." 2. "I need to drink at least 2 to 3 L of fluid daily." 3. "I need to eat small, frequent meals and snacks if nauseated." 4. "I need to increase my intake of dietary items that are high in calcium."

4. "I need to increase my intake of dietary items that are high in calcium." Rationale: The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption of calcium. Dietary restriction of calcium may be used as a component of therapy. The client should eat foods high in potassium, especially if the client is taking furosemide. Options 2 and 3 also are appropriate instructions for the client. IGGY

The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which should the nurse expect to note on assessment of the client? 1. Skin atrophy 2. The presence of sunken eyes 3. Drooping on one side of the face 4. A rounded "moon-like" appearance to the face

4. A rounded "moon-like" appearance to the face Rationale: With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic corticosteroid use, the person with Cushing's syndrome develops a rounded moon-like face; prominent jowls; red cheeks; and hirsutism on the upper lip, lower cheek, and chin. IGGY

A client has a tumor that is interfering with the function of the hypothalamus. The nurse expects that which clinical problem will be exhibited by the client? 1. Melatonin excess or deficit 2. Glucocorticoid excess or deficit 3. Mineralocorticoid excess or deficit 4. Antidiuretic hormone (ADH) excess or deficit

4. Antidiuretic hormone (ADH) excess or deficit Rationale: The hypothalamus exerts an influence on both the anterior and the posterior pituitary gland. Abnormalities can result in excess or deficit of substances normally mediated by the pituitary. ADH could be affected by disease of the hypothalamus because the hypothalamus produces ADH and stores it in the posterior pituitary gland. The pineal gland is responsible for melatonin production. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client? 1. To stop the medication if side effects occur 2. To avoid taking the medication if nausea occurs 3. That minimal side effects will occur with use of this medication 4. That an increased dose of medication may be needed during times of stress

4. That an increased dose of medication may be needed during times of stress Rationale: The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the health care provider (HCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in Addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the HCP.