Week 2
After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching? A. "I will not eat any fatty foods when I am collecting urine for this test." B. "To end the collection, I must empty my bladder and add this urine to the collection." C. "I need to keep the urine container cool in a separate refrigerator or cooler." D. "I won't save the first urine sample of the day."
A. "I will not eat any fatty foods when I am collecting urine for this test." Rationale: A need for further teaching is needed when the client says that he/she will not eat any fatty foods while collecting urine for a 24-hour urine test to evaluate a hormone level. Eating fatty foods does not interfere with collection or testing of the urine sample. The other statements indicate correct understanding of the client's actions for collection of an accurate 24-hour urine specimen.
A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction? Select all that apply. A. 15 lb weight gain B. Decreased libido C. Four sinus infections D. Frequent constipation E. Increased foot callus formation F. Occasional dripping of clear fluid from both breasts G. Severely sprained ankle from a volley ball injury
A. 15 lb weight gain B. Decreased libido F. Occasional dripping of clear fluid from both breasts Rationale: Several hormones secreted in excess can cause weight gain, although so can increased caloric intake and decreased energy output. However in this instance it is occurring along with other indicators of pituitary hyperfunction. Decreased libido is associated with increased prolactin production, as well as decreased gonadotropins. Galactorrhea (leaking of fluid from the breast) in a man is associated with excess prolactin. Increased sinus infections are not associated with changing pituitary hormone levels. Constipation could be associated with decreased thyroid stimulating hormone but not pituitary hyperfunction. Callus formation and a sprained ankle are physical responses not related to endocrine function.
Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) A. Bending at the waist B. Talking C. Deep breathing D. Coughing E. Wearing makeup F. Using dental floss
A. Bending at the waist D. Coughing Rationale: Coughing early after surgery both increases intracranial pressure (ICP) and also increases pressure in the incision area and may lead to a leak of cerebrospinal fluid. Bending at the waist also increases ICP.
Which action in the plan of care for a client who is hospitalized for pituitary function testing would be most appropriate for the nurse to delegate to an experienced assistive personnel (AP)? A. Checking the client's blood glucose levels every 4 hours B. Monitoring the client's response to the IV insulin given during a stimulation test C. Teaching the client about a hormone suppression test D. Assessing the client for symptoms of hypopituitarism
A. Checking the client's blood glucose levels every 4 hours Rationale: Monitoring blood glucose is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.
For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm? A. Chest pain B. Constipation C. Headache D. Increased sleepiness
A. Chest pain Rationale: Bromocriptine can cause serious cardiac dysrhythmias and coronary artery spasms.
Which action best exemplifies the expected outcome of appropriate negative feedback control over endocrine gland hormone secretion? A. Decreased secretion of glucagon when blood glucose approaches normal levels B. Increased secretion of parathyroid hormone in response to a calcium-containing intravenous infusion C. Increased secretion of thyroid stimulating hormone in response to long-term exogenous thyroid hormone replacement therapy D. Decreased secretion of cortisol in response to a pituitary tumor stimulating the increased secretion of adrenocorticotropic hormone
A. Decreased secretion of glucagon when blood glucose approaches normal levels. Rationale: A negative feedback mechanism signals an endocrine gland to secrete a hormone in response to a body change to cause a reaction that will result in actions to oppose the action of the initial condition change and restore homeostasis. Serum calcium levels determine when and to what degree parathyroid hormone PTH is released. PTH secretion decreases when serum calcium levels are high, and it increases when serum calcium levels are low. If thyroid hormone levels are high, as would be the case if a client was taking exogenous thyroid hormone replacement therapy, release of both thyrotropin-releasing hormone (TRH) and thyroid stimulating hormone TSH is inhibited. Adrenocorticotropic hormone (ACTH) triggers the release of cortisol from the adrenal cortex, not suppression of its release.
For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) A. Decreased urine output B. Hypotension C. Weigh gain of more than 2.2 lb (1 kg) in 24 hours D. Persistent headache E. Hyperglycemia F. Acute confusion
A. Decreased urine output C. Weight gain of more than 2.2lbs (1 kg) in 24 hours D. Persistent headache F. Acute confusion Rationale: Drug therapy for DI can cause a greatly increased kidney reabsorption of water and lead to life-threatening water toxicity. Indications of water toxicity are a relatively rapid onset of acute confusion, rapid weight gain, decreased urine output, persistent headache, and nausea and vomiting.
What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold? A. Ensuring the phlebotomist wears a facemask while in the client's room B. Asking the phlebotomist to delay the blood draw C. Monitoring the client closely for cold-like symptoms D. Placing a facemask on the client
A. Ensuring the phlebotomist wears a facemask while in the client's room Rationale: The nurse needs to make sure the phlebotomist wears a facemask because the client is immunosuppressed and at higher risk for respiratory infection. Anyone with a suspected upper respiratory infection who must enter the client's room needs to wear a mask to prevent the spread of infection.Asking the phlebotomist to delay the blood draw could lead to harm by not providing sufficient information about the client's condition. The phlebotomist, not the client, is exhibiting cold-like symptoms, so monitoring the client for these symptoms is not appropriate. Having the client wear a mask during the blood draw does not protect him or her from any airborne microorganisms that remain in the atmosphere of the room or droplets that may reside on surfaces.
Which assessment has the highest priority for the nurse to perform for a client with syndrome of inappropriate antidiuretic hormone (SIADH) receiving tolvaptan therapy for 24 hours? A. Evaluating serum sodium levels B. Evaluating serum potassium levels C. Examining the skin and sclera for jaundice D. Examining the IV site for indications of phlebitis
A. Evaluating serum sodium levels Rationale: Tolvaptan carries a black box warning of increased risk for developing hypernatremia within 12 to 24 hours that can lead to CNS demyelination and death. Serum potassium levels are not directly affected by this drug. Although the drug is associated with an increased risk for jaundice, this problem appears after 30 days of use. Tolvaptan is an oral drug, not a parenteral one.
Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? A. Increased facial hair and absent menses in a 28-year-old nonpregnant woman B. Increased appetite in a 40-year-old man who started an aerobic exercise program 1 week ago C. Male-pattern baldness in a 32-year-old man D. Dry skin on the shins of a 70-year-old woman
A. Increased facial hair and absent menses in a 28-year-old nonpregnant women. Rationale: Absence of menses when pregnancy is not present is considered abnormal, especially when accompanied by hirsutism. Possible endocrine problems associated with these changes include ovarian, adrenal gland, hypothalamic, or anterior pituitary dysfunction. Male-pattern baldness in a man is usually associated with a genetic predisposition. Dry skin is a normal finding in older women. An increased appetite when physical activity increases is also considered normal.
Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider? A. Serum sodium increases from 122 mEq/L to 140 mEq/L. B. Serum potassium decreases from 4.2 mEq/L to 3.8 mEq/L. C. Serum chloride decreases from 109 mEq/L to 99 mEq/L. D. Serum calcium increases from 9.5 mg/dL to 10.2 mg/dL.
A. Serum sodium increases from 122 mEq/L to 140 mEq/L. Rationale: The purpose of tolvaptan is to restore a normal sodium concentration to the blood and other extracellular fluid. In the case of syndrome of inappropriate antidiuretic hormone, excessive amounts of antidiuretic hormone have caused more water to be absorbed, causing the serum sodium to be diluted. When tolvaptan therapy brings the serum sodium level to normal levels, it must be discontinued to prevent hypernatremia. A serum sodium of 140 mEq/L is within the normal range.
Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? A. Urine output of 30 to 50 mL/hr B. Blood glucose level of 110 mg/dL (6.1 mmol/L) C. Respiratory rate of 20 breaths/min D. Potassium level of 3.9 mEq/L (mmol/L)
A. Urine output of 30 to 50 mL/hr Rationale: With DI, insufficient amounts of vasopressin (antidiuretic hormone [ADH]) prevent reabsorption of water, leading to profound diuresis that can result in dehydration. Desmopressin, a synthetic form of ADH, is the drug of choice to stop fluid loss.A blood glucose result of 110 mg/dL (6.1 mmol/L) is within the range of normal blood glucose levels, as are the respiratory rate and the potassium level.
Which of the following are the priority precautions the nurse will teach the client who remains at continuing risk for adrenal hypofunction and is taking hormone replacement therapy to prevent harm related to the disorder? Select all that apply. A. Avoid crowds and people who are ill B. Check your heart rate for irregular or skipped beats twice daily C. Do not choose low sodium versions of prepared foods D. Get up slowly from sitting or lying positions E. Keep a source of glucose, such as candy, with you at all times F. Never skip your hormone replacement drugs
Answers: A, B, C, D, E, F All precautions are a priority. The hormone replacement therapy reduces inflammation and Immunity, increasing the risk for infection. A pathologic problem with adrenal hypofunction and reduced aldosterone is increased serum potassium levels that cause cardiac dysrhythmias. Adrenal hypofunction causes low sodium levels, and the client needs to ensure an adequate intake of this mineral. The disorder is associated with hypotension and postural hypotension. Another common problem is hypoglycemia. The client should always have a concentrated oral glucose source on hand and eat it whenever symptoms of hypoglycemia are present. Skipping hormone replacement therapy increases the likelihood that serious and potentially life-threatening complications can occur quickly. Blood hormone levels need to be relatively constant.
Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? A. "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." B. "I will keep the cat food bowl on my counter so that I do not have to bend over." C. "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." D. "If the dressing gets wet, I will wash the incision line and redress it immediately."
B. "I will keep the cat food bowl on my counter so that I do not have to bend over." Rationale: After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waste and should not bear down, cough, or lay flat. Wearing dark glasses while outside is not necessary to prevent complications from the surgery.
What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid? A. "Corticosteroids are a type of hormone, and once you have been started on a replacement hormone, you must continue the hormone replacement therapy for the rest of your life." B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." C. "It is possible for your health problem to recur when corticosteroid therapy is halted suddenly." D. "The drug suppressed your immune system while you were taking it. Slowly decreasing the dose over time prevents your immune system from starting up too quickly and causing allergic reactions."
B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." Rationale: One of the most frequent causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of ACTH and adrenal production of cortisol. None of the other statements are completely accurate.
What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"? A. "You must learn to control your behavior. Because you are disturbing others, I am going to keep the door to your room closed and restrict your visitors." B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." C. "I will tell your primary health care provider order a psychiatric consult for you." D. "You are probably feeling this way because you are frightened about having a chronic disease. Would you like some information about a support group?"
B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." Rationale: Changes in blood cortisol levels can cause the client to show neurotic or psychotic behaviors. The client's need to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and more steady blood cortisol levels. Drug therapy to reduce these feelings and behaviors may be appropriate.
For which client will the nurse question the prescription for long-term androgen therapy? A. A 40 year old who also has syndrome of inappropriate antidiuretic hormone (SIADH). B. A 52 year old with a history of prostate cancer treatment. C. A 30 year old who is taking antiviral therapy for HIV disease. D. A 66 year old with impotence that is resistant to standard erectile dysfunction therapy.
B. A 52 year old with a history of prostate cancer treatment. Rationale: Androgen therapy can make any residual prostate cancer cells proliferate and cause a recurrence of the disease.
Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences? A. Prolactin and prolactin inhibiting hormone (PIH) B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) C. Growth hormone (GH) and melanocyte-stimulating hormone (MSH) D. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) Rationale: Deficiencies of (ACTH) or TSH are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands.
Which instruction/precaution does the nurse teach a client to prevent harm during a 24-hour urine specimen collection? A. Be sure to keep the specimen cool for the entire collection period. B. Avoid splashing urine in the container when a preservative is present. C. Add the preservative to the collection container before adding any urine. D. Discard the first specimen that marks the beginning of the 24-hour test period.
B. Avoid splashing urine in the container when a preservative is present. Rationale: All instructions/precautions are needed for correct collection of a 24-hour urine collection. The only precaution that will prevent harm is the one for avoiding the splashing of any urine in the container with the preservative.
Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? A. Urine output for the past 24 hours has increased. B. Client reports numbness and tingling around the mouth. C. Temperature is now elevated. D. pH is now 7.43.
B. Client reports numbness and tingling around the mouth. Rationale: Hyperaldosteronism causes potassium to be excreted excessively. As hypokalemia becomes more severe, paresthesias occur with numbness and tingling around the mouth and of the fingers and toes.
Which laboratory findings will the nurse use to validate the statement of a client with diabetes that therapy instructions for glucose control "have been followed to the letter" for the past 2 months? A. Random blood glucose level B. Glycosylated hemoglobin (HbA1c) C. Fasting blood insulin level D. Fasting blood glucose level
B. Glycosylated Hemoglobin (HbA1c) Rationale: The glycosylated hemoglobin (HbA1c) evaluates the average blood glucose level for 2 to 3 months; this is the best indicator of overall blood glucose control.
What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? A. Decreased sodium; decreased glucose B. Increased sodium; increased glucose C. Increased sodium; decreased glucose D. Decreased sodium; increased glucose
B. Increased sodium; increased glucose Rationale: Any of the glucocorticoids have some mineralocorticoid activity and increase the reabsorption of sodium from the kidney tubules, thus increasing the serum sodium level. Cortisol also increases liver production of glucose (gluconeogenesis) and inhibits peripheral glucose uptake by the cells. Both these actions increase blood glucose levels.
In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? A. High carbohydrate, low potassium, and fluid restriction B. Low carbohydrate, high calorie, and low sodium C. Low protein, high carbohydrate, and low calcium D. High protein, high carbohydrate, and low potassium
B. Low carbohydrate, high calorie, and low sodium Rationale: The client with Cushing disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and hypertension. Clients are encouraged to moderately restrict sodium intake.
Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocotisone that the client is responding positively to this drug therapy? A. Serum sodium 147 mEq/L (mmol/L); serum potassium 7.1 mEq/L (mmol/L) B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L) C. Serum sodium 127 mEq/L (mmol/L); serum potassium 2.8 mEq/L (mmol/L) D. Serum sodium 119 mEq/L ((mmol/L); serum potassium 6.2 mEq/L (mmol/L)
B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L) Rationale: With adrenal hypofunction reduced levels of cortisol and aldosterone decrease serum sodium levels below normal (hyponatremia) and increase serum potassium levels above normal (hyperkalemia). Adequate drug therapy with hormone replacement is expected to return these electrolytes back to their normal ranges (sodium = 135-145 mEq/L [mmol/L]; potassium = 3.5-5.0 mEq/L [mmol/L]). Response A indicates hypernatremia and hyperkalemia. Response C indicates hyponatremia and hypokalemia. Response D indicates severe hyponatremia and hyperkalemia.
Which assessment finding in a 40-year-old client is most relevant for the nurse to assess further for a possible endocrine problem? A. He has lost 10 lbs in the past month following a low carbohydrate eating plan. B. The client reports now only needed to shave once weekly instead of daily. C. His new prescription for eye glasses is for a higher strength. D. The client's father died of a stroke at age 70 years.
B. The client reports now only needing to shave once weekly instead of daily. Rationale: A change in degree of facial hair is could indicate an endocrine problem, particularly of the pathway for testicular function. An intentional weight loss of 10 lb over a month's time is within the normal range for gender and age. Although the need for a stronger prescription for eye glasses at this age could potentially be related to an endocrine problem, many other factors are more likely to be related to this problem. The same is true of his father's stroke.
What is the nurse's best first response when a client with a suspected endocrine disorder says, "I can't, you know, satisfy my wife anymore."? A. "Don't worry. It happens to everyone occasionally." B. "Do you use any over the counter or recreational drugs?" C. "Can you please tell me more?" D. "Would you like to speak with a counselor?"
C. "Can you please tell me more?" Rationale: An open-ended question such as, "Can you please tell me more?," is a best first response because it allows the nurse to explore the client's feelings more thoroughly. Clients with endocrine disorders may report issues with infertility, impotence, and changes in sexual function.
Which precaution is most important for the nurse to teach a female client to prevent harm while undergoing drug therapy with estrogen and progesterone for hypopituitarism? A. "Use a barrier method of contraception to prevent an unplanned pregnancy." B. "Wear a hat with a brim and use sunscreen when outdoors." C. "Do not smoke or use nicotine in any form." D. "Avoid drinking caffeinated beverages."
C. "Do not smoke or use nicotine in any form." Both estrogen therapy and progesterone therapy increase the risk for thromboembolism formation. This condition greatly increases the chance for strokes, heart attacks, and pulmonary embolism. Cigarette smoking and other forms of nicotine increase this risk. Pregnancy is unlikely to occur without further medical intervention. These hormones do not increase photosensitivity or the general risk for harm from ultraviolet radiation exposure. There are no recommendations for avoiding caffeine while taking these drugs.
Which changes in laboratory values will the nurse expect to see in a client who has tumor causing excess secretion of aldosterone? (Select all that apply.) A. Hypoglycemia B. Hyponatremia C. Hypokalemia D. Hypernatremia E. Hyperglycemia F. Hyperkalemia
C. Hypokalemia D. Hypernatremia Rationale: Aldosterone is the mineralocorticoid that maintains extracellular fluid volume and electrolyte composition. It promotes sodium and water reabsorption and potassium excretion in the kidney. Excessive amounts of this hormone result in hypernatremia and hypokalemia.
Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)? A. New-onset hypertension. B. The client reports extreme salt craving. C. No change in urine output with minimal fluid intake. D. The client's headache is gradually increasing in intensity.
C. No change in urine output with minimal fluid intake. Rationale: DI results from absent or insufficient secretion of antidiuretic hormone (ADH, vasopressin) from the posterior pituitary and can result from a head injury that damages this endocrine gland. With less or absent ADH, the client is unable to reabsorb water even when fluid intake is low. Although headache is usually present with a head injury, it is not associated with DI. The dehydration associated with DI would cause hypotension and an increased serum sodium concentration.
Which laboratory finding in a client with a possible pituitary disorder will the nurse report to the health care provider immediately? A. Blood glucose 148 mg/dL (7.4 mmol/L) B. Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) C. Serum sodium 110 mEq/L (110 mmol/L) D. Serum potassium 3.2 mEq/L (3.2 mmol/L)
C. Serum sodium 110 mEq/L (110 mmol/L) Rationale: The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L). A result of 110 mEq/L (110 mmol/L) represents severe hyponatremia, requiring immediate action to prevent increased intracranial pressure, seizures, and death as the intravascular fluid shifts into brain tissue. The most likely cause of the problem is an increased vasopressin level that is increasing water reabsorption and diluting the serum sodium level.
Which statement regarding trophic (tropic) hormones is true? A. All are categorized as catecholamines. B. Responses are independent of target tissue receptors. C. Their target tissues are always another endocrine gland. D. They represent the final hormone secreted in a complex negative feedback pathway.
C. Their target tissues are always another endocrine gland. Rationale: Trophic (tropic) hormones stimulate the secretion of other hormones from another endocrine gland. Just like any other hormone, a receptor is required for action (receptor can be on the receptor or somewhere else inside the responsive target tissue. Only epinephrine, norepinephrine, and dopamine are catecholamines. None of them are trophic hormones. Trophic hormones represent the initiating hormone or an intermediate hormone in a more complex negative feedback pathway, not the final hormone.
Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased
C. Urine output volume decreased; urine specific gravity increased Rationale: Diabetes insipidus (DI) occurs with reduced or absent secretion of vasopressin (ADH). As a result, water is excessively excreted, causing a decrease in blood volume and an increase in urine volume. Blood is concentration indicating dehydration and urine is very dilute, as measured by specific gravity, is very low. When interventions to counter act DI are effective, the adult increases water reabsorption so that urine output volume decreases at the same time that urine concentration increases, seen as an increased urine specific gravity.
A nurse caring for a client with Cushing's syndrome who must remain on continued corticosteroid therapy for another health problem will use which of the following actions to prevent harm? A. Urging the client to salt his or her food. B. Testing voided urine for the present of glucose. C. Using non-adhesive methods to secure an IV access. D. Ensuring that the prescribed corticosteroid drug is given on an empty stomach.
C. Using non-adhesive methods to secure an IV access. Rationale: The skin of a client on chronic corticosteroid therapy is thin, very fragile, and easily injured. The client also is a increased risk for infection and an open skin site increases that risk. Using nonadhesive methods to secure an IV access protects the skin from injury. Usually the client on a corticosteroid has problems with sodium retention and is on a salt-restricted diet. Urine testing for glucose not accurate and is no longer performed. Corticosteroids irritate the stomach lining and can cause GI bleeding for many reasons. They are recommended to be taken with food to prevent GI irritation.
Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess? A. "Do you think if I lost weight my sleep apnea would improve?" B. "Why do I feel thirsty all the time?" C. "How can I make my skin less itchy?" D. "Does everyone's feet get bigger during menopause?"
D. "Does everyone's feet get bigger during menopause?" Rationale: Growth hormone is secreted and is needed throughout the life span. When it is secreted in excess in adults, organs can enlarge and bones containing desmoid bone type increase in size, including the facial bones, hands, and feet.The other client questions are reasonable for a client with sleep apnea, hyperglycemia, and menopause to ask.
Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency? A. "Are you experiencing any pain during sexual intercourse?" B. Do you work with or have hobbies that involve exposure to chemicals?" C. "Have you gained or lost any weight recently?" D. "How often do you need to shave your face?"
D. "How often do you need to shave your face?" Rationale: A gonadotropin deficiency reduces the expression of secondary sexual characteristics and leads to decreased libido and fertility in both male and female clients. Male clients lose facial fair and need to shave less frequently. This change may be the first problem noticed by the client. A deficiency does not result in painful intercourse for men although it can in women from vaginal dryness.
A client preparing for surgery to remove a cortisol-secreting tumor from the adrenal gland asks the nurse whether the physical changes from the excessive cortisol will go away as a result of the surgery so she can look like herself again. What is the nurse's best response? A. "The surgery is to remove the tumor, not reconstructive surgery." B. "You will notice a great difference in your appearance starting within a week after surgery." C. "All the changes will resolve but may take a year or longer to completely disappear." D. "The fatty changes and and acne will resolve with time but the stretch marks only fade."
D. "The fatty changes and acne will resolve with time but the stretch marks only fade." Rationale: The good news is that the changes that are not related to tissue structure, such as the moon face, buffalo hump, weight gain, truncal obesity, and acne will resolve and go away but may take a year or longer to do so. Her muscles can become stronger and larger again as well. However, the stretch marks will only fade and become less noticeable. Although she did not ask about bone changes and osteoporosis, this may never completely resolve.
The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 42 year old with diabetes insipidus who has a dose of desmopressin due. B. A 35 year old with hyperaldosteronism who has a serum potassium of 3.0 mEq/L (3.0 mmol/L). C. A 50 year old with pituitary adenoma who is reporting a severe headache. D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).
D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L). Rationale: The nurse first attends to the client with adrenal insufficiency who has a blood glucose level of 36 mg/dL (2.0 mmol/L). The client's condition is considered a medical emergency and must be assessed and treated immediately.
For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? A. Dry lips and oral mucosa on examination B. Nasal drainage that tests negative for glucose C. Urine specific gravity of 1.016 D. Client report of a headache and stiff neck
D. Client report of a headache and stiff neck Rationale: Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. The finding requires the nurse to immediately notify the primary health care provider.Dry lips and mouth are not unusual after surgery. Nasal drainage that tests negative for glucose is normal, expected, and not significant. A urine specific gravity of 1.016 is within normal limits.
Which factor or condition does the nurse expect to result in an increase in a client's production of thyroid hormones (TH)? A. Getting 8 hours of sleep nightly B. Chronic constipation C. Protein-calorie malnutrition D. Cold environmental temperatures
D. Cold environmental temperatures Rationale: Cold and stress are two factors that cause the hypothalamus to secrete thyrotropin-releasing hormone (TRH), which then stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH) to increase production of the two major thyroid hormones.
Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production? A. Inspecting feet and legs for ulcers B. Planning for weight-bearing activities C. Stressing the important of fiber in the diet D. Encouraging fluids every 2 hours
D. Encouraging fluids every 2 hours Rationale: A decrease in ADH production in the older adult causes urine to be more dilute. In this instance, urine might not concentrate when fluid intake is low, allowing for excess water loss. Encouraging fluid intake every 2 hours, even during the night, is important to prevent dehydration.
Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? A. Administering an infusion of 150 mL hypertonic saline over the next 3 hours B. Drawing blood for hemoglobin and hematocrit levels C. Measuring serial weights at the same daily with the client wearing the same amount of clothing D. Inserting an indwelling catheter and monitoring urine output
D. Inserting an indwelling catheter and monitoring urine output Rationale: The first intervention the nurse performs is to administer an infusion of 150 mL hypertonic saline over 3 hours. When the serum sodium level is below 115 mEq/L (115 mmol/L), the client is at increased risk for seizures and coma.
Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands? A. 5-lb weight loss B. Dry, cracked lips C. Thinning pubic hair D. Skin darkening
D. Skin darkening Rationale: Clients whose adrenal insufficiency is caused by adrenal glands that cannot produce appropriate levels of adrenal hormones have overall skin darkening. When the problem is in the adrenal gland and not either the hypothalamus or pituitary, plasma ACTH and melanocyte-stimulating hormone (MSH) levels are elevated in response to the adrenal-hypothalamic-pituitary feedback system. (Both ACTH and MSH are made from the same prehormone molecule.) Anything that stimulates increased production of ACTH also leads to increased production of MSH. Elevated MSH levels result in areas of increased pigmentation. Skin darkening does not occur when adrenal insufficiency is caused by hypofunction of the hypothalamus or pituitary gland.
