PREP U Chp 52
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: a. bradycardia. b. a blood pressure of 176/88 mm Hg. c. a blood glucose level of 130 mg/dl. d. a blood pressure of 130/70 mm Hg.
b
A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of: a. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. b. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. c. Decreased cardiac output related to hypotension secondary to Cushing's syndrome. d. Risk for imbalanced fluid volume related to excessive sodium loss.
a
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. a. Potassium b. Calcium c. Magnesium d. Sodium
b
Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? a. Observe urine output. b. Observe the color of stool. c. Monitor vital signs every 4 hours. d. Monitor bowel patterns.
b
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands?
4
Which of the following is a clinical manifestation of hypothyroidism?
A pulse rate below 60 beats/minute.
The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level?
A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.
Which diagnostic test is done to determine a suspected pituitary tumor? a. Radiography of the abdomen b. Radioimmunoassay c. Measuring blood hormone levels d. Computed tomography
Computed tomography scan
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing syndrome
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP)
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following?
Detecting evidence of hormone hypersecretion
A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress?
Glucocorticoids
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor?
Handle body fluids carefully.
A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease?
Helps the body adjust to stress
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland?
Oxytocin
Which glands regulate calcium and phosphorous metabolism?
Parathyroid
A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction?
Parathyroid gland
ADH is secreted by which gland?
Posterior pituitary
The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones?
Radioimmunoassay
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms?
The moon face and acne will resolve when the medication is tapered off.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism? a. Striae b. Buffalo hump c. Exophthalmos d. Tetany
c
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
calcium gluconate
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:
sodium and potassium abnormalities.
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions?
weight loss
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? a. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. b. Monitor laboratory values daily for elevated thyroid-stimulating hormone. c. Evaluate the quality of the client's voice postoperatively, noting any drastic changes. d. Observe for swelling of the neck, tracheal deviation, and severe pain.
d
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
Milk
The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? a. Potassium of 6.0 mEq/L b. A blood pressure reading of 135/90 mm Hg c. Glucose of 100 mg/dL d. Sodium of 140 mEq/L
a
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask?
"Has your shoe size increased recently?"
A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns?
"I'll stay here with you while the technician draws your blood."
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?
A decrease in urine output
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? a. Hyperthyroidism b. Diabetes insipidus (DI) c. Hypothyroidism d. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
a
Which of the following is the primary hormone for the long-term regulation of sodium balance?
Aldosterone
What is the most common cause of hyperaldosteronism?
An adrenal adenoma
What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply.
An elevated systolic blood pressure Muscular fatigability Weight loss.
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse
A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply.
Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage.
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?
Assess vital signs.
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder?
Blood pressure varying between 120/86 and 240/130 mm Hg
A patient is being evaluated for a diagnosis of pheochromocytoma. He is scheduled for epinephrine and norepinephrine laboratory tests. Which of the following plasma levels is a positive value that is diagnostic for pheochromocytoma?
Epinephrine @ 450 pg/mL
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does notinclude which of the following?
Hypotension
Which of the following clinical signs are associated with diabetes insipidus?
Hypotension
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?
Magnetic resonance imaging (MRI)
For a client with Graves' disease, which nursing intervention promotes comfort?
Maintaining room temperature in the low-normal range
A client has been hospitalized with myxedema. Which of the following actions will the nurse take to care for this client?
Measure the client's arterial blood gases Monitor the client's oxygen saturation levels Turn and reposition the client at regular intervals Give fluids to the client with caution
A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?
Potassium chloride
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client?
Propylthiouracil
A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply.
Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. Examine extremities for pitting edema. Administer prescribed diuretics. Monitor weight.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?
Serum potassium level of 5.8 mEq/L
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see?
Serum potassium level of 6.8 mEq/L
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?
Sympathetic
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
Tachycardia
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands?
The secretions are released directly into the blood stream.
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client? a. Hydrochlorothiazide b. Furosemide c. Bumetanide d. Metolazone
a
Which of the following hormones would the nurse identify as being secreted by the thyroid gland? a. Thymosin b. Somatotropin c. Parathormone d. Thyroxine
d
A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for?
diabetes insidious
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:
encouraging fluid
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism?
hand flexing inward
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone?
increase serum calcium level
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
restricting fluids
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering:
Vasopressin
Which hormone is secreted by the posterior pituitary?
Vasopressin
A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? a. metabolic rate b. fluid/electrolyte balance c. sleep/wake cycles d. growth
a
A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? a. Hysteroscopy b. Hypophysectomy c. Thyroidectomy d. Ablation
b
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?
Adrenal Cortex
A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? a. Periorbital swelling b. Exophthalmos c. Bulging eyes d. Retinal detachment
b
Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?
Bulging forehead
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output
A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following?
Dysfunction of the thyroid gland itself
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply.
Hypothermia Hypoventilation Hypotension
The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. Which of the following best identifies the location of this gland?
In the upper part of the chest above or near the heart
One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is:
Kidney stones.
Cardiac effects of hyperthyroidism include
Palpitations
Vision and visual fields are altered in disorders of which of the following endocrine glands?
Pituitary
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following?
Positive Chvosteks sign
A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? a. "It is the gland that is responsible for regulating the hypothalamus." b. "It regulates the function of other endocrine glands." c. "It regulates metabolism." d. "The gland does not have any other function other than to cause secretion of the growth hormones."
b
A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? a. Syndrome of inappropriate antidiuretic hormone (SIADH) b. Myxedema coma c. Thyroid storm d. Diabetes insipidus
b
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: a. thick, coarse skin. b. hypotension. c. deposits of adipose tissue in the trunk and dorsocervical area. d. weight gain in arms and legs.
c
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? a. brain b. cardiac atria c. kidneys d. liver
c
What dietary modifications should be recommended to a client with hyperthyroidism? a. Restrict calorie intake. b. Increase calorie intake by 70%. c. Consume a high-protein diet. d. Limit intake of nutritionally dense foods such as milk products, eggs, and cheese.
c
A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? a. Melatonin b. Parathormone c. Calcitonin d. Insulin
d
A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? a. Retinal detachment b. Corneal abrasions c. Glaucoma d. Pressure on the optic nerve
d
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: a. multinodular goiter. b. thyroiditis. c. Hashimoto's thyroiditis. d. Graves' disease.
d
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? a. hormonal underproduction b. hormonal overproduction c. increase in hormonal levels d. decrease in hormonal levels
d
A client with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of:
hyponatremia and hyperkalemia.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? a. "Maintain a moderate exercise program." b. "Lose weight." c. "Jog at least 2 miles per day." d. "Rest as much as possible."
a
A postpartum client is receiving intravenous oxytocin (Pitocin) after birth. Why will this medication be used for this client after the birth of her child? a. Stimulates the contraction of the uterus and prevents bleeding b. Decreases the postpartum cramping c. Will prevent lactation for a woman who is bottle feeding her newborn d. Helps treat nausea
a
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? a. "I'll call my physician if I notice tingling around my lips." b. "I'll schedule a follow-up visit with my physician as soon as I get home." c. "I will take my pain medications according to the schedule we developed." d. "I will increase my fluid and calcium intake."
d
Parathyroid hormone (PTH) has which effects on the kidney? a. Increased absorption of vitamin D and excretion of vitamin E b. Increased absorption of vitamin E and excretion of vitamin D c. Stimulation of calcium reabsorption and phosphate excretion d. Stimulation of phosphate reabsorption and calcium excretion
d
The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? a. Dwarfism b. Simmonds' disease c. Acromegaly d. Gigantism
d
Which intervention is the most critical for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Warming the client with a warming blanket c. Measuring and recording accurate intake and output d. Maintaining a patent airway
d
Which of the following is considered a late symptom of hypothyroidism? a. Physical sluggishness b. Brittle nails c. Loss of libido d. Cold intolerance
d
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences:
heat intolerance and systolic hypertension.
The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:
hypocalcemia
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer?
observe stool color
A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer:
phentolamine (Regitine)
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
phosphorus
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder?
pituitary disorder
A nurse should expect a client with hypothyroidism to report:
puffiness of the face and hands.
