Lewis Chapter 48, Endocrine

The nurse is caring for a client with Addison's disease. The nurse checks the client's vital signs and determines that the client has orthostatic hypotension. The nurse determines that this finding relates to which factor?

A decreased secretion of aldosterone

Which signs/symptoms should the nurse expect to note when collecting data on a client with Addison's disease?

Hypotension and vomiting

The nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique would provide data necessary to support the admitting diagnosis?

Inspection of facial features

The nurse is collecting data from a client who is being admitted to the hospital for a diagnostic workup for primary hyperparathyroidism. The nurse understands that which client complaint would be characteristic of this disorder?

Polyuria

The nurse is caring for a client with a diagnosis of hypoparathyroidism. The nurse reviews the client's laboratory results and notes that the calcium level is extremely low. The nurse should expect to note which sign/symptom on data collection?

Positive Trousseau's sign

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse should most closely monitor which assessment in the preoperative period?

Vital signs

While collecting data on a client being prepared for an adrenalectomy, the nurse obtains a temperature reading of 100.8° F. The nurse analyzes this temperature reading as which?

A finding that needs to be reported immediately

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

A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, nurse Julia 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. 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.

17. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: a. Trousseau's sign. b. Homans' sign. c. Hegar's sign. d. Goodell's sign.

A. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

5. 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. 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).

You are the nursing student and you are taking care of the patient recently diagnosed with hyperthyroidism. You can visibly see the thryroid gland enlarged. What is the next thing you should assess? A) Assess for a bruit or a thrill B) Listen to respiratory rate and look at SpO2 C) Check for peripheral pulses D) Poke the neck to see if it is soft or hard

B. Because an enlarged thyroid gland can constrict the neck (often caused by a goiter) it is very important to monitor the patient's respiratory status. After that a bruit or thrill may be felt for over the distended thyroid gland. Palpating to see if the neck is soft or hard may also be done, as a hard nodule may be indicative thyroid cancer.

The nurse is counseling the patient with hypoparathyroidism about nutrition choices r/t her disease process. Which of the following trays demonstrates correct understanding of the teaching? A) Yogurt, cream of chicken soup, and apple sauce with sweet tea B) Fried salmon, green beans, and a white wheat bread roll C) Sausage and egg sandwich with whole wheat bread and coffee with creamer D) Turkey sandwich with lettuce, tomato, fruit cup and a glass of milk

B. The recommended diet for patients with hypoparathyroidism includes foods that are high in calcium yet low in phosphorous (remember the balancing act) Fish, green beans, and white wheat are recommended foods because they are low in phosphorous. Milk and dairy products, while are high in calcium are also high in phosphorous and are thus restricted. Hypoparathyroidism is as much an issue with too much phosphorus as calcium (although s/s are r/t hypocalcemia) Other restricted foods include eggs and spinach. Other foods encouraged include broccoli, cucumbers, and nondairy creamer.

Following hypophysectomy, a client complains of being very thirsty and having to urinate frequently. Which is the initial nursing action?

Check the urine specific gravity.

When caring for a client diagnosed with pheochromocytoma, which information should the nurse know when assisting with planning care?

Excessive catecholamines are released.

What is a hormone secreted from the posterior lobe of the pituitary gland? Answers: A. LH B. MSH C. ADH D. GnRH

. C ADH is secreted from the posterior pituitary. LH comes from the anterior pituitary, MSH from the intermediate. GnRH is released from the hypothalamus.

Which of the following symptoms are expected in the patient with pheochromocytoma? Select all that Apply (SATA): A) Hypertension B) HA C) Hypoglycemia D) Hypermetabolism E) Dry skin

A, B, and D. The five H's: HA, Hypertension, Hyperhydrosis (sweating), Hypermetabolism and Hyperglycemia.

8. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin (Pitressin Synthetic). b. furosemide (Lasix). c. regular insulin. d. 10% dextrose.

A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring?

Blood pressure of 80/60 mmHg

A client with a pituitary tumor will undergo transsphenoidal hypophysectomy. The nurse reinforces which information in the preoperative teaching plan for the client?

Blowing the nose following surgery is prohibited.

6. 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 effect? a. Dysuria b. Leg cramps c. Tachycardia d. Blurred vision

C. 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.

The nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate?

Reassure the client that this is usually a temporary condition.

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

A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

11. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. Muscle weakness b. Tremors c. Diaphoresis d. Constipation

A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

The nurse is providing preoperative teaching to the patient about to undergo a thyroidectomy. Which statement, if made by the patient, indicates the need for further teaching? A) I need to eat super healthy before the surgery and should limit my calories to a healthy amount B) Before the surgery I should practice raising my elbows and placing both hands behind my neck to provide support C) Well, I will have to quit drinking my coffee and alcohol for now D) I will be sure increase my intake of protein and carbohydrates

A. a high calorie diet should be encouraged preoperatively because of the increased metabolic needs of the body. Practicing supporting the neck before the surgery is a good way to remember what to do after the surgery. The patient should avoid consuming any stimulants including tea, coffee, and cola. The patient should increase intake of protein and carbohydrates preoperatively because of increased metabolic needs.

Uh oh, the patient records got scrambled up. You need to go in and see each of the patients in the clinic to see which problem they have. Which of the following patients does the nurse suspect to be the patient with hyperparathyroidism? A) The patient with shakiness in his hands and c/o numbness and tingling in fingers and toes B) The patient c/o back pain and abdominal cramping with nausea C) The patient with a BP of 167/87 and HR 110 with profuse sweating D) The patient c/o of fatigue and depression with bronze skin pigmentation

B. Remember, the patient with hyperparathyroidism is experiencing symptoms r/t too much calcium in the bloodstream. That means they will have issues with Stones (Renal), Bones (bone pain, joint pain, osteoporosis), Moans (GI upset, abdominal cramps), and psychic moans (mental changes). Patient A might be a patient with hypoparathyroidism. Patient C might be a patient with Pheochromocytoma. Patient D might be a patient with Addison's disease

A client is admitted with a diagnosis of pheochromocytoma. The nurse should monitor which parameter to detect the most common sign of pheochromocytoma?

Blood pressure elevation

21. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: a. Thyroid storm. b. Cretinism. c. myxedema coma. d. Hashimoto's thyroiditis.

C. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

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

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

You the nurse are taking care of the patient with hypoparathyroidism. Based on your knowledge of the disease process. Which of the following do you expect to be your priority in planning care for this patient? A) Acute Pain B) Fluid Volume Deficit C) Ineffective Airway Maintenance D) Impaired Cerebral Perfusion

C. Due to bronchospasm that can be caused by decreased calcium levels, it is important for the nurse to assess airway and breathing pattern. Signs associated with hypoparathyroidism are d/t hypocalcemia and the number one sign is tetany.

The patient with Addison's disease presents to the clinic saying "I've gained five pounds in the past week!" You note some edema in both lower extremities. What does the nurse suspect to be the problem? A) Precipitation of Addisonian Crisis B) Heart Failure d/t end stage Addison's disease C) Excessive hormone replacement dose D) Adrenocarcinoma development

C. Signs of too high a corticosteroid dose include edema and weight gain. S/S of an Addisonian crisis include hypotension, tachycardia, cyanosis, pallor, and tachypnea. Heart failure is not associated with Addison's disease. There is no evidence of a tumor in the adrenal glands based on these symptoms.

The nurse working on an endocrine nursing unit understands that which correct concept is used in planning care?

Clients who have hyperparathyroidism should be protected against falls.

In explaining the condition to a client, a nurse would say that Cushing's syndrome is caused primarily by: Answers: A. Low levels of glucocorticoids B. Excess secretion of sodium C. Autoimmunity in the pancreas D. Elevated levels of cortisol

D Cushing's syndrome is caused by elevated levels of cortisol. Glucocorticoids tend to cause this.

The doctor walks into the patient room and says. "You have pheochromocytoma" and leaves. The patient begins to cry and says, "What does that mean?" What is the best response by the nurse? A) It is a tumor in your pituitary gland. You are probably going to die. B) You seem upset. Tell me how you are feeling. C) Pheochromocytoma is a disorder of the adrenal glands where too little steroids are released into the blood stream D) This is a caused by a benign tumor in certain glands in your body located above your kidneys

D This is a caused by a benign tumor in certain glands in your body located above your kidneys

9. 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 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.

15. 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. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other options.

25. 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. 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.

7. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? a. Diabetes mellitus b. Diabetes insipidus c. Hypoparathyroidism d. Hyperparathyroidism

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

The patient diagnosed with SIADH (Syndrome of inappropriate antidiuretic hormone) has a sodium level of 129 mEq/L. He is receiving IV 3% saline at 100 mL/hr. Which of the following is the nurse most concerned about? A) The patient complains of cramps in his hands B) There is trace edema in the lower extremities C) HR 110 D) The patient is suddenly states "Who are you?"

D. Decreased LOC is a sign of CMP (Central Pontine Myelinlysis) An extremely life-threatening condition that can occur with patient receiving high levels of sodium rich IV fluids. It is a medical emergency and the infusion should be stopped immediately. Cramps in the hands and trace edema are being treated with the infusion of 3% saline solution. HR 110 is also important, but not as emergent as sudden confusion.

You are providing discharge teaching to the client with primary Addison's disease. Which statement, if made by the patient, indicates the need for further teaching? A) I will have to take my Florinef and prednisone for the rest of my life B) During hot weather I will be sure to eat lots of salty foods C) I should continue to monitor my blood pressure for any drops D) Because I can't tolerate the heat I will cancel my trip to the Bahamas but I can still go skiing

D. Pt. should avoid cold weather in order to prevent precipitation of an Addisonian crisis which can be caused by stress on the body. The patient should be taught that medication will be taken for the rest of the patient's life. Salt intake should be increased during hot weather d/t hyponatremia. A drop in blood pressure could be a sign of an impending Addisonian crisis

The nurse is collecting data on a client with a diagnosis of hypothyroidism. Which of these behaviors, if present in the client's history, should the nurse determine as being likely related to the symptoms of this disorder?

Depression

The nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide (Lasix). The nurse reinforces dietary instructions to the client. Which is an appropriate instruction?

Drink at least 2 to 3 L of fluid daily.

The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? Select all that apply

Dry skin Constipation Cold intolerance

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder?

Excessive thirst and urine output

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs and symptoms noted in the client should alert the nurse to the presence of this crisis? Select all that apply.

Fever Sweating Agitation

The nurse is caring for a client following an adrenalectomy and is monitoring for signs of adrenal insufficiency. Which are signs and symptoms related to adrenal insufficiency? Select all that apply.

Fever Weakness Hypotension Mental status changes

The nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. Which is the appropriate choice for this client to meet nutritional needs?

Graham crackers and warm milk

The nurse is preparing to reinforce instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which diet should be prescribed for this client?

High-sodium, high-carbohydrate diet

A client is diagnosed with hyperparathyroidism. The nurse teaching the client about dietary alterations to manage the disorder tells the client to limit which food in the diet?

Ice cream

The nurse should expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply.

Instruct the client about thyroid replacement therapy. Encourage the client to consume fluids and high-fiber foods in the diet. Instruct the client to contact the health care provider if episodes of chest pain occur.

The nurse is reinforcing discharge instructions to a client who had a unilateral adrenalectomy. Which information should be a component of the instructions?

Instructions about early signs of a wound infection

A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse assists in developing a plan of care for the client. Which nursing measure would be included in the plan regarding this medication?

Signs and symptoms of hypothyroidism

The nurse is caring for a client with hypothyroidism who is overweight. Which food items should the nurse suggest to include in the plan?

Skim milk, apples, whole-grain bread, and cereal

The nurse is caring for a client following a thyroidectomy. The client tells the nurse that she is concerned because of voice hoarseness. The client asks the nurse whether the hoarseness will subside. Which statement by the nurse regarding the hoarseness is accurate?

The hoarseness is normal and will gradually subside.

The nurse caring for a client scheduled for a transsphenoidal hypophysectomy to remove a tumor in the pituitary gland assists in developing a plan of care for the client. The nurse suggests including which specific information in the preoperative teaching plan?

Toothbrushing will not be permitted for at least 2 weeks following surgery.

The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most important to discuss with the health care provider before the test? a. History of renal insufficiency b. Complains of chronic headache c. Recent bilateral visual field loss d. Blood glucose level of 134 mg/dL

a. History of renal insufficiency

A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test? a. Bilateral poor peripheral vision b. Allergies to iodine and shellfish c. Recent weight loss of 20 pounds d. Complaint of ongoing headaches

b. Allergies to iodine and shellfish

A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test? a. Urinary 17-ketosteroids b. Antidiuretic hormone level c. Growth hormone stimulation test d. Adrenocorticotropic hormone level

b. Antidiuretic hormone level

Which action by a new registered nurse (RN) caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? a. The RN checks the blood pressure on both arms. b. The RN palpates the neck thoroughly to check thyroid size. c. The RN lowers the thermostat to decrease the temperature in the room. d. The RN orders nonmedicated eye drops to lubricate the patient's bulging eyes.

b. The RN palpates the neck thoroughly to check thyroid size.

The nurse is caring for a 45-year-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider? a. The patient complains of intense thirst. b. The patient has a 5-lb (2.3 kg) weight loss. c. The patient's urine osmolality does not increase. d. The patient feels dizzy when sitting on the edge of the bed.

b. The patient has a 5-lb (2.3 kg) weight loss.

During the physical examination of a 36-year-old female, the nurse finds that the patient's thyroid gland cannot be palpated. The most appropriate action by the nurse is to a. palpate the patient's neck more deeply. b. document that the thyroid was nonpalpable. c. notify the health care provider immediately. d. teach the patient about thyroid hormone testing.

b. document that the thyroid was nonpalpable.

A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to a. insert and maintain a retention catheter. b. keep the specimen refrigerated or on ice. c. drink at least 3 L of fluid during the 24 hours. d. void and save that specimen to start the collection.

b. keep the specimen refrigerated or on ice.

A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide? a. "Avoid adding any salt to your foods for 24 hours before the test." b. "You will need to lie down for 30 minutes before the blood is drawn." c. "Come to the laboratory to have the blood drawn early in the morning." d. "Do not have anything to eat or drink before the blood test is obtained."

c. "Come to the laboratory to have the blood drawn early in the morning."

Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder? a. "What methods do you use to help cope with stress?" b. "Have you experienced any blurring or double vision?" c. "Have you had a recent unplanned weight gain or loss?" d. "Do you have to get up at night to empty your bladder?"

c. "Have you had a recent unplanned weight gain or loss?"

The nurse is teaching the patient with hyperthyroidism the importance of stress management. She is teaching how to do deep breathing exercises and listens to the patient's thoughts on coping mechanism and spirituality. The nurse knows this is an important part of this patients plan because: a) Knowing how to cope with stress will help this patient be able to work through some of the difficult treatments of this disease b) Every patient needs to know how to cope with stress c) Extra stress with the patient with hyperthyroidism can lead to life threatening complications d) Listening to the patients thoughts instead of imposing one's own thoughts encourages the patient to become self-reliant

c. Extra stress on the patient with hyperthyroidism can precipitate a life-threatening condition known as thyroid storm. It is important for the nurse to explain procedures to lower patient anxiety to prevent this condition.

Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level? a. The blood glucose is elevated. b. The phosphate level is normal. c. The serum albumin level is low. d. The magnesium level is normal.

c. The serum albumin level is low.

Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland? a. Thyroxine (T4) level b. Triiodothyronine (T3) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level

c. Thyroid-stimulating hormone (TSH) level

The nurse will teach a patient to plan to minimize physical and emotional stress while the patient is undergoing a. a water deprivation test. b. testing for serum T3 and T4 levels. c. a 24-hour urine test for free cortisol. d. a radioactive iodine (I-131) uptake test.

c. a 24-hour urine test for free cortisol.

expected finding in new diagnosis of cushing's disease

hirsutism due to increased androgen production

acute adrenal insufficiency requires treatment with

hydrocortisone sodium succinate

hyperparathyroidism is associated with

hypercalcemia

in HHS the patient produces enough insulin to prevent ketosis but not enough to prevent

hyperglycemia; pH will be normal but glucose will be over 600

graves disease is also known as

hyperthyroidism and causes insomnia and anxiety

chvostek's sign & trousseau sign are both expected findings of

hypocalcemia in which there is evidence of latent tetany

With SIADH, hypersecretion of ADH causes

hyponatremia

Central diabetes insipidus may be caused by damage to the

hypothalamus (or pituitary gland).

expected finding for patient with diabetes insipidus

increased Hct level

Management of mild hyperparathyroidism includes increasing oral fluid intake to prevent

kidney stones from developing

for patient using a thermometer to test bathwater due to diabetic neuropathy, the temp should be

less than 43.3 C or 110 F

A client is admitted to the emergency department and they diagnose of myxedema coma is made. What nursing action with the nurse prepared to carry out initially

maintain a patent airway

purpose of 24 hour urine collection in patient with pheochromocytoma

measure levels of catecholamines and metanephrines

for a patient taking desmopressin in the treatment of diabetes insipidus, adjustment is needed in the medication dosage for

nocturia

adverse effects of long term corticosteroid therapy include

osteroperosis, moon face, increased risk of infection, weigt gain, blurred vision

Graves' disease - an autoimmune disorder that leads to

overactivity of the thyroid gland.

in patient with pheochromocytoma avoid

palpating the abdomen and provide darkened room to promote rest

hyperthyroid expected findings

palpitations, heat intolerance, tremor, diaphoresis, insomnia

hyperosmolar hyperglycemic state (HHS)

rare but deadly metabolic state is more common in the elderly with type 2 DM. HHS is characterized by hyperglycemia and severe dehydration without ketoacidosis.

Hypoparathyroidism

a disorder in which the parathyroid glands do not produce enough parathyroid hormone (PTH). PTH helps control serum levels of calcium, phosphorus, and vitamin D.

Cushing syndrome

a disorder that occurs when the body is exposed to high levels of the hormone cortisol.

The nurse is caring for a client who is about to undergo an adrenalectomy. Which of the following Preoperative interventions is most appropriate for this client? a. Maintain careful use of medical and surgical asepsis when providing care and treatments. b. Teach the client about a diet high in sodium to correct any potential sodium imbalances preoperatively. c. Explain to the client that electrolytes and glucose levels will be measured postoperatively. d. Teach the client how to effectively cough and deep breathe once surgery is complete.

a. Maintain careful use of medical and surgical asepsis when providing care and treatments. Rationale: Use careful medical and surgical asepsis when providing care and treatments since Cortisol excess increases the risk of infection. # 2 is incorrect. Nutrition should be addressed preoperatively. Request a dietary consultation to discuss with the client about a diet high in vitamins and proteins. If hypokalemia exists, include foods high in potassium. Glucocorticoid excess increases catabolism. Vitamins and proteins are necessary for tissue repair and wound healing following surgery. # 3 is incorrect. Monitor the results of laboratory tests of electrolytes and glucose levels. Electrolyte and glucose imbalances are corrected

A nurse on a general medical-surgical unit is caring for a client with Cushing's syndrome. Which of the following statements is correct about the medication regimen for Cushing's syndrome? a. Mitotane is used to treat metastatic adrenal cancer. b. Aminogluthimide may be administered to clients with ectopic ACTH-secreting tumors before surgery is performed. c. Ketoconazole increases cortisol synthesis by the adrenal cortex. d. Somatostatin analog increases ACTH secretion in some clients.

a. Mitotane is used to treat metastatic adrenal cancer. Rationale: Mitotane directly suppresses activity of the adrenal cortex and decreases peripheral metabolism of corticosteroids. It is used to treat metastatic adrenal cancer. # 2 is incorrect because aminogluthimide may be administered to clients with ectopic ACTH-secreting tumors that cannot be surgically removed. # 3 is incorrect because ketoconazole inhibits, not increases, cortisol synthesis by the adrenal cortex. # 4 is incorrect because somatostatin suppresses, not increases, ACTH secretion.

The nurse is caring for a client with pheochromocytoma. Which of the following must be included in planning the nursing care for this client ? a. Monitor blood pressure frequently, assessing for hypertension. b. Assess only for physical stressors present. c. Collect a random urine sample. d. Prepare the client for chemotherapy to shrink the tumor.

a. Monitor blood pressure frequently, assessing for hypertension. Rationale: Pheochromocytomas are tumors of chromaffin tissues in the adrenal medulla. These tumors which are usually benign produce catecholamines (epinephrine or norepinephrine) that stimulate the sympathetic nervous system. Although many organs are affected, the most dangerous effects are peripheral vasoconstriction and increased cardiac rate and contractility with resultant paroxysmal hypertension. Systolic blood pressure may rise to 200 to 300 mmHg, the diastolic to 150 to 175 mmHg. # 1 is correct because the careful monitoring of blood pressure is essential. Attacks are often precipitated by physical, emotional, or environmental stimuli, so # 2 is incorrect because more than physical stressors are considered. This condition is life threatening and is usually treated with surgery as the preferred treatment. # 3 is incorrect because it is a random sample and not a 24 hour urine collection. Because catecholamine secretion is episodic, a 24-hour urine is a better surveillance method than serum catecholamines. (Pagana & Pagana, 2002). Surgical removal of the tumor(s) by adrenalectomy is the treatment of choice. # 4 is incorrect because surgery would be the treatment usually completed.

The nurse is caring for a child with a diagnosis of diabetes insipidus. The nurse anticipates that the health care provider will prescribe which medications?

Desmopressin acetate (DDAVP)

A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor? a. Total protein b. Blood glucose c. Ionized calcium d. Serum phosphate

c. Ionized calcium

A 60-year-old patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for a. increased serum sodium. b. decreased urinary output. c. elevated serum potassium. d. evidence of fluid overload.

c. elevated serum potassium.

Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? a. "I notice my breasts are tender lately." b. "I am so thirsty that I drink all day long." c. "I get up several times at night to urinate." d. "I feel a lump in my throat when I swallow."

d. "I feel a lump in my throat when I swallow."

An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a. ice in a basin. b. glargine insulin. c. a cardiac monitor. d. 50% dextrose solution.

d. 50% dextrose solution.

A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels. a. calcitonin b. catecholamine c. thyroid hormone d. parathyroid hormone

d. parathyroid hormone

A nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarseness and a week voice. What nursing action is appropriate

reassure the client that is usually a temporary condition

thyroid storm s/s

tachycardia, hypertension, fever, sweating, restlessness, tremors, abdominal pain

The water deprivation test DETERMINES

the cause of polydipsia and polyuria - central diabetes insipidus (DI), nephrogenic DI, or psychogenic polydipsia.

Myxedema coma

the extreme manifestation of hypothyroidism; uncommon but potentially lethal.

thyroid storm usually follows

thyroid removal or acute stress, trauma, infection or hyperthyroidism

an indication of hypocalcemia following a thyroidectomy

tingling in hands & feet (paresthesia); cool, clammy, nervous, tachycardia, anxiety, confusion

A nurses caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medicine has been prescribed to

treat hypoglycemic tetany

pheochromocytoma is a

tumor of the adrenal glands

Extra PTH results in hypercalcemia. There is also increased calcium in the

urine, which may cause kidney stones. If the client's serum calcium levels are only slightly elevated, s/he should drink plenty of fluids to minimize the risk of kidney stones.

sildenafil (Viagra) is prescribed for a client to treat erectile dysfunction. A nurse reviews the clients medical record and would question the prescription if which of the following is noted in the clients history

use of nitroglycerin

test used to screen for pheochromocytoma

vanillylmandellic acid test

s/s of addison's disease include

•Muscle weakness, fatigue, •Weight loss, decreased appetite, hyperpigmentation (dark), Low BP, fainting, Salt craving, hypoglycemia, NDV, muscle or joint pains, Irritability, depression, Body hair loss or sexual dysfunction in women

A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show a. increased urinary cortisol. b. decreased serum thyroxine. c. elevated serum aldosterone levels. d. low urinary catecholamines excretion.

a. increased urinary cortisol.

A nurse is preparing a diet plan for a 50 yr old with simple goiter. Which of the following should be included in the clients diet to decrease the enlargement of he thyroid gland? a. iodine b. sodium c. potassium d. calcium

a. iodine

chvosteks sigh is seen with

abnormal facial twitch when touching the facial nerve in front of the ear

In patients with primary adrenal insufficiency will have this result from ACTH stimulation test

absent or very decreased

A client has an endocrine system dysfunction of the pancreas. The nurse anticipates that the client will exhibit impaired secretion of which substance?

Insulin

A nurses caring for a postoperative parathyroidectomy client. Which of the following would require the nurses immediate attention

Laryngeal strider

Aldosterone is produced by the

adrenal glands

The nurse is caring for a postoperative parathyroidectomy client. Which would require the nurse's immediate attention?

Laryngeal stridor

A client has been diagnosed with hypoparathyroidism. Which food groups should be included in the diet?

Low in phosphorus and high in calcium

A client with hypoparathyroidism has hypocalcemia. The nurse avoids giving the client the prescribed vitamin and calcium supplement with which liquid?

Milk

Which of the following would the nurse monitor for as signs of thyroid storm? SATA: A) T 101.5 B) HR 59 C) Constipation D) Edema E) Chest pain

A, D, and E. Thyroid storm is a form of severe hyperthyroidism usually of abrupt onset. S/S are typically characterized by exaggeration of hyperthyroidism. An extreme fever over 101.3 degrees often occurs along with extreme tachycardia (>130) During thyroid storm increased cardiac compromise may occur as evidenced by edema (HF), chest pain, dyspnea, or palpitations.

An older client with a history of hyperparathyroidism and severe osteoporosis is hospitalized. The nurse caring for the client plans to address which problem first?

The possibility of injury

when is calcium likely to be impaired

as a complication of thyroid removal

patient teaching to prepare for vanillylmandellic acid test

avoid coffee, tea, bananas, chocolate for 2 to 3 days prior to the test

how propanolol is used in treatment of thyroid storm

decrease rapid heart rate caused by excessive thyroid stimulation

3. Symptoms of Grave's ophthalmopathy include all of the following except: a. Bulging eyeballs b. Dry, irritated eyes and puffy eyelids c. Cataracts d. Light sensitivity

A Grave's ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-mentioned symptoms, Grave's ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the eyes. About one-quarter of persons with Grave's disease develop Grave's ophthalmopathy. The condition is frequently self-limiting, resolving without treatment over the course of a year or two.

demopressin acetate (DDVAP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response

decreased urine output it (promotes renal conservation)

The water deprivation test is used to diagnose

diabetes insipidus.

The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder?

"Cushing's disease is characterized by an oversecretion of glucocorticoid hormones."

The nurse is reinforcing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood?

"I can eat foods that contain potassium."

The nurse is monitoring a client following a thyroidectomy for signs/symptoms of hypocalcemia. Which sign/symptom noted in the client indicates the presence of hypocalcemia?

Tingling around the mouth

The nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further teaching? Select all that apply.

"I need to limit playing football to only the weekends." "I should exercise in the evening to encourage a good sleep pattern."

The nurse is reinforcing home care instructions to a client with a diagnosis of Cushing's syndrome. Which client statement reflects a need for further teaching?

"I need to read the labels on any over-the-counter medications I purchase."

The nurse is instructing a client with Addison's disease about a newly prescribed medication, fludrocortisone acetate (Florinef). Which statement by the client indicates a need for further teaching?

"I will be glad to gain weight."

expected finding for a patient with primary cushing's disease

elevated blood glucose

A client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." Which response by the nurse is appropriate?

"You have concerns about the surgical treatment for your condition?"

In educating a client, the nurse is likely to explain the following is the cause of Hashimoto's disease: Answers: A. Antibodies attacking the thyroid gland B. Inflammation in the kidneys C. An adenocarcinoma in the brain D. Overactivation of the pituitary gland

A Hashimoto's disease is caused by autoimmunity to the thyroid gland, often involving antibodies.

Which client is at risk for developing thyrotoxicosis?

A client with Graves' disease who is having surgery

SIADH is caused by

excessive release of ADH

A nurse is reviewing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? 1. "I can eat foods that contain potassium." 2. "I will need to limit the amount of protein in my diet." 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."

*1. "I can eat foods that contain potassium."* *rationale* A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.

Which statement by the client would cause the nurse to suspect that the thyroid test results drawn on the client this morning may be inaccurate? 1. "I had a radionuclide test done 3 days ago." 2. "When I exercise I sweat more than normal." 3. "I drank some water before the blood was drawn." 4. "That hamburger I ate before the test sure tasted good."

*1. "I had a radionuclide test done 3 days ago."* *rationale* Option 1 indicates that a recent radionuclide scan had been performed. Recent radionuclide scans performed before the test can affect thyroid laboratory results. No food, fluid, or activity restrictions are required for this test, so options 2, 3, and 4 are incorrect.

A client has just been admitted with a diagnosis of myxedema coma. If all of the following interventions were prescribed, the nurse would place highest priority on completing which of the following first? 1. Administering oxygen 2. Administering thyroid hormone 3. Warming the client 4. Giving fluid replacement

*1. Administering oxygen* *rationale* As part of maintaining a patent airway, oxygen would be administered first. This would be quickly followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones.

A nurse is collecting data on a client with a diagnosis of hypothyroidism. Which of these behaviors, if present in the client's history, would the nurse determine as being likely related to the manifestations of this disorder? 1. Depression 2. Nervousness 3. Irritability 4. Anxiety

*1. Depression* *rationale* Hypothyroid clients experience a slow metabolic rate, and its manifestation includes apathy, fatigue, sleepiness, and depression. Options 2, 3, and 4 identify the clinical manifestations of hyperthyroidism.

A nurse is reviewing a plan of care for a client with Addison's disease. The nurse notes that the client is at risk for dehydration and suggests nursing interventions that will prevent this occurrence. Which nursing intervention is an appropriate component of the plan of care? *Select all that apply.* 1. Encouraging fluid intake of at least 3000 mL/day 2. Encouraging an intake of low-protein foods 3. Monitoring for changes in mental status 4. Monitoring intake and output 5. Maintaining a low-sodium diet

*1. Encouraging fluid intake of at least 3000 mL/day* *3. Monitoring for changes in mental status* *4. Monitoring intake and output* *rationale* The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase the intake of sodium, protein, and complex carbohydrates. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required.

A client with Addison's disease asks the nurse how a newly prescribed medication, fludrocortisone acetate (Florinef), will improve the condition. When formulating a response, the nurse should incorporate that a key action of this medication is to: 1. Help restore electrolyte balance. 2. Make the body produce more cortisol. 3. Replace insufficient circulating estrogens. 4. Alter the body's immune system functioning.

*1. Help restore electrolyte balance.* *rationale* Fludrocortisone acetate is a long-acting oral medication with mineralocorticoid and moderate glucocorticoid activity. It is prescribed for the long-term management of Addison's disease. Mineralocorticoids cause renal reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. These actions help restore electrolyte balance in the body. The other options are incorrect.

In planning nutrition for the client with hypoparathyroidism, which diet would be appropriate? 1. High in calcium and low phosphorous 2. Low in vitamins A, D, E, and K 3. High in sodium with no fluid restriction 4. Low in water and insoluble fiber

*1. High in calcium and low phosphorous* *rationale* Hypocalcemia is the end result of hypoparathyroidism resulting from either a lack of parathyroid hormone (PTH) secretion or ineffective PTH influence on tissue. Calcium is the major controlling factor of PTH secretion. Because of this, the diet needs to be high in calcium but low in phosphorus because these two electrolytes must exist in inverse proportions in the body. The other options are not dietary interventions with hypoparathyroidism.

A client with hypoparathyroidism has hypocalcemia. The nurse avoids giving the client the prescribed vitamin and calcium supplement with which of the following liquids? 1. Milk 2. Water 3. Iced tea 4. Fruit juice

*1. Milk* *rationale* Milk products are high in phosphates, which should be avoided by a client with hypoparathyroidism. Otherwise, calcium products are best absorbed with milk because the vitamin D in the milk promotes calcium absorption.

A nurse notes in the medical record that a client with Cushing's syndrome is experiencing fluid overload. Which interventions should be included in the plan of care? *Select all that apply.* 1. Monitoring daily weight 2. Monitoring intake and output 3. Maintaining a low-potassium diet 4. Monitoring extremities for edema 5. Maintaining a low-sodium diet

*1. Monitoring daily weight* *2. Monitoring intake and output* *4. Monitoring extremities for edema* *5. Maintaining a low-sodium diet* *rationale* The client with Cushing's syndrome experiencing fluid overload should be maintained on a high-potassium and low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water. Monitoring weight, intake, output, and extremities for edema are all appropriate interventions for such a nursing diagnosis.

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

*1. Positive Trousseau's sign* *rationale* Hypoparathyroidism is related to a lack of parathyroid hormone secretion or to 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 positive Chvostek's and Trousseau's signs, which indicate potential tetany. Options 2, 3, and 4 are not related to the presence of hypocalcemia.

A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse assists in developing a plan of care for the client. A priority nursing measure to be included in the plan regarding this medication is to monitor the client for: 1. Signs and symptoms of hypothyroidism 2. Signs and symptoms of hyperglycemia 3. Relief of pain 4. Signs of renal toxicity

*1. Signs and symptoms of hypothyroidism* *rationale* Excessive dosing with propylthiouracil may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

A nurse is preparing to discharge a client who has had a parathyroidectomy. When teaching the client about the prescribed oral calcium supplement, what information should the nurse include? 1. Take the calcium 30 to 60 minutes following a meal. 2. Avoid sunlight because it can cause skin color change. 3. Store the calcium in the refrigerator to maintain potency. 4. Check the pulse daily and hold the dosage if it is below 60 beats per minute.

*1. Take the calcium 30 to 60 minutes following a meal.* *rationale* Oral calcium supplements can be taken 30 to 60 minutes after meals to enhance their absorption and decrease gastrointestinal irritation. All the other options are unrelated to oral calcium therapy.

An older client with a history of hyperparathyroidism and severe osteoporosis is hospitalized. The nurse caring for the client plans first to address which problem? 1. The possibility of injury 2. Constipation 3. Urinary retention 4. Need for teaching about the disorder

*1. The possibility of injury* *rationale* The client with severe osteoporosis as a result of hyperparathyroidism is at risk for injury as a result of pathological fractures that can occur from bone demineralization. The client may also have a risk for constipation from the disease process but this is a lesser priority than client safety. The client may or may not have urinary elimination problems, depending on other factors in the client's history. There is no information in the question to support whether the client needs teaching.

A nurse is monitoring a client following a thyroidectomy for signs of hypocalcemia. Which of the following signs, if noted in the client, likely indicates the presence of hypocalcemia? 1. Tingling around the mouth 2. Negative Chvostek's sign 3. Flaccid paralysis 4. Bradycardia

*1. Tingling around the mouth* *rationale* Following a thyroidectomy, the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and fingertips, muscle twitching or spasms, palpitations or dysrhythmias, and positive Chvostek's and Trousseau's signs. Options 2, 3, and 4 are not signs of hypocalcemia.

During routine postoperative assessment of a client who has undergone hypophysectomy, the client complains of thirst and frequent urination. Knowing the expected complications of this surgery, the nurse would next check the: 1. Urine specific gravity 2. Serum glucose 3. Respiratory rate 4. Blood pressure

*1. Urine specific gravity* *rationale* Following hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone (ADH) deficiency. This deficiency is related to surgical manipulation. The nurse should assess specific gravity and notify the registered nurse if the results are less than 1.005. Although options 2, 3, and 4 may be components of the assessment, the nurse would next check urine specific gravity.

A nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which of the following items in the diet? 1. Vegetables 2. Meat 3. Fish 4. Cereals

*1. Vegetables* *rationale* The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals. Vegetables are allowed in the diet.

A nurse is caring for a client with pheochromocytoma. The client is scheduled for an adrenalectomy. During the preoperative period, the priority nursing action would be to monitor the: 1. Vital signs 2. Intake and output 3. Blood urea nitrogen (BUN) level 4. Urine for glucose and acetone

*1. Vital signs* *rationale* Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a brain attack (stroke) or sudden blindness. Although all of 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.

A nurse is collecting data on a client with hyperparathyroidism. Which of the following questions would elicit the accurate information about this condition from the client? 1. "Do you have tremors in your hands?" 2. "Are you experiencing pain in your joints?" 3. "Have you had problems with diarrhea lately?" 4. "Do you notice swelling in your legs at night?"

*2. "Are you experiencing pain in your joints?"* *rationale* Hyperparathyroidism causes an 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 pathological fractures.

A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 1. "Cushing's disease is characterized by an oversecretion of insulin." 2. "Cushing's disease is characterized by an oversecretion of glucocorticoid hormones." 3. "Cushing's disease is characterized by an undersecretion of corticotropic hormones." 4. "Cushing's disease is characterized by an undersecretion of glucocorticoid hormones."

*2. "Cushing's disease is characterized by an oversecretion of glucocorticoid hormones."* *rationale* Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones. Addison's disease is characterized by the failure of the adrenal cortex to produce and secrete adrenocortical hormones. Options 1 and 4 are inaccurate regarding Cushing's syndrome.

A client has been diagnosed with hypoparathyroidism. The nurse teaches the client to include foods in the diet that are: 1. High in phosphorus and low in calcium 2. Low in phosphorus and low in calcium 3. Low in phosphorus and high in calcium 4. High in phosphorus and high in calcium

*3. Low in phosphorus and high in calcium* *rationale* Hypoparathyroidism results in hypocalcemia. A therapeutic diet for this disorder is one that is high in calcium but low in phosphorus because these two electrolytes have inverse proportions in the body. All of the other options are unrelated to this disorder and are incorrect.

A nurse is reinforcing home care instructions to a client with a diagnosis of Cushing's syndrome. Which statement reflects a need for further client education? 1. "Taking my medications exactly as prescribed is essential." 2. "I need to read the labels on any over-the-counter medications I purchase." 3. "My family needs to be familiar with the signs and symptoms of hypoadrenalism." 4. "I could experience the signs and symptoms of hyperadrenalism because of Cushing's."

*2. "I need to read the labels on any over-the-counter medications I purchase."* *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 before purchasing any over-the-counter medications, and maintaining regular follow-up care. The nurse should also instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

A nurse has just supervised a newly diagnosed diabetes mellitus client self-inject NPH insulin at 7:30 ᴀᴍ. The nurse reviews the time frames for peak insulin action with the client, telling the client to be especially watchful for a hypoglycemic reaction between: 1. 7:30 ᴀᴍ and 9:30 ᴀᴍ 2. 1:30 ᴘᴍ and 7:30 ᴘᴍ 3. 8:30 ᴘᴍ and 12:00 ᴀᴍ 4. 2:30 ᴀᴍ and 4:30 ᴀᴍ

*2. 1:30 ᴘᴍ and 7:30 ᴘᴍ* *rationale* NPH is an intermediate-acting insulin. It begins to work in 1 to 2 hours (onset), peaks in 6 to 12 hours, and lasts for 18 to 24 hours (duration). Hypoglycemic reactions most likely occur during peak time, which in this case is option 2.

Which of the following clients is at risk for developing thyrotoxicosis? 1. A client with hypothyroidism 2. A client with Graves' disease who is having surgery 3. A client with diabetes mellitus scheduled for debridement of a foot ulcer 4. A client with diabetes insipidus scheduled for an invasive diagnostic test

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

A nurse is caring for a client with Addison's disease. The nurse checks the vital signs and determines that the client has orthostatic hypotension. The nurse determines that this finding relates to which of the following? 1. A decrease in cortisol release 2. A decreased secretion of aldosterone 3. An increase in epinephrine secretion 4. Increased levels of androgens

*2. A decreased secretion of aldosterone* *rationale* A decreased secretion of aldosterone results in a limited reabsorption of sodium and water; therefore the client experiences fluid volume deficit. A decrease in cortisol, an increase in epinephrine, and an increase in androgen secretion do not result in orthostatic hypotension.

While collecting data on a client being prepared for an adrenalectomy, the nurse obtains a temperature reading of 100.8° F. The nurse analyzes this temperature reading as: 1. Within normal limits 2. A finding that needs to be reported immediately 3. An expected finding caused by the operative stress response 4. Slightly abnormal but an insignificant finding

*2. A finding that needs to be reported immediately* *rationale* An adrenalectomy is performed because of excess adrenal gland function. Excess cortisol production impairs the immune response, which puts the client at risk for infection. Because of this, the client needs to be protected from infection, and minor variations in normal vital sign values must be reported so that infections are detected early, before they become overwhelming. In addition, the surgeon may elect to postpone surgery in the event of a fever because it can be indicative of infection. Options 1, 3, and 4 are not correct interpretations.

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

*2. 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 following this procedure, the health care provider needs to be notified immediately. Options 1, 3, and 4 indicate appropriate postoperative interventions.

A client is admitted with a diagnosis of pheochromocytoma. The nurse would monitor which of the following to detect the most common sign of pheochromocytoma? 1. Skin temperature 2. Blood pressure 3. Urine ketones 4. Weight

*2. Blood pressure* *rationale* Hypertension is the major symptom associated with pheochromocytoma and is monitored by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are other clinical manifestations of pheochromocytoma; however, hypertension is the most common sign.

A client with a pituitary tumor will undergo transsphenoidal hypophysectomy. The nurse includes which priority item in the preoperative teaching plan for the client? 1. Brushing the teeth vigorously and frequently is important to minimize bacteria in the mouth. 2. Blowing the nose following surgery is prohibited. 3. A small area will be shaved at the base of the neck. 4. It will be necessary to cough and deep breathe following the surgery.

*2. Blowing the nose following surgery is prohibited.* *rationale* The approach used for this surgery is the oronasal route, specifically where the upper lip meets the gum. The surgeon then uses a route through the sphenoid sinus to get to the pituitary gland. The client is not allowed to blow the nose, sneeze, or cough vigorously because these activities could raise intracranial pressure. The client also is not allowed to brush the teeth, to avoid disrupting the surgical site. Alternate methods for performing mouth care are used.

The nurse caring for a client who has had a subtotal thyroidectomy reviews the plan of care and determines which problem is the priority for this client in the immediate postoperative period? 1. Dehydration 2. Infection 3. Urinary retention 4. Bleeding

*4. Bleeding* *rationale* Hemorrhage is one of the most severe complications that can occur following thyroidectomy. The nurse must frequently check the neck dressing for bleeding and monitor vital signs to detect early signs of hemorrhage, which could lead to shock. T3 and T4 do not regulate fluid volumes in the body. Infection is a concern for any postoperative client but is not the priority in the immediate postoperative period. Urinary retention can occur in postoperative clients as a result of medication and anesthesia but is not the priority from the options provided.

A nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide (Lasix). The nurse reinforces dietary instructions to the client. Which of the following is an appropriate instruction? 1. Increase dietary intake of calcium. 2. Drink at least 2 to 3 L of fluid daily. 3. Eat sparely when experiencing nausea. 4. Decrease dietary intake of potassium.

*2. Drink at least 2 to 3 L of fluid daily.* *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. This is aided by the sufficient intake of fluids. Dietary restriction of calcium may be used as a component of therapy. The parathyroid is responsible for calcium production, and the term, "hyperparathyroidism" can be indicative of an increase in calcium. The client should eat foods high in potassium, especially if the client is taking furosemide. Limiting nutrients is not advisable.

When caring for a client diagnosed with pheochromocytoma, what information should the nurse know when assisting with planning care? 1. Profound hypotension may occur. 2. Excessive catecholamines are released. 3. The condition is not curable and is treated symptomatically. 4. Hypoglycemia is the primary presenting symptom.

*2. Excessive catecholamines are released.* *rationale* Pheochromocytoma is a catecholamine-producing tumor of the adrenal gland and causes secretion of excessive amounts of epinephrine and norepinephrine. Hypertension is the principal manifestation, and the client has episodes of a 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 client scheduled for a thyroidectomy says to the nurse, "I am so scared to get cut in my neck." Based on the client's statement, the nurse determines that the client is experiencing which problem? 1. Inadequate knowledge about the surgical procedure 2. Fear about impending surgery 3. Embarrassment about the changes in personal appearance 4. Lack of support related to the surgical procedure

*2. Fear about impending surgery* *rationale* The client is having a difficult time coping with the scheduled surgery. The client is able to express fears but is scared. No data in the question support options 1, 3, and 4.

A nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which of the following signs and symptoms, if noted in the client, will alert the nurse to the presence of this crisis? *Select all that apply.* 1. Bradycardia 2. Fever 3. Sweating 4. Agitation 5. Pallor

*2. Fever* *3. Sweating* *4. Agitation* *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 greater than 100° F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.

A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. The appropriate choice for this client to meet nutritional needs would be which of the following? 1. Crackers with cheese and tea 2. Graham crackers and warm milk 3. Toast with peanut butter and cocoa 4. Vanilla wafers and coffee with cream and sugar

*2. Graham crackers and warm milk* *rationale* The client with pheochromocytoma needs to be provided with a diet that is high in vitamins, minerals, and calories. Of particular importance is that food or beverages that contain caffeine (e.g., chocolate, coffee, tea, and cola) are prohibited.

A nurse is caring for a client after thyroidectomy and monitoring for signs of thyroid storm. The nurse understands that which of the following is a manifestation associated with this disorder? 1. Bradycardia 2. Hypotension 3. Constipation 4. Hypothermia

*2. Hypotension* *rationale* Clinical manifestations associated with thyroid storm include a fever as high as 106° F (41.1° C), severe tachycardia, profuse diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hyperreflexia, abdominal pain, diarrhea, and dehydration. With this disorder, the client's condition can rapidly progress to coma and cardiovascular collapse.

A nurse is caring for a client following an adrenalectomy and is monitoring for signs of adrenal insufficiency. Which of the following, if noted in the client, indicates signs and symptoms related to adrenal insufficiency? *Select all that apply.* 1. Double vision 2. Hypotension 3. Mental status changes 4. Weakness 5. Fever

*2. Hypotension* *3. Mental status changes* *4. Weakness* *5. Fever* *rationale* The nurse should be alert to signs and symptoms of adrenal insufficiency in a client following adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. Double vision is generally not associated with this condition.

A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen. The nurse plans care and places highest priority on which potential problem? 1. Nervousness 2. Infection 3. Concern about appearance 4. Inability to care for self

*2. Infection* *rationale* The client with a stab wound has a break in the body's first line of defense against infection. The client with Cushing's disease is at great risk for infection because of excess cortisol secretion and subsequent impaired antibody function and decreased proliferation of lymphocytes. The client may also have a potential for the problems listed in the other options but these are not the highest priority at this time.

A nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique will provide data necessary to support the admitting diagnosis? 1. Auscultation of lung sounds 2. Inspection of facial features 3. Percussion of the thyroid gland 4. Palpation of the adrenal glands

*2. Inspection of facial features* *rationale* Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and a blank expression that are characteristic of myxedema. The techniques in the remaining options will not reveal any data that would support the diagnosis of myxedema.

A nurse is providing discharge instructions to a client who had a unilateral adrenalectomy. Which of the following will be a component of the instructions? 1. The reason for maintaining a diabetic diet 2. Instructions about early signs of a wound infection 3. Teaching regarding proper application of an ostomy pouch 4. The need for lifelong replacement of all adrenal hormones

*2. Instructions about early signs of a wound infection* *rationale* A client who is undergoing a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Because of the anti-inflammatory properties of corticosteroids, clients who undergo an adrenalectomy are at increased risk for developing wound infections. Because of this increased risk for infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection is present. Options 1, 3, and 4 are incorrect instructions.

A nurse is caring for a postoperative parathyroidectomy client. Which of the following would require the nurse's immediate attention? 1. Incisional pain 2. Laryngeal stridor 3. Difficulty voiding 4. Abdominal cramps

*2. Laryngeal stridor* *rationale* During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which cause swelling and the compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration that is caused by the compression of the trachea and that leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway.

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which symptom is indicative of this disorder? 1. Diarrhea 2. Polydipsia 3. Weight gain 4. Blurred vision

*2. Polydipsia* *rationale* Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale in color, and its specific gravity is low. Anorexia and weight loss occur. Diarrhea, weight loss, and blurred vision are not manifestations of the disorder.

A nurse is collecting data from a client who is being admitted to the hospital for a diagnostic workup for primary hyperparathyroidism. The nurse understands that 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 (polyuria). This diuresis leads to dehydration and the client would lose weight. Options 1, 3, and 4 are gastrointestinal (GI) symptoms but are not associated with the common GI symptoms typical of hyperparathyroidism (nausea, vomiting, anorexia, constipation).

The anticipated intended effect of fludrocortisone acetate (Florinef) for the treatment of Addison's disease is to: 1. Stimulate the immune response. 2. Promote electrolyte balance. 3. Stimulate thyroid production. 4. Stimulate thyrotropin production.

*2. Promote electrolyte balance.* *rationale* Florinef is a long-acting oral medication with mineralocorticoid and moderate glucocorticoid activity used for long-term management of Addison's disease. Mineralocorticoids act on the renal distal tubules to enhance the reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. In small doses, fludrocortisone acetate causes sodium retention and increased urinary potassium excretion. The client rapidly can develop hypotension and fluid and electrolyte imbalance if the medication is discontinued abruptly. Options 1, 3, and 4 are not associated with the effects of this medication.

What would the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves' disease? 1. Provide a high-fiber diet. 2. Provide a restful environment. 3. Provide three small meals per day. 4. Provide the client with extra blankets.

*2. Provide a restful environment.* *rationale* Because of the hypermetabolic state, the client with Graves' disease needs to be provided with an environment that is restful both physically and mentally. Six full meals a day that are well balanced and high in calories are required, because of the accelerated metabolic rate. Foods that increase peristalsis (e.g., high-fiber foods) need to be avoided. These clients suffer from heat intolerance and require a cool environment.

A nurse is caring for a client with hypothyroidism who is overweight. Which food items would the nurse suggest to include in the plan? 1. Peanut butter, avocado, and red meat 2. Skim milk, apples, whole-grain bread, and cereal 3. Organ meat, carrots, and skim milk 4. Seafood, spinach, and cream cheese

*2. Skim milk, apples, whole-grain bread, and cereal* *rationale* Clients with hypothyroidism may have a problem with being over-weight because of their decreased metabolic need. They should consume foods from all food groups, which will provide them with the necessary nutrients; however, the foods should be low in calories. Option 2 is the only option that identifies food items that are low in calories.

When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is appropriate? 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 (CSF) leak. If this occurs, the drainage should be collected and tested for glucose, indicating the presence of CSF. 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.

A client who returned to the nursing unit 8 hours ago after hypophysectomy has clear drainage saturating the nasal dressing. The nurse should take which action first? 1. Continue to observe for further drainage. 2. Test the drainage for glucose.* 3. Put the head of the bed flat. 4. Test the drainage for occult blood.

*2. Test the drainage for glucose.* *rationale* Following hypophysectomy the client should be monitored for rhinorrhea (clear nasal drainage), which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the drainage should be collected and tested for the presence of CSF by testing it for glucose. CSF tests positive for glucose, whereas true nasal secretions would not. It is not necessary to test drainage that is clear for occult blood. The head of the bed should not be lowered, to prevent a rise in intracranial pressure. Continuing to observe the drainage without taking action could put the client at risk for developing a serious complication.

result of excessive secretion of ADH

excessive retention of water and dilutional hyponatremia

A nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further instruction? *Select all that apply.* 1. "I enjoy exercising but I need to be careful." 2. "I need to pace my activities throughout the day." 3. "I need to limit playing football to only the weekends." 4. "I should gauge my activity level by my energy level." 5. "I should exercise in the evening to encourage a good sleep pattern."

*3. "I need to limit playing football to only the weekends."* *5. "I should exercise in the evening to encourage a good sleep pattern."* *rationale* The client should be instructed to avoid high-impact activity or contact sports such as football. Exercising late in the evening may interfere with restful sleep. The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to use energy level as a guide to activity.

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which response by the nurse is appropriate? 1. "Don't be concerned, this problem can be covered with clothing." 2. "This is permanent, but looks are deceiving and not that important." 3. "Usually, these physical changes slowly improve following treatment." 4. "Try not to worry about it. There are other things to be concerned about."

*3. "Usually, these physical changes slowly improve following treatment."* *rationale* The client with Cushing's syndrome should be reassured that most physical changes resolve with treatment. Options 1, 2, and 4 are not therapeutic responses.

Following hypophysectomy, a client complains of being very thirsty and having to urinate frequently. The initial nursing action is to: 1. Document the complaints. 2. Increase fluid intake. 3. Check the urine specific gravity. 4. Check for urinary glucose.

*3. Check the urine specific gravity.* *rationale* Following hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should check the urine for specific gravity and report the results if they are less than 1.005. Urinary glucose and diabetes mellitus is not a concern here. In this situation, increasing fluid intake would require a health care provider's prescription. The client's complaint would be documented but not as an initial action.

A nurse is caring for a client with pheochromocytoma. Which data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hr 2. A coagulation time of 5 minutes 3. Congestion heard on auscultation of the lungs 4. A blood urea nitrogen (BUN) level of 20 mg/dL

*3. Congestion heard on auscultation of the lungs* *rationale* The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, congestive heart failure (CHF), increased platelet aggregation, and stroke. Death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic aneurysm. Congestion heard on auscultation of the lungs is indicative of CHF. A urinary output of 50 mL/hr is an appropriate output; the nurse would become concerned if the output were less than 30 mL/hr. A coagulation time of 5 minutes is normal. A BUN level of 20 mg/dL is a normal finding.

A nurse is preparing to provide instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which of the following diets would likely be prescribed for this client? 1. Low-protein diet 2. Low-sodium diet 3. High-sodium diet 4. Low-carbohydrate diet

*3. High-sodium diet* *rationale* A high-sodium, high-complex carbohydrate, and high-protein diet will be prescribed for the client with Addison's disease. To prevent excess fluid and sodium loss, the client is instructed to maintain an adequate salt intake of up to 8 g of sodium daily and to increase salt intake during hot weather, before strenuous exercise, and in response to fever, vomiting, or diarrhea.

A client is diagnosed with hyperparathyroidism. The nurse teaching the client about dietary alterations to manage the disorder tells the client to limit which of the following foods in the diet? 1. Bananas 2. Oatmeal 3. Ice cream 4. Chicken breast

*3. Ice cream* *rationale* The client with hyperparathyroidism is likely to have elevated calcium levels. This client should reduce intake of dairy products such as milk, cheese, ice cream, or yogurt. Apples, bananas, chicken, oatmeal, and pasta are low-calcium foods.

A nurse would expect to note 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. Instruct the client to contact the health care provider if episodes of chest pain occur. 6. Inform the client that iodine preparations will be prescribed to treat the disorder.

*3. Instruct the client about thyroid replacement therapy.* *4. Encourage the client to consume fluids and high-fiber foods in the diet.* *5. Instruct the client to contact the health care provider 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 hormones and providing measures to support the signs and symptoms related to a decreased metabolism. 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. The client often has cold intolerance and requires a warm environment. The client would notify the health care provider if chest pain occurs since it could be an indication of overreplacement of thyroid hormone. Iodine preparations are used to treat hyperthyroidism. These medications decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone.

A client with newly diagnosed Cushing's syndrome expresses concern about personal appearance, specifically about the "buffalo hump" that has developed at the base of the neck. When counseling the client about this manifestation, the nurse should incorporate the knowledge that: 1. This is a permanent feature. 2. It can be minimized by wearing tight clothing. 3. It may slowly improve with treatment of the disorder. 4. It will quickly disappear once medication therapy is started.

*3. It may slowly improve with treatment of the disorder.* *rationale* The client with Cushing's syndrome should be reassured that most physical changes resolve over time with treatment. The other options are incorrect.

hyponatremia, as serum sodium drops

extra water enters body cells and causes them to swell. Convulsions, shock, coma and death may occur with cerebral edema and increased brain cell volume.

A nurse reviews a plan of care for a postoperative client following a thyroidectomy and notes that the client is at risk for breathing difficulty. Which of the following nursing interventions will the nurse suggest to include in the plan of care? 1. Maintain a supine position. 2. Encourage coughing and deep breathing exercises. 3. Monitor neck circumference frequently. 4. Maintain a pressure dressing on the operative site.

*3. Monitor neck circumference frequently.* *rationale* Following a thyroidectomy, the client should be placed in an upright position to facilitate air exchange. The nurse should assist the client with deep breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision. A pressure dressing is not placed on the operative site because it could affect breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. Neck circumference is monitored at least every 4 hours to assess for postoperative edema.

Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma? 1. Weigh the client. 2. Test the client's urine for glucose. 3. Monitor the client's blood pressure. 4. Palpate the client's skin to determine warmth.

*3. Monitor the client's blood pressure.* *rationale* Hypertension is the major symptom that is associated with pheochromocytoma. The blood pressure status is monitored by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are also clinical manifestations of pheochromocytoma, but hypertension is the major symptom.

A nurse assists in developing a plan of care for a client with hyperparathyroidism receiving calcitonin-human (Cibacalcin). Which outcome has the highest priority regarding this medication? 1. Relief of pain 2. Absence of side effects 3. Reaching normal serum calcium levels 4. Verbalization of appropriate medication knowledge

*3. Reaching normal serum calcium levels* *rationale* Hypercalcemia can occur in clients with hyperparathyroidism, and calcitonin is used to lower plasma calcium level. The highest priority outcome in this client situation would be a reduction in serum calcium level. Option 1 is unrelated to this medication. Although options 2 and 4 are expected outcomes, they are not the highest priority for administering this medication.

A nurse caring for a client scheduled for a transsphenoidal hypophysectomy to remove a tumor in the pituitary gland assists to develop a plan of care for the client. The nurse suggests including which specific information in the preoperative teaching plan? 1. Hair will need to be shaved. 2. Deep breathing and coughing will be needed after surgery. 3. Toothbrushing will not be permitted for at least 2 weeks following surgery. 4. Spinal anesthesia is used.

*3. Toothbrushing will not be permitted for at least 2 weeks following 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 coughing and deep breathing are important, specific to this procedure is avoiding toothbrushing to prevent disruption of the surgical site. Also, coughing may disrupt the surgical site.

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which of the following items in the preoperative period? 1. Intake and output 2. Blood urea nitrogen (BUN) 3. Vital signs 4. Urine glucose and ketones

*3. Vital signs* *rationale* Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.

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

*4. "I can take any medications if I need to before the collection."* *rationale* 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 and discard the first urine and note the time and start the test. The 24-hour urine specimen collection bottle must be kept on ice or refrigerated. In a VMA collection, the client is instructed to avoid tea, chocolate, vanilla, and all fruits for 2 days before urine collection begins. Also clients are reminded not to take certain medications for 2 to 3 days before the test.

A client with myxedema has changes in intellectual function such as impaired memory, decreased attention span, and lethargy. The client's husband is upset and shares his concerns with the nurse. Which statement by the nurse is helpful to the client's husband? 1. "Would you like me to ask the health care provider for a prescription for a stimulant?" 2. "Give it time. I've seen dozens of clients with this problem that fully recover." 3. "I don't blame you for being frustrated, because the symptoms will only get worse." 4. "It's obvious that you are concerned about your wife's condition, but the symptoms may improve with continued therapy."

*4. "It's obvious that you are concerned about your wife's condition, but the symptoms may improve with continued therapy."* *rationale* Using therapeutic communication techniques, the nurse acknowledges the husband's concerns and conveys that the client's symptoms are common with myxedema. With thyroid hormone therapy, these symptoms should decrease, and cognitive function often returns to normal. Option 1 is not helpful, and it blocks further communication. Option 3 is pessimistic and untrue. Option 2 is not appropriate and offers false reassurance.

A client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." What response by the nurse is appropriate? 1. "I think you are making the right decision to have the surgery." 2. "You are very ill. Your health care provider has made the correct decision." 3. "There is no reason to worry. Your health care provider is a wonderful surgeon." 4. "You have concerns about the surgical treatment for your condition."

*4. "You have concerns about the surgical treatment for your condition."* *rationale* Paraphrasing is restating the client's message in the nurse's own words. Option 4 addresses the therapeutic communication technique of paraphrasing. The client is reaching out for understanding. In option 3, the nurse is offering a false reassurance, and this type of response will block communication. Option 2 also represents a communication block because it reflects a lack of the client's right to an opinion. In option 1, the nurse is expressing approval, which can be harmful to a nurse-client relationship.

A nurse working on an endocrine nursing unit understands that which correct concept is used in planning care? 1. Clients with Cushing's syndrome are likely to experience episodic hypotension. 2. Clients with hyperthyroidism must be monitored for weight gain. 3. Clients who have diabetes insipidus should be assessed for fluid excess. 4. Clients who have hyperparathyroidism should be protected against falls.

*4. Clients who have hyperparathyroidism should be protected against falls.* *rationale* Hyperparathyroidism is a disease that involves excess secretion of parathyroid hormone (PTH). Elevation of PTH causes excess calcium to be removed from the bones. There is a decline in bone mass, which may cause a fracture if a fall occurs. Cushing's syndrome is likely to cause hypertension. Clients with hypothyroidism must be monitored for weight gain and clients with hyperthyroidism must be monitored for weight loss. Clients who have diabetes insipidus should be assessed for fluid deficit.

A nursing student notes in the medical record that a client with Cushing's syndrome is experiencing body image disturbances. The need for additional education regarding this problem is identified when the nursing student suggests which nursing intervention? 1. Encouraging the client's expression of feelings 2. Evaluating the client's understanding of the disease process 3. Encouraging family members to share their feelings about the disease process 4. Evaluating the client's understanding that the body changes need to be dealt with

*4. Evaluating the client's understanding that the body changes need to be dealt with* *rationale* Evaluating the client's understanding that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. Options 1, 2, and 3 are appropriate because they address the client and family feelings regarding the disorder.

Which clinical manifestation should the nurse expect to note when assessing a client with Addison's disease? 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, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in options 1, 2, and 3 are not associated with Addison's disease.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse who is assisting to care for the client obtains which of the following immediately in preparation for the treatment of this syndrome? 1. NPH insulin 2. A nasal cannula 3. Intravenous (IV) infusion of sodium bicarbonate 4. IV infusion of normal saline

*4. IV infusion of normal saline* *rationale* The primary goal of treatment is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. IV fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. A nasal cannula for oxygen administration is not necessarily required to treat HHNS.

A client has an endocrine system dysfunction of the pancreas. The nurse anticipates that the client will exhibit impaired secretion of which of the following substances? 1. Amylase 2. Lipase 3. Trypsin 4. Insulin

*4. 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.

A nurse is caring for a client following a thyroidectomy. The client tells the nurse that she is concerned because of voice hoarseness. The client asks the nurse whether the hoarseness will subside. The nurse appropriately tells the client that the hoarseness: 1. Indicates nerve damage 2. Is harmless but permanent 3. Will worsen before it subsides 4. Is normal and will gradually subside

*4. Is normal and will gradually subside* *rationale* Hoarseness that develops in the postoperative period is usually the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. Options 1, 2, and 3 are incorrect.

Which nursing measure would be effective in preventing complications in a client with Addison's disease? 1. Restricting fluid intake 2. Offering foods high in potassium 3. Checking family support systems 4. Monitoring the blood glucose

*4. Monitoring the blood glucose* *rationale* The decrease in cortisol secretion that characterizes Addison's disease can result in hypoglycemia. Therefore monitoring the blood glucose would detect the presence of hypoglycemia so that it can be treated early to prevent complications. Fluid intake should be encouraged to compensate for dehydration. Potassium intake should be restricted because of hyperkalemia. Option 3 is not a priority for this client.

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which intervention would best assist the client with this problem? 1. Administering methimazole (Tapazole) every 8 hours 2. Lubricating the eyes with tap water every 2 to 4 hours 3. Instructing the client to avoid straining or heavy lifting 4. Obtaining dark glasses for the client

*4. Obtaining dark glasses for the client* *rationale* Because photophobia (light intolerance) accompanies this disorder, dark glasses are helpful in alleviating the symptom. Medical therapy for Graves' disease does not help alleviate the clinical manifestation of exophthalmos. Other interventions may be used to relieve the drying that occurs from not being able to completely close the eyes; however, the question is asking what the nurse can do for photophobia. 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 is at risk for developing an eye infection because the solution is not sterile. There is no need to prevent straining with exophthalmos.

A nurse is caring for a client experiencing thyroid storm. Which of the following would be a priority concern for this client? 1. Inability to cope with the treatment plan 2. Lack of sexual drive 3. Self-consciousness about body appearance 4. Potential for cardiac disturbances

*4. Potential for cardiac disturbances* *rationale* Clients in thyroid storm are experiencing a life-threatening event, which is associated with uncontrolled hyperthyroidism. It is characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability. The signs and symptoms of the disorder develop quickly, and therefore emergency measures must be taken to prevent death. These measures include maintaining hemodynamic status and patency of airway as well as providing adequate ventilation. Options 1, 2, and 3 are not a priority in the care of the client in thyroid storm.

A nurse is collecting data regarding 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 registered nurse immediately. 4. Reassure the client that this is usually a temporary condition.

*4. Reassure the client that this is usually a temporary condition.* *rationale* Weakness and hoarseness of the voice can occur as a result of trauma of the laryngeal nerve. If this develops, the client should be reassured that the problem will subside in a few days. Unnecessary talking should be discouraged. It is not necessary to notify the registered nurse immediately. These signs do not indicate bleeding or the need to administer calcium gluconate.

A nurse is caring for a postoperative adrenalectomy client. Which of the following does the nurse specifically monitor for in this client? 1. Peripheral edema 2. Bilateral exophthalmos 3. Signs and symptoms of hypocalcemia 4. Signs and symptoms of hypovolemia

*4. Signs and symptoms of hypovolemia* *rationale* Following adrenalectomy, the client is at risk for hypovolemia. Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. A deficiency of adrenocortical hormones does not cause the clinical manifestations noted in options 1, 2, and 3.

An indication of Chvostek' sign is: Answers: A. Twitching of the lips after tapping the face B. Elevated blood sugar after glucose infusion C. Inability to hold one's arms straight D. Spasms of the hand after blood circulation is cut off

. A Twitching of the lips after tapping the face in the right place is an indication of Chvostek's sign and a sign of hypocalcaemia. Spasms of the hand are associated with Trousseau's sign.

A client with Graves' disease experiences a thyroid storm and has tachycardia and hypertension. What medication is most likely to be used? Answers: A. Levofloxcin B. Chlorothiazide C. Percocet D. Propylthiouracil

. D Propylthiouracil is a commonly used medication for treating hyperthyroidism. Levofloxacin is an antibiotic, chlorothiazide is a diuretic, and Percocet a painkiller.

. The nurse assessing a female client with Cushing's syndrome would expect to note which of the following? a) hirsutism b) hypotension c) hypoglycemia d) pallor

1) A - An increased production of androgens that accompanies a rise in cortisol levels with Cushing's syndrome produces hirsutism and acne in women. Other clinical findings of Cushing's syndrome include hypertension caused by sodium retention, impaired glucose tolerance or diabetes mellitus caused by cortisol's anti-insulin effect and ability to enhance gluconeogenesis, and skin changes including bruising and purplish red striae caused by protein catabolism.

Acromegaly is most frequently diagnosed in: a. Middle-aged adults b. Newborns c. Children ages 2 to 5 d. Adults age 65 and older

1. A: Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone. Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences of acromegaly include type 2 diabetes, hypertension and increased risk of cardiovascular disease, arthritis and colon polyps.

10. A nurse provides dietary instructions to a client with a diagnosis of hyperparathyroidism. Which statement by the client indicates the need for further instructions? a) I need to drink 3000 ml of fluid per day b) I should drink cranberry juice daily c) I should eat foods high in calcium d) I should eat foods high in fiber

10) C - The client with hyperparathyroidism should consume at least 3000 mL of fluid per day. Measures to prevent dehydration are necessary because dehydration increases serum calcium levels and promotes the formation of renal stones. Cranberry juice and prune juice help make the urine more acidic. A high urinary acidity helps prevent renal stone formation because calcium is more soluble in acidic urine than in alkaline urine. Clients should be on a low-calcium, low-vitamin D diet. High-fiber foods are important to prevent constipation and fecal impaction resulting from the hypercalcemia that occurs with this disorder.

10. All of the following statements about Hashimoto's disease are true except: a. Many patients are entirely asymptomatic b. Not all patients become hypothyroid c. Most cases of obesity are attributable to Hashimoto's disease d. Hypothyroidism may be subclinical

10. C: Although weight gain may be a symptom of Hashimoto's disease, the majority of obese people have normal thyroid function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto's disease include fatigue, cold intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.

16. A nurse is caring for a client with hyperthyroidism and is instructing the client about dietary measures. The nurse tells the client that it is important to eat foods that are: a) high in bulk and fiber b) low in calories c) low in carbohydrates and fats d) high in calories

16) D - The client with hyperthyroidism is usually extremely hungry because of increased metabolism. The client should be instructed to consume a high-calorie diet with six full meals a day. The client should be instructed to eat foods that are nutritious and contain ample amounts of protein, carbohydrates, fats, and minerals. Clients should be discouraged from eating foods that increase peristalsis and thus result in diarrhea, such as highly seasoned, bulky, and fibrous foods.

17. Untreated hyperthyroidism during pregnancy may result in all of the following except: a. Premature birth and miscarriage b. Low birthweight c. Autism d. Preeclampsia

17. C: In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.

19. Endocrine disorders may be triggered by all of the following except: a. Stress b. Infection c. Chemicals in the food chain and environment d. Cell phone use

19. D: Endocrine function may be influenced by myriad factors. In addition to the above-mentioned, there is evidence that exposure to naturally occurring and man-made endocrine disruptors such as tributyltin, certain bioaccumulating chlorinated compounds, and phytoestrogens is widespread and in susceptible individuals, may trigger endocrine disorders.

2. A nurse is admitting a client with a diagnosis of Addison's disease to the hospital. On assessment, the nurse would expect to note which finding that is a manifestation of this disorder? a) peripheral edema b) excessive facial hair c) lower than normal blood glucose level d) high blood pressure

2) C - Blood glucose levels are low in Addison's disease as a result of decreased secretion of glucocorticoids (cortisol). Edema is absent, and aldosterone secretion is decreased so the client develops a deficient fluid volume. Facial hair increases with adrenocortical hyperfunction. Clients with Addison's disease develop hypotension as a result of deficient fluid volume. Options A, B and D are unrelated to Addison's disease.

20. A husband of a client with graves' disease expresses concern regarding his wife's health because during the past 3 months she has been experiencing nervousness, inability to concentrate even on trivial tasks, and outbursts of temper. On the basis of this information, which nursing diagnosis would the nurse identify as appropriate for the client? a) ineffective coping b) disturbed sensory perception c) social isolation d) grieving

20) A - Frequently, family and friends may report that the client with Graves' disease has become more irritable or depressed. The signs and symptoms in the question are supporting data for the nursing diagnosis of Ineffective coping and are not related to options B, C, and D. The question does not provide data to support options B, C, and D.

9. Persons at increased risk of developing Hashimoto's disease include all of the following except: a. Persons with vitiligo b. Asian-Americans c. Persons with rheumatoid arthritis d. Persons with Addison's disease

9. B: Along with the above-mentioned groups, persons with type 1 diabetes and persons suffering from pernicious anemia (insufficient vitamin b12) are at increased risk of developing Hashimoto's disease. Because it tends to run in families, there is likely a genetic susceptibility as well. Environmental factors such as excessive iodine consumption and selected drugs also have been implicated as potential risk factors.

21. A nurse is caring for a client with hypoparathyroidism. In planning for discharge from the hospital, the nurse identifies which of the following as a potential psychosocial nursing diagnosis? a) impaired comfort related to cold intolerance secondary to decreased metabolic rate b) constipation related to decreased peristaltic action secondary to decreased metabolic rate c) high risk for impaired skin integrity related to edema d) anxiety related to the need for lifelong dietary interventions to control the disease

21) D - Medical management of hypoparathyroidism is aimed at correcting the hypocalcemia. This is accomplished with prescribed medications as well as lifelong compliance to dietary guidelines, which include consumption of foods high in calcium but low in phosphorus. Knowing that the interventions are lifelong can create some anxiety for the client, and this problem needs to be addressed before hospital discharge. The other options are unrelated to this condition and to a psychosocial concern.

27. A nurse provides instructions to a client who is scheduled for a radioactive iodine uptake test. Which statement by the client indicates a need for further instructions? a) the test measures the rate of iodine uptake by my thyroid gland b) I will need to drink a small dose of radioactive iodine before the test c) a 24 hour urine specimen will need to be collected to measure iodine excretion d) I need to minimize close contact with others in my family for a period of 48 hours after the test because of the radioactivity in my system

27) D - The client undergoing a radioactive iodine uptake test needs to be reassured that the amount of radioactive iodine used is very small, that it is not harmful to the client, and that the client will not be radioactive. The other options are correct regarding this diagnostic test.

29. A nurse is caring for a client with Cushing's syndrome who demonstrates withdrawn behavior. The nurse recognizes that this client's behavior is likely related to which nursing diagnosis? a) deficient diversional activity b) powerlessness c) hopelessness d) disturbed body image

29) D - Physical changes in the client's appearance can occur with Cushing's syndrome. Such changes include hirsutism, moon face, buffalo hump, acne, and striae. These changes cause a body image disturbance. Options A, B, and C are not commonly associated with Cushing's syndrome.

3. A nurse is preparing to perform an assessment on a client being admitted to the hospital with a diagnosis of Cushing's syndrome. When performing the assessment, the nurse checks for which significant manifestation of the disorder? a) fluid retention b) stretch marks c) goiter d) melanosis

3) A - Excessive secretion of adrenocortical hormones results in water and sodium reabsorption, causing fluid retention. Stretch marks (striae) are a common feature and can result in a disturbed body image, but are not significant and do not represent a life-threatening situation. Goiter is not a manifestation of Cushing's syndrome. Melanosis is a common manifestation associated with Addison's disease.

30. A client with Addison's disease makes all of the following statements. Which one does the nurse analyze as requiring further discussion? a) I wear a Medic-Alert bracelet at all times b) I need to weigh myself daily and record it c) It is important that I drink enough fluids and increase my salt intake d) my medication doses will not need to be adjusted for any reason

30) D - The client with Addison's disease is experiencing deficits of mineralocorticoids, glucocorticoids, and androgens. Aldosterone deficiency affects the ability of the nephrons to conserve sodium, so the client experiences sodium and fluid volume deficit. The client needs to manage this problem with daily hormone replacement and increased fluid and sodium intake. Clients are instructed to weigh themselves daily as a means of monitoring fluid volume balance. Glucocorticoids and mineralocorticoids are essential components of the stress response. Additional doses of hormone replacement therapy are needed with any type of physical or psychological stressor. This information needs to be conveyed to the client and requires that the client wear a Medic-Alert bracelet so that health care professionals are aware of this problem if the client were to experience a medical emergency.

4. A clinic nurse is performing an assessment on a client who has hypothyroidism. The nurse would expect to note which clinical manifestation? a) complaints of difficulty sleeping b) complaints of diarrhea c) significant weight loss since the last clinic visit d) complaints of intolerance to cold weather

4) D - An insufficient level of thyroid hormone causes a decrease in metabolic rate and heat production. Intolerance to cold would be noted. Options A, B and C are clinical manifestations of hyperthyroidism.

Which of the following would be an indication of Androgen Insensitivity Syndrome? Answers: A. A 33 year old woman with a karyotype of XY B. A 16 year old male with reduced kidney function C. Failure to respond to cortisol therapy D. Several pregnancies all of which ended in miscarriages

A Androgen Insensitivity Syndrome is when the body does not respond to androgens such as testosterone. This can result in genetic males being born with the appearance of women.

. A client has been diagnosed with goiter. The nurse looks for documentation of which of the following in the client's medical record? a) decreased wound healing b) chronic fatigue c) enlarged thyroid gland d) heart damage

6) C - An enlarged thyroid gland occurs in goiter. Decreased wound healing, chronic fatigue, and heart damage are not specifically associated with this condition.

8. A nurse is caring for a client following thyroidectomy and is monitoring for complications. Which of the following if noted in the client, would indicate a need for physician notification? a) surgical pain in the neck area b) voice hoarseness c) numbness and tingling around the mouth d) weakness of the voice

8) C - Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or traumatized during surgery. If the client develops numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching, the physician should be called immediately. A hoarse or weak voice may occur temporarily if there has been unilateral injury to the laryngeal nerve during surgery. Pain is expected in the postoperative period. Calcium gluconate ampules should be available at the bedside, and the client should have a patent intravenous (IV) line in the event that hypocalcemic tetany occurs

8. Hashimoto's disease is: a. Chronic inflammation of the thyroid gland b. Diagnosed most frequently in Asian-Americans and Pacific Islanders c. A form of hyperthyroidism d. A rare form of hypothyroidism

8. A: Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60. When treatment is indicated, synthetic T4 is administered.

9. A nurse is monitoring a client for complications following thyroidectomy. The nurse notes that the client's voice is very hoarse, and the client is concerned about the hoarseness and asks the nurse about it. The nurse makes which response to alleviate the client's concern? a) hoarseness and weak voice indicate permanent damage to the nerves b) this complication is expected c) this problem is temporary and will probably subside in a few days d) it is best that you not talk at all until the problem is further evaluated

9) C Temporary hoarseness and a weak voice may occur if there has been unilateral injury to the laryngeal nerve during surgery. If hoarseness or a weak voice is present, the client is reassured that the problem will probably subside in a few days. Unnecessary talking is discouraged to minimize hoarseness. The statements in options A, B, and D will not alleviate the client's concern.

Addison's disease (primary insufficiency) of the adrenal gland results from

failure to produce adequate levels of cortisol and aldosterone

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

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

The parathyroid glands play a major role in regulating which substances? A. Calcium and Phosphorus B. Cholride and potassium C. Potassium and calcium D. Sodium and potassium

A. Calcium and Phosphorus

ACTH stimulation test is to assess for

Addison's disease

A client has just been admitted with a diagnosis of myxedema coma. If all of the following interventions were prescribed, the nurse should place highest priority on completing which action first?

Administering oxygen

A client with acromegaly will most likely experience which symptom? A. Bone pain B. Frequent infections C. Fatigue D. Weight loss

Answer A is correct. Acromegaly is an increase in secretion of growth hormone. The growth hormones cause expansion and elongation of the bones. Answers B, C, and D are not directly associated with acromegaly, so they are incorrect.

The client with a suspected pituitary tumor will most likely exhibit symptoms of: A. Alteration in visual acuity B. Frequent diarrhea C. Alterations in blood glucose D. Urticaria

Answer A is correct. The pituitary is located in the middle of the skull adjacent to the optic nerve and brain. Pressure on the optic nerve can cause an increase in intracranial pressure. Clients frequently complain of headache, nausea, vomiting, and decreasing visual acuity as the intracranial pressure increases. B, C, and D are incorrect because they are not associated with a pituitary tumor.

A client with Cushing's syndrome should be instructed to: A. Avoid alcoholic beverages B. Limit the sodium in her diet C. Increase servings of dark green vegetables D. Limit the amount of protein in her diet

Answer B is correct. A client with Cushing's syndrome has adrenocortical hypersecretion, so she retains sodium and water. The client may drink alcohol in moderation, so answer A is incorrect, and there is no need to eat more green vegetables or limit protein, so answers C and D are incorrect.

A client is admitted for removal of a goiter. Which nursing intervention should receive priority during the post-operative period? A. Maintaining fluid and electrolyte balance B. Assessing the client's airway C. Providing needed nutrition and fluids D. Providing pain relief with narcotic analgesics

Answer B is correct. A goiter is hyperplasia of the thyroid gland. Removal of a goiter can result in laryngeal spasms and airway occlusion. The other answers are lesser in priority.

A client with Addison's disease will most likely exhibit which symptom? A. Hypertension B. Bronze pigmentation C. Hirsutism D. Purple striae

Answer B is correct. Answer B is correct because a bronze pigmentation is a sign of Addison's disease. Answers A, C, and D are symptoms of Cushing's syndrome, making them incorrect.

Which vitamin is directly involved in the metabolism of the hormones secreted by the parathyroid? A. Vitamin C B. Vitamin D C. Vitamin K D. Vitamin B9

Answer B is correct. Vitamin D is related to absorption of calcium and phosphorus. A, C, and D are incorrect because they are not related to the absorption of calcium and phosphorus.

A client is admitted for treatment of hypoparathyroidism. Based on the client's diagnosis, the nurse would anticipate an order for: A. Potassium B. Magnesium C. Calcium D. Iron

Answer C is correct. The parathyroid is responsible for calcium and phosphorus absorption. Clients with hypoparathyroidism have hypocalcemia. Answers A, B, and D are not associated with hypoparathyroidism therefore they are incorrect.

Which item should be kept at the bedside of a client who has just returned from having a thyroidectomy? A. A padded tongue B. An endotracheal tube C. An airway D. A tracheostomy set

Answer D is correct. Laryngeal swelling is not uncommon in clients following a thyroidectomy. A tracheostomy tray should be kept available. The ventilator is not necessary, so answer A is incorrect. The endotracheal tube is very difficult, if not impossible, to intubate if swelling has already occurred, so answer B is incorrect. The airway will do no good because the swelling is in the trachea, so answer C is incorrect.

Which of the following would the nurse most expect to find in the patient with hypoparathyroidism? A) Hypertension and cramps in extremities B) Dysphagia and stiffness in hands or feet C) Positive Trousseau's sign and profuse sweating D) Increased Phosphorous levels and tremors

B. Dysphagia related to laryngeal spasms and stiffness or camping in extremities would be expected signs and symptoms of hypoparathyroidism. Hypertension, profuse sweating, and increased phosphorous levels would not be expected with this condition.

The nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which item in the diet?

Vegetables

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which health care provider's prescription noted on the record indicates the need for clarification?

Apply a loose dressing if any clear drainage is noted.

Which of the following symptoms is not typical of Cushing's syndrome? Answers: A. Osteoporosis B. Weight loss C. Diabetes D. Mood instability

B Cushing's syndrome tends to produce rapid weight gain, not weight loss.

A 26 year old female client presents with the symptom of unwanted facial hair. What of the following conditions is most likely? Answers: A. Graves' disease B. PCOS C. Hyperthyroidism D. Addison's disease

B PCOS is well known to cause hormonal irregularities in women which can result in hair growth.

13. 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 usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

Acromegaly is NOT the result of excess growth hormone secretion in children, IT IS IN ADULTS

In children, too much growth hormone causes gigantism, resulting in an abnormal increase in height and bone growth. Acromegaly occurs in adulthood.

14. All of the following organs may be affected by multiple endocrine neoplasia type 1 except: a. Parathyroid glands b. Kidneys c. Pancreas and Duodenum d. Pituitary gland

B: Kidneys Multiple endocrine neoplasia type 1, also known as Werner's syndrome, is a heritable disorder that causes tumors in endocrine glands and the duodenum. Although the tumors associated with multiple endocrine neoplasia type 1 are generally benign, they can produce symptoms chemically by releasing excessive amounts of hormones or mechanically by pressing on adjacent tissue.

11. The most common benign tumor of the pituitary gland is a: a. Glioma b Prolactinoma c. Carcinoid tumor d. Islet cell tumor

B: Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into the blood or mechanically by pressing on surrounding tissues. In women, symptoms may include menstrual irregularities and infertility; in men erectile dysfunction and libido may be impaired.

4. An ACTH stimulation test is commonly used to diagnose: a. Grave's disease b. Adrenal insufficiency and Addison's disease c. Cystic fibrosis d. Hashimoto's disease

B: The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic adrenal insufficiency or Addison's disease generally do not respond with the expected increase in cortisol levels. An abnormal ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.

A client presents with hypocalcemia, hyperphosphatemia, muscle cramps, and positive Trosseau's sign. What diagnosis does this support? Answers: A. Diabetes insipidus B. Conn's syndrome C. Hypoparathyroidism D. Acromegaly

C Hypoparathyroidism often leads to the symptoms mentioned. Conn's syndrome is an aldosterone-producing adenoma.

A nursing student is studying for a test on care of the client with endocrine disorders. Which of the following statements demonstrates an understanding of the difference between hyperthyroidism and hypothyroidism? a. "Deficient amounts of TH cause abnormalities in lipid metabolism, with decreased serum cholesterol and triglyceride levels." b. "Graves' disease is the most common cause of hypothyroidism." c. "Decreased renal blood flow and glomerular filtration rate reduces the kidney's ability to excrete water, which may cause hyponatremia." d. "Increased amounts of TH cause a decrease in cardiac output and peripheral blood flow."

C. "Decreased renal blood flow and glomerular filtration rate reduces the kidney's ability to excrete water, which may cause hyponatremia." Rationale: # 1 is incorrect because deficient amounts of TH cause abnormalities in lipid metabolism with elevated serum cholesterol and triglyceride levels. # 2 is incorrect because Graves' disease is the most common cause of hyperthyroidism, not hypothyroidism. # 4 is incorrect because increased amounts of TH cause an increase in cardiac output and peripheral blood flow.

2. Grave's disease is: a. The most common cause of hypothyroidism b. The most common cause of hyperparathyroidism c. The most common cause of hyperthyroidism d. The most common cause of adrenal insufficiency

C: Grave's disease is an autoimmune disorder characterized by an enlarged thyroid gland and overproduction of thyroid hormones producing symptoms of hyperthyroidism such as rapid heartbeat, heat intolerance, agitation or irritability, weight loss, and trouble sleeping. It usually presents in persons age 20 to 40 and it is much more common in women than in men.

15. What is the treatment for hyperparathyroidism? a. Synthetic thyroid hormone b. Desiccated thyroid hormone c. Surgical removal of the glands d. Calcium and phosphate

C: When hyperparathyroidism requires treatment, surgery is the treatment of choice and is considered curative for 95% of cases. Because untreated hyperparathyroidism may elevate blood and urine levels of calcium and deplete phosphorus, bones and teeth may lose the minerals needed to remain strong.

Clients should take levothyroxine (Synthroid)

Clients should take this medication in the morning with a full glass of water. Levothyroxine should be taken on an empty stomach, at least one hour before any other medications or vitamins.

trousseau sign is seen with

a carpal spasm occurs when the upper arm is compressed, as by a tourniquet or a blood pressure cuff.

pheochromocytoma symptoms are

headache, sweating, fast heartbeat, with markedly high blood pressure

5. All of the following are symptoms of Cushing's syndrome except: a. Severe fatigue and weakness b. Hypertension and elevated blood glucose c. A protruding hump between the shoulders d. Hair loss

D: Cushing's syndrome also may cause fragile, thin skin prone to bruises and stretch marks on the abdomen and thighs as well as excessive thirst and urination and mood changes such as depression and anxiety. Women who suffer from high levels of cortisol often have irregular menstrual cycles or amenorrhea and present with hair on their faces, necks, chests, abdomens, and thighs.

6. Which of the following conditions is caused by long-term exposure to high levels of cortisol? a. Addison's disease b. Crohn's disease c. Adrenal insufficiency d. Cushing's syndrome

D: Cushing's syndrome is a form of hypercortisolism. Risk factors for Cushing's syndrome are obesity, diabetes, and hypertension. Cushing's syndrome is most frequently diagnosed in persons ages 20 to 50 who have characteristic round faces, upper body obesity, large necks, and relatively thin limbs.

A nurse is reviewing discharge teaching with a client you has Cushing's syndrome. Which statement made by the client indicates that the instructions related to dietary management were understood

I can eat foods that contain potassium

A community health nurse visit a client at home. Prednisone 10 mg orally daily has been prescribed for a client and the nurse reinforces teaching for the client about the medication. What statement made by the client indicates that further teaching is necessary

I can take aspirin or my antihistamine if I need it

Hypopituitarism

a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones (ACTH, ADH, FSH, GH, LH, oxytocin, prolactin, TSH).

After receiving furosemide (Lasix) 40 mg slow intravenous push for chest pain related to shortness of breath and generalized edema, the client responds poorly. The client has no relief of the chest pain, shortness of breath, or edema and only minimal urine output (less than 40 mL of urine). The health care provider is notified, and after reviewing the chart, suspects the client has syndrome of inappropriate antidiuretic hormone (SIADH). Which findings would lead to this specific diagnosis? Refer to chart.

Minimal responsiveness to furosemide (Lasix) and small cell lung cancer

The nurse reviews a plan of care for a postoperative client following a thyroidectomy and notes that the client is at risk for breathing difficulty. Which nursing intervention should the nurse include in the plan of care?

Monitor neck circumference frequently.

The nurse is reviewing a plan of care for a client with Addison's disease. The nurse notes that the client is at risk for dehydration and suggests nursing interventions that will prevent this occurrence. Which nursing intervention is an appropriate component of the plan of care? Select all that apply.

Monitoring intake and output Monitoring for changes in mental status Encouraging fluid intake of at least 3000 mL/day

A client newly diagnosed with Addison's disease is giving a return explanation of teaching done by the primary nurse. Which of the following statements indicates that further teaching is necessary? a. "I need to increase how much I drink each day." b. "I need to weigh myself if I think I am losing or gaining weight." c. "I need to maintain a diet high in sodium and low in potassium." d. "I need to take my medications each day."

b. "I need to weigh myself if I think I am losing or gaining weight." The client is at risk for ineffective therapeutic regimen management. Clients with Addison's disease must learn to provide lifelong self-care that involves varied components: medications, diet, and recognizing and responding to stress. Changes in lifestyle are difficult to maintain permanently. The client needs to take the medications on a daily basis. The client needs to perform daily weights to monitor for signs of dehydration. The client needs to maintain a diet high in sodium and low in potassium, as well as maintain an increased fluid intake. # 2 is incorrect because daily weights need to be performed instead of weighing when a problem is suspected.

A client presents to the emergency room with a history of Graves' disease. The client reports having symptoms for a few days, but has not previously sought or received any additional treatment. The client also reports having had a cold a few days back. Which of the following interventions would be appropriate to implement for this client, based on the history and current symptoms? Select all that apply. a. Administer aspirin b. Replace intravenous fluids c. Induce shivering d. Relieve respiratory distress e. Administer a cooling blanket

b. Replace intravenous fluids c. Induce shivering d. Relieve respiratory distress e. Administer a cooling blanket Rationale: Thyroid storm (also called thyroid crisis) is an extreme state of hyperthyroidism that is rare today because of improved diagnosis and treatment methods (Porth, 2005). When it does occur, those affected are usually people with untreated hyperthyroidism (most often Graves' disease) and people with hyperthyroidism who have experienced a stressor, such as an infection, trauma. The rapid increase in metabolic rate that results from the excessive TH causes the manifestations of thyroid storm. The manifestations include hyperthermia, with body temperatures ranging from 102°F (39°C) to 106°F (41°C); tachycardia; systolic hypertension; and gastrointestinal symptoms (abdominal pain, vomiting, diarrhea). Agitation, restlessness, and tremors are common, progressing to confusion, psychosis, delirium, and seizures. The mortality rate is high. Rapid treatment of thyroid storm is essential to preserve life. Treatment includes cooling without aspirin (which increases free TH) or inducing shivering, replacing fluids, glucose, and electrolytes, relieving respiratory distress, stabilizing cardiovascular function, and reducing TH synthesis and secretion. #1 is incorrect because cooling happens without the use of aspirin. All of the other choices are correct.

function of aldosterone is to

helps maintain BP, help the kidney maintain the water/sodium balance and excrete potassium.

expected finding in patient with adrenal insufficiency

high calcium

in patients with pheochromocytoma there is a release of

high levels of epinephrine and norepinephrine

diet requirements for Addison's patient

high salt, carbs, and protein with low potassium

Which of the following nursing implications is most important in a client being medicated for Addison's disease? a. Administer oral forms of the drug with food to minimize its ulcerogenic effect. b. Monitor capillary blood glucose for hypoglycemia in the diabetic client. c. Instruct the client to never abruptly discontinue the medication. d. Teach the client to consume a diet that is high in potassium, low in sodium, and high in protein.

c. Instruct the client to never abruptly discontinue the medication. Rationale: The primary medical treatment of Addison's disease is replacement of corticosteroids and mineralcorticoids, accompanied by increased sodium in the diet. The client needs to know the importance of maintaining a diet high is sodium and low in potassium. Medications should never be discontinued abruptly because crisis can ensue. Oral forms of the drug are given with food in Cushing's disease.

A nurse is caring for a client with Addison's disease. Which of the following nursing considerations should be employed when caring for this client? a. avoid sodium in the clients diet b. monitor and protect skin integrity c. document the specific gravity of urine d. monitor increases in blood pressure

c. document the specific gravity of urine

Which of the following would be a nursing priority for a client just DX with Addison's disease? a. avioding unnecessary activity b. encouraging client to wear a med alert tag c. ensuring the client is adequatly hydrated d. explaining that the client will need life long hormone therapy

c. ensuring the client is adequatly hydrated

parathyroid gland regulates

calcium, phospherus and magnesium balance within blood and bone

thyroid storm can quickly cause

congestive heart failure and pulmonary edema

ACTH adrenocorticotropic hormone measures

corticol response to to ACTH

A Clinical Instructor is questioning a student nurse about disorders of the parathyroid glands. Which statement by the nursing student, would indicate the need for further teaching? a. "Hyperparathyroidism results in an increased release of calcium and phosphorus by bones, with resultant bone decalcification." b. "Hyperparathyroidism results in deposits in soft tissues and the formation of renal calculi." c. "Hypoparathyroidism results in impaired renal tubular regulation of calcium and phosphate." d. "Hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the pancreas."

d. "Hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the pancreas." Rationale: Choices 1, 2, and 3 are all correct statements. # 4 demonstrates a need for further teaching because hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the intestines, not the pancreas.

A nurse on a surgical floor is caring for a post-operative client who has just had a subtotal thyroidectomy. Which of the following assessments should be completed first on the client? a. Assess for signs of tetany by checking for Chvostek's and Trousseau's signs b. Assess dressing (if present) and the area under the client's neck and shoulders for drainage. c. Administer analgesic pain medications as ordered, and monitor their effectiveness. d. Assess respiratory rate, rhythm, depth, and effort.

d. Assess respiratory rate, rhythm, depth, and effort. Rationale: All of the above assessments have importance, but airway and breathing in a client should always be addressed first when prioritizing care. Assess for signs of latent tetany due to calcium deficiency, including tingling of toes, fingers, and lips; muscular twitches; positive Chvostek's and Trousseau's signs; and decreased serum calcium levels. However, tetany may occur in 1 to 7 days after thyroidectomy so # 1 is not the highest priority. Assessing for hemorrhage is always important, but the danger of hemorrhage is greatest in the first 12 to 24 hours after surgery, and as this client is immediately post operative it is not the main concern at this time. Pain medication is important but according to Maslow, pain is a psychosocial need to be addressed after a physiologic need.

A nurse is caring for a 60 yr old client affected with hypoparathyroidism. When checking the lab report, the nurse finds that the clients calcium level was very low. Which of the following vitamins regulates the calcium level in the body? a. A b. D c. E d. K

d. K

A client is admitted to the hospital with a medical DX of hyperthyroidism. When taking a history which information would be most significant? A. edema, intolerance to cold, lethargy b. peri-orbital edema, lethargy mask like face c. weight loss, intolerance to cold, muscle wasting d. weight loss, intolerance to heat, exophthalmos

d. weight loss, intolerance to heat, exophthalmos