Adult health - Endocrine Exam 2

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hoarseness 2. Hypocalcemia 3. Audible stridor 4. Edema at the surgical site

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

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

Answer: 1, 3 Rationale: The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

The nurse creates a plan of care for a client with a new diagnosis of Graves' disease. The nurse would include which intervention in the plan of care? 1. Keep the room temperature cool. 2. Place extra blankets on the client's bed. 3. Provide a diet low in calories and protein. 4. Encourage frequent ambulation and other physical activities.

Answer: Keep the room temperature cool Rationale:Graves' disease is a form of hyperthyroidism characterized by a hypermetabolic state, and the client benefits most from an environment that is physically and mentally restful. Therefore, the client is encouraged to rest. To compensate for the hypermetabolic state, the client needs a diet that is high in calories and protein. These clients experience heat intolerance and diaphoresis and require a cool environment.

The nurse would assess for which clinical manifestations in a client with hypothyroidism? 1. Goiter, diarrhea, and hoarseness 2. Anxiety, palpitations, and hair loss 3. Constipation, anemia, and periorbital edema 4. Fatigue, nausea, and a leg ulcer that will not heal

Constipation, anemia, and periorbital edema Rationale:Hypothyroidism symptoms include constipation, fatigue, anemia, periorbital edema, and possibly a goiter. Diarrhea and palpitations are not symptoms of hypothyroidism but can be associated with hyperthyroidism. A leg ulcer that will not heal is suggestive of diabetes or vascular disease.

The patient with an adrenal hyperplasia is returning from surgery after an adrenalectomy. What immediate postoperative complication would the nurse monitor the patient for? Vomiting Infection Thromboembolism Rapid blood pressure changes

Correct Answer: Rapid blood pressure changes Rationale: The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.

1 The nurse is creating a dietary plan for a client with primary hypothyroidism. The nurse would include which most appropriate food items in the plan? 1. Organ meat, carrots, and skim milk 2. Seafood, spinach, and cream cheese 3. Peanut butter, avocado, and red meat 4. Skim milk, apples, and whole-grain bread

Skim milk, apples, and whole-grain bread Rationale:Clients with hypothyroidism experience a slow metabolic rate. They should consume foods from all food groups, which will provide them with the necessary nutrients; however, they should be low in calories. The correct option is the only one in which all the food choices are low in calories.

The home care nurse visits an older client who has hyperparathyroidism with severe osteoporosis. The nurse identifies which client problem in the plan of care as the priority for this client? 1. Social isolation 2. Risk for loneliness 3. Susceptibility to injury 4. Possible low self-esteem due to deformities

Susceptibility to injury Rationale:The individual with hyperparathyroidism with severe osteoporosis is at risk for pathological fractures because of bone demineralization (option 3). Thus, home safety is a priority. No data in the question indicate that options 1, 2, and 4 are of concern.

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

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

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1. "I should consume less than 1 liter of fluid per day." 2. "I should use my treadmill or go for walks daily." 3. "I should follow a moderate-calcium, high-fiber diet." 4. "My alendronate helps keep calcium from coming out of my bones."

Answer: 1 Rationale: In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secretion. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorption (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to two liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical activity, particularly weight-bearing activity, minimizes bone resorption and helps protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Even though serum calcium is already high, clients should follow a moderate-calcium diet, because a low-calcium diet will surge PTH. Calcium causes constipation, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorption. In bone resorption, bone is broken down and calcium is deposited into the serum.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hoarseness 2. Hypocalcemia 3. Audible stridor 4. Edema at the surgical site

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

Adrenal gland function is best assessed using which method? 1. Palpation of the kidneys 2. Testing serum cortisol levels 3. Testing blood urea nitrogen (BUN) and creatinine levels 4. Checking urine output and testing for creatinine clearance levels

Testing serum cortisol levels Rationale:To determine whether the adrenal glands can respond to stress and are functioning appropriately, cortisol levels are evaluated. This test will not be valid if the client has taken corticosteroids recently. BUN and creatinine, urine output, and creatinine clearance are used to assess kidney function.

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

Answer: 1, 2, 4, 5 Rationale: Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

Answer: 3, 4, 5, 6 Rationale: Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism

The nurse is caring for a patient receiving high-dose oral corticosteroid therapy after a kidney transplant. Which side effect would the nurse monitor for as it presents the greatest risk? Infection Low blood pressure Increased urine output Decreased blood glucose

Correct Answer: Infection Rationale: Side effects of corticosteroid therapy include increased susceptibility to infection, edema related to sodium and water retention (decreasing urine output), hypertension, and hyperglycemia.

The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions would be included in the plan of care? (Select all that apply.) Obtain daily weights. Limit fluids to 1000 mL/day. Administer diuretics as ordered. Monitor for signs of hypernatremia. Minimize turning and range of motion. Elevate the head of the bed at 10 degrees or less.

Obtain daily weights. Limit fluids to 1000 mL/day. Administer diuretics as ordered. Elevate the head of the bed at 10 degrees or less. Rationale: The care for the patient with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

A nurse is caring for a client with thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse would assess for which sign or symptom? 1. Bradycardia 2. Constipation 3. Persistent sweating 4. Low-grade temperature

Persistent sweating Rationale:Thyroid storm is an acute, life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Clinical manifestations of thyroid storm include systolic hypertension, tachycardia, diarrhea, persistent sweating, and a fever as high as 106° F. Other manifestations include abdominal pain, dehydration, extreme vasodilation, stupor rapidly progressing to coma, atrial fibrillation, and cardiovascular collapse. Bradycardia, constipation, and low-grade temperature are not a part of the clinical picture in thyroid storm.

A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse about a brassy taste in the mouth when taking the medication. Which instruction would the nurse provide to the client? 1. Dilute the medication in 8 oz of water. 2. Report the symptom to the primary health care provider (PHCP). 3. Continue to take the medication because the symptom is normal. 4. Take one-half dose of the prescribed medication for the next 2 days.

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

A nurse is caring for a client after a thyroidectomy. Which specific emergency equipment would the nurse have available as it relates to this procedure? 1. Defibrillator 2. Tracheostomy tray 3. Dextrose 50% in water 4. Normal saline for intravenous bolus

Tracheostomy tray Rationale:After thyroidectomy, airway obstruction, although not common, can occur. This is considered an emergency situation. If this develops, emergency management needs to occur, and oxygen, suction equipment, and a tracheostomy tray need to be immediately available at the bedside. The other supplies are not necessary specifically for thyroidectomy.

Which statement indicates correct understanding of radioactive iodine treatment for hyperthyroidism? 1. "This treatment may help reduce exophthalmos." 2. "This treatment is safe to administer to lactating mothers." 3. "The client will notice remission of symptoms within 2 to 4 weeks." 4. "Clients over the age of 30 are acceptable candidates for this treatment."

"Clients over the age of 30 are acceptable candidates for this treatment." Rationale:Radioactive iodine may be an acceptable treatment of hyperthyroidism in clients who are over the age of 30 and are not pregnant or lactating. This treatment decreases overproduction of thyroid hormones; however, it will not improve associated signs such as exophthalmos. Total remission of symptoms occurs over several months.

A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client? 1. "Flush the toilet at least 3 times after use." 2. "Increase intake of fruits with a core, such as apples and pears." 3. "Avoid contact with pregnant women, infants, and children for 3 months." 4. "Use disposable eating utensils, plates, and cups for the next 6 months."

"Flush the toilet at least 3 times after use." Rationale:Bodily fluids contain the radioactive material, so others needs to be shielded from possible exposure. Clients would at best have a dedicated toilet for use during the first 2 weeks and need to also flush 3 times after use. Some radioactivity will be in the saliva for about the first week, so during this time fruits with cores that will become contaminated need to be avoided. Disposable eating utensils would also be used during this period of time. Contact with pregnant women, infants, and children is avoided for the first week and then a distance of 3 feet (1 meter) or more needs to be maintained, and exposure would be limited to 1 hour per day.

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

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

The nurse determines that the client needs further instruction about prescribed thyroid replacement medication if which statement is made? 1. "I would expect full therapeutic effect from the medication within 3 to 5 days." 2. "I need to take my medication in the morning about 1 hour before eating breakfast." 3. "I need to make sure that I store the medication in the dark container I received it in." 4. "I need to check with my primary health care provider before taking any over-the-counter medications."

"I need to take my medication in the morning about 1 hour before eating breakfast." Rationale:The client would be taught that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid medications, so expecting a full therapeutic effect in 3 to 5 days indicates a need for additional teaching. The medication needs to be taken in the morning to prevent insomnia at night and on an empty stomach. All thyroid tablets must be protected from light. The client taking thyroid medications needs to consult with the primary health care provider before taking any over-the-counter medications, and labels need to be read thoroughly.

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

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

The client presents with an appearance that causes the nurse to suspect Cushing's syndrome. What aspects of the client's appearance would suggest this syndrome? Select all that apply. 1. Moon face 2.Buffalo hump 3. Truncal obesity 4.Facial dermatitis 5. Thinner arms and legs 6. Pale and yellowish sclera

1. Moon face 2. Buffalo hump 3. Truncal obesity 5. Thinner arms and legs Rationale:The appearance of a client with Cushing's syndrome would be consistent with the following: moon face, buffalo hump, truncal obesity, and arms and legs that are thinner. There would not be any facial dermatitis, and the sclera would not be pale and yellowish. In addition, abdominal striae may also be present.

A primary health care provider has prescribed methimazole for a client with hyperthyroidism. The nurse would question the client about which of the following that is a contraindication to the use of this treatment? 1. Pregnancy 2. Renal failure 3. Prolonged QT interval 4. Adverse reaction to levothyroxine

1. Pregnancy Rationale:Methimazole is used to treat hyperthyroidism. Methimazole is considered first-line treatment; however, this medication cannot be used for clients who are in their first trimester of pregnancy, have had a previous adverse reaction to methimazole, or need rapid reduction of symptoms. Renal failure, prolonged QT interval, and adverse reaction to levothyroxine are not related to contraindications for methimazole.

The nurse would include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

3. A thyroid-releasing inhibitor will be prescribed. 4Encourage the client to consume a well-balanced diet. Rationale:The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the primary health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A nurse is reviewing the primary health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription would the nurse question and verify? 1. Acetaminophen 2. Docusate sodium 3. Morphine sulfate 4. Levothyroxine sodium

3. Morphine sulfate Rationale:Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin. The nurse contacts the primary health care provider (PHCP), anticipating that the PHCP will prescribe which medication? 1. A decreased dosage of warfarin 2. An increased dosage of warfarin 3. A decreased dosage of levothyroxine 4. An increased dosage of levothyroxine

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

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

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

A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

Answer: 1, 3 Rationale: In Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as acute adrenal insuf iciency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor. Addisonian crisis is a life-threatening emergency. One of the roles of endogenous cortisol is to enhance vascular tone and vascular response to the catecholamines epinephrine and norepinephrine. Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. The role of aldosterone in the body is to support the blood pressure by holding salt and water and excreting potassium. When there is insufficient aldosterone, salt and water are lost and potassium builds up; this leads to hypotension from decreased vascular volume, hyponatremia, and hyperkalemia. The remaining options are not associated with addisonian crisis.

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high-Fowler's. 5. Administer a vasopressin antagonist as prescribed.

Answer: 1, 3, 5 Rationale: Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed, and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored. To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 mL/hr 5. Clear drainage on nasal dripper pad

Answer: 2, 4, 5 Rationale: Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery, and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone, and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postoperative risk of meningitis. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no association with complications of sublingual transsphenoidal hypophysectomy.

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hr 2. A coagulation time of 5 minutes 3. A heart rate that is 90 beats per minute and irregular 4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)

Answer: 3 Rationale: Pheochromocytoma is a catecholamine-producing tumor usually found in the adrenal medulla, but extra-adrenal locations include the chest, bladder, abdomen, and brain; it is typically a benign tumor but can be malignant. Excessive amounts of epinephrine and norepinephrine are secreted. The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A coagulation time of 5 minutes is normal. A urinary output of 50 mL/hr is an adequate output. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L) is a normal finding

A nurse has just received report on four clients. Which client should the nurse see first? 1. A client who underwent a thyroidectomy and has new onset hoarseness. 2. A client who has Cushing syndrome who has been noted to have a blood sugar of 134 mg/ DL (7.4 mmol/L). 3. A client was in renal failure and laboratory report noting a creatinine of 3.2 mg/ DL (282.3 umol/ L 4. A client who has been diagnosed with ulcerative colitis and recently passed 100ML of loose bloody stool

Answer: A client who underwent a thyroidectomy and has new onset hoarseness. Rationale: new onset of hoarseness following a thyroidectomy may be a sign of tracheal edema and impending airway obstruction, and the nurse should evaluate this client first period the client would Cushing syndrome may have increased blood sugar associated with stress and hospitalization and will need further information to determine whether the blood sugar was obtained when the client was fasting. A client in renal failure would be expected to have an increase in creatinine, and the nurse can later follow up to compare this result with previous results. A client with ulcerative colitis will experience loose, bloody stools and needs to be continuously evaluated for months, but this is not the nurse's first priority

1. A client returns to the nursing unit from the recovery room after a parathyroidectomy. The nurse notes that the client is sleepy but arousable, has a blood pressure of 90/60 mm Hg, and has an apical pulse rate of 102 beats/min. What is the immediate nursing action? 1. Recheck the vital signs. 2. Try to keep the client awake. 3. Place the client in Trendelenburg's position. 4. Check the back of the dressing for bleeding.

Answer: Check the back of the dressing for bleeding. Rationale:A decrease in blood pressure and tachycardia could indicate postoperative bleeding. In a client who has had a parathyroidectomy, often bleeding cannot be observed on the front of the dressing because it trickles around the neck to the back. Therefore, it is important for the nurse to check the front, sides, and back of the dressing and the sheets underneath the neck. Although the nurse will monitor the client's vital signs and assess level of consciousness and document the findings, assessment of the cause for the low blood pressure and elevated pulse rate needs to be performed first. Placing the client in Trendelenburg's position (head is placed lower than the rest of the body) is not the best measure in a client after a parathyroidectomy because it can increase swelling in the neck area that may result in an obstructed airway. A modified Trendelenburg's position (head flat with legs elevated) may be necessary in this client if shock develops. There is no useful reason to keep the client awake.

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

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

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

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

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

Calcitonin Rationale:The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). This client is experiencing hypercalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. Calcium chloride and calcium gluconate are medications used for the treatment of tetany, which occurs from acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided.

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

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

The nurse receives a phone call from a patient taking cyclophosphamide for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that they have muscle cramps, weakness, and very little urine output. Which response by the nurse is best? "Start taking supplemental potassium, calcium, and magnesium." "Stop taking the medication now and call your health care provider." "These symptoms will decrease with continued use of the medication." "Increase your fluid intake to 3000 mL for 24 hours to improve your urine output."

Correct Answer: "Stop taking the medication now and call your health care provider." Rationale: Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL/day. A loop diuretic such as furosemide (Lasix) is used to promote diuresis, and supplements of potassium, calcium, and magnesium may be needed.

The nurse is teaching a patient with acromegaly from an unresectable benign pituitary tumor about octreotide therapy. The nurse would provide further teaching if the patient makes which statement? "The provider will infuse this medication through an IV." "I will inject the medication in the subcutaneous layer of the skin." "The medication should decrease the growth hormone production to normal." "I will have my growth hormone level measured every 2 weeks for several weeks."

Correct Answer: "The provider will infuse this medication through an IV." Rationale: Drug therapy is an option for patients whose tumors are not surgically resectable. The primary drug used is octreotide, a somatostatin analog. It reduces growth hormone (GH) levels to normal in many patients. Octreotide is given by subcutaneous injection three times a week. GH levels are measured every 2 weeks to K guide drug dosing, and then every 6 months until the desired response is obtained.

A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What would the nurse expect as the next step in determining a diagnosis for this patient? Administration of β-blocker medications Abdominal palpation to search for a tumor Administration of potassium-sparing diuretics A 24-hour urine collection for fractionated metanephrines

Correct Answer: A 24-hour urine collection for fractionated metanephrines Rationale: Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma, an α-adrenergic receptor blocker is used preoperatively to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed. Most likely they would be used for hyperaldosteronism, which is another cause of hypertension.

Which assessment finding would the nurse expect in a patient who has been taking oral prednisone several weeks and is experiencing sudden withdrawal? (Select all that apply.) BP 80/50 Heart rate 54 Glucose 63 mg/dL Sodium 148 mEq/L Potassium 6.3 mEq/L Temperature 101.1°F

Correct Answer: BP 80/50 Glucose 63 mg/dL Potassium 6.3 mEq/L Temperature 101.1°F Rationale: Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. During acute adrenal insufficiency, the patient exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies, including hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.

The nurse is caring for a patient recently started on levothyroxine for hypothyroidism. What information reported by the patient requires immediate action? Weight gain or weight loss Chest pain and palpitations Muscle weakness and fatigue Decreased appetite and constipation

Correct Answer: Chest pain and palpitations Rationale: Levothyroxine is used to treat hypothyroidism. With replacement, the patient can be overmedicated, causing hyperthyroidism. Any chest pain, heart palpitations, or heart rate greater than 100 beats/min experienced by a patient starting thyroid replacement should be reported immediately, and electrocardiography and serum cardiac enzyme tests should be performed.

What would be included in the plan of care for a patient with Cushing disease? Lab monitoring for hyperkalemia Vital sign monitoring for hypotension Counseling related to body image changes Diet consultation to determine low protein choices

Correct Answer: Counseling related to body image changes Rationale: Elevated corticosteroid levels can cause body changes, including truncal obesity, moon face, and hirsutism in women and gynecomastia in men. Counseling and support should be offered because of the changes in body image. Hypokalemia and hypertension are consistent with Cushing disease. Sodium restriction and potassium supplementation are indicated. High-protein choices are necessary to counteract catabolic processes and assist with wound healing.

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction about desmopressin acetate would be most appropriate? Expect to have some nasal irritation while using this drug. Monitor for symptoms of hypernatremia as a drug side effect. Report any decrease in urinary output to the health care provider. Drink at least 3000 mL of water per day while taking this medication.

Correct Answer: Expect to have some nasal irritation while using this drug. Rationale: Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention if they have severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing.

The nurse is caring for a patient after a parathyroidectomy. The nurse would prepare to administer IV calcium gluconate if the patient has which manifestations? Facial muscle spasms and laryngospasms Tingling in the hands and around the mouth Decreased muscle tone and muscle weakness Shortened QT interval on the electrocardiogram

Correct Answer: Facial muscle spasms and laryngospasms Rationale: Nursing care for a patient after a parathyroidectomy includes monitoring for a sudden decrease in serum calcium levels causing tetany, a condition of neuromuscular hyperexcitability. If tetany is severe (e.g., muscular spasms or laryngospasms develop), IV calcium gluconate should be administered. Mild tetany, characterized by unpleasant tingling of the hands and around the mouth, may be present but should decrease over time without treatment. Decreased muscle tone, muscle weakness, and shortened QT interval are manifestations of hyperparathyroidism.

The patient in the emergency department after a car accident is wearing medical identification listing Addison's disease. What would the nurse expect to be included in the care of this patient? Low-sodium diet Increased glucocorticoid replacement Limiting IV fluid replacement therapy Withholding mineralocorticoid replacemt

Correct Answer: Increased glucocorticoid replacement Rationale: The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's may need large volumes of IV fluid replacement and a high-sodium diet. Withholding mineralocorticoid replacement cannot be done for patients with Addison's disease.

The nurse is caring for a patient admitted with suspected hyperparathyroidism and hypercalcemia. Which assessment findings would the nurse expect? (Select all that apply.) Nausea and vomiting Neurologic irritability Lethargy and weakness Increasing urine output Hyperactive bowel sounds

Correct Answer: Nausea and vomiting Lethargy and weakness Increasing urine output Rationale: Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability and hyperactive bowel sounds do not occur with hypercalcemia.

What is a nursing priority when caring for a patient with hypothyroidism? Patient teaching related to levothyroxine Providing a dark, low-stimulation environment Closely monitoring the patient's intake and output Initiating precautions related to radioactive iodine therapy

Correct Answer: Patient teaching related to levothyroxine Rationale: A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to closely monitor intake and output. Low stimulation and radioactive iodine therapy are used to treat hyperthyroidism.

The provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments would the nurse prioritize when providing postoperative care for this patient? White blood cell levels and signs of infection Serum calcium levels and signs of hypocalcemia Hemoglobin, hematocrit, and red blood cell levels Level of consciousness and signs of acute delirium

Correct Answer: Serum calcium levels and signs of hypocalcemia Rationale: Loss of the parathyroid gland is associated with hypocalcemia. Whereas infection and anemia are not associated with loss of the parathyroid gland, cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.

A patient who smokes reports having significant stress and has some eye problems. On assessment, the nurse notes exophthalmos. What additional findings would the nurse assess for? Muscle weakness and slow movements Puffy face, decreased sweating, and dry hair Systolic hypertension and increased heart rate Decreased appetite, increased thirst, and pallor

Correct Answer: Systolic hypertension and increased heart rate Rationale: The manifestations are consistent with Graves' disease or hyperthyroidism. Systolic hypertension, increased heart rate, and increased thirst are associated with hyperthyroidism. Cigarette smoking places the patient at increased risk for Graves' disease. The inhaled cigarette toxins may absorb via the eye orbits, causing exophthalmos. A puffy face; decreased sweating; dry, coarse hair; muscle weakness and slow movements; decreased appetite; and pallor are all manifestations of hypothyroidism.

Which nursing action would be appropriate for a client who is newly diagnosed with Cushing syndrome? A. Monitor blood glucose levels daily. B. Increase intake of fluids high in potassium. C. Encourage adequate rest between activities. D. Offer the client a sodium-enriched menu.

Correct Answer: A Rationale:Cushing syndrome results from a hypersecretion of glucocorticoids in the adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus. Monitoring of serum glucose levels assesses for increased blood glucose levels so that treatment can begin early. A common finding in Cushing syndrome is generalized edema. Although potassium is needed, it is generally obtained from food intake, not by offering potassium-enhanced fluids. Fatigue is usually not an overwhelming factor in Cushing syndrome, so an emphasis on the need for rest is not indicated. A low-calorie, low-carbohydrate, low-sodium diet is not recommended.

In assessing a client diagnosed with primary aldosteronism, the nurse expects the laboratory test results to indicate a decreased serum level of which substance? A. Sodium B. Phosphate C. Potassium D. Glucose

Correct Answer: C Rationale:Clients with primary aldosteronism exhibit a profound decline in serum levels of potassium; hypokalemia; hypertension is the most prominent and universal sign. The serum sodium level is normal or elevated, depending on the amount of water resorbed with the sodium. Option B is influenced by parathyroid hormone (PTH). Option D is not affected by primary aldosteronism.

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

Decreased serum calcium level Rationale:Hypocalcemia may occur if the parathyroid glands are removed or damaged or if their blood supply is impaired during thyroid surgery, resulting in decreased parathyroid hormone (PTH) levels and leading to decreased serum calcium levels. Serum sodium, albumin, and glucose levels are not affected by thyroid surgery.

Which finding indicates to the nurse that vasopressin is effectively managing symptoms associated with diabetes insipidus? 1. Polydipsia 2. Hypotension 3. Decreased urine output 4. Increased serum osmolality

Decreased urine output Rationale:Vasopressin, a synthetic form of antidiuretic hormone, will result in retention of fluid and electrolytes, resulting in increased blood pressure, resolution of excessive thirst, and a decrease in serum osmolality as more fluid is available throughout the body. Urine output will decrease as a result of administration of vasopressin. Because of an increased circulating volume, blood pressure is expected to increase. Excessive thirst is a symptom of poorly controlled or untreated diabetes insipidus. With vasopressin administration, fluid is retained, and serum osmolality will decrease.

The client presents with these findings: constipation, polyuria, tachycardia, and serum osmolality of 325 mOsm/kg (325 mmol/kg) and urine specific gravity of 1.000. The nurse would be correct to suspect which disorder? 1. Diabetes insipidus 2. Hyperparathyroidism 3. Hyperglycemic-hyperosmolar state (HHS) 4. Syndrome of inappropriate antidiuretic hormone (SIADH)

Diabetes insipidus Rationale:Diabetes insipidus results in excessive loss of urine with low specific gravity and an increase in serum osmolality related to elevated concentration of sodium in blood. The client may present with polyuria and polydipsia, constipation, tachycardia, and hypotension. Urine specific gravity can be very high in clients with HHS secondary to dehydration. Hyperparathyroidism may result in polyuria and tachycardia; however, serum osmolality and urine specific gravity are generally unaffected. SIADH would result in a low serum osmolality and elevated urine specific gravity of greater than 1.005.

The nurse is monitoring a client with hyperparathyroidism for signs of hypercalcemia. The nurse would expect to note which finding if hypercalcemia is present? 1. Paresthesias 2.. Positive Chvostek's sign 3. Diminished bowel sounds 4. Hyperactive deep tendon reflexes

Diminished bowel sounds Rationale: Signs of hypercalcemia include decreased gastrointestinal motility, muscle weakness, diminished or absent deep tendon reflexes, increased urine output, and an increased heart rate and blood pressure. Options 1, 2, and 4 are signs of hypocalcemia.

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

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

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

Feeling cold Loss of body hair Persistent lethargy Puffiness of the face Rationale:Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

The nurse is caring for a client with Addison's disease. The client has just had surgery, and the nurse suspects that the client may be experiencing addisonian crisis. What manifestations may be present in a client with addisonian crisis? Select all that apply. 1. Fever 2. Shock 3. Lack of appetite 4. Severe hypertension 5. Generalized weakness 6. Irritability and confusion

Fever Shock Generalized weakness Irritability and confusion Rationale:In assessing the possibility of an addisonian crisis, the nurse would look for signs of shock, fever, generalized weakness, irritability, and confusion. The client also may exhibit tachycardia, dehydration, hyponatremia, hyperkalemia, or hypoglycemia. Severe hypertension and lack of appetite are not symptoms of an addisonian crisis.

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

Fever Nausea Tremors Confusion Rationale:Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

The client has excessive production and release of cortisol. Based on this information, the nurse would expect which manifestations to be present? 1. Pallor and interstitial edema 2. Hypotension and weight gain 3. Alopecia and hyperexcitability 4. Hyperglycemia and depression

Hyperglycemia and depression Rationale:Excessive production and release of cortisol results in Cushing's syndrome. Elevated levels of cortisol cause weight gain, round face (moon face), hirsutism, fatigue, depression, elevated blood glucose levels, and a dorsocervical fat pad (buffalo hump). Abnormal hair growth, not hair loss, is present with Cushing's syndrome. The client may have psychological changes that can range from depression to psychosis. Blood pressure will be elevated, not decreased. Pallor and interstitial edema are not signs associated with Cushing's syndrome.

The nurse is reviewing the health history and examination findings and notes that the client has exophthalmos and complains of double vision. These assessment findings indicate which systemic condition? 1. Septic shock 2. Hypertension 3. Fluid overload 4. Hyperthyroidism

Hyperthyroidism Rationale:Visual changes such as blurring or double vision and tiring of the eyes may be one of the earliest problems for a client with hyperthyroidism. Exophthalmos, or protruding eyes, is also seen with hyperthyroidism. These assessment findings are not characteristic of the other conditions listed.

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

Hypothyroidism Rationale:Propylthiouracil is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. Propylthiouracil is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia.

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

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

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1. Iodine 2. Calcium 3. Phosphorus 4. Magnesium

Iodine Rationale:Adequate dietary iodine is needed to produce T3 and T4. The other requirements for adequate T3 and T4 production are an intact thyroid gland and a functional hypothalamus-pituitary-thyroid feedback system. The remaining options are not responsible for the abnormal amounts of circulating T3 and T4.

The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifestations might the nurse expect to note on examination of this client? Select all that apply. 1. Irritability 2. Periorbital edema 3. Coarse, brittle hair 4. Slow or slurred speech 5. Abdominal distention 6. Soft, silky, thinning hair

Irritability Periorbital edema Coarse, brittle hair Slow or slurred speech Abdominal distention Soft, silky, thinning hair Rationale:The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. The client may exhibit skin manifestations, such as coarse, brittle hair; thick, brittle nails; coarse, scaly skin; delayed wound healing; periorbital edema; and face puffiness. Neuromuscular manifestations include lethargy, slow or slurred speech, and impaired memory. Gastrointestinal manifestations include complaints of constipation, weight gain, and abdominal distention. Irritability and soft, silky, thinning hair on the scalp are manifestations of hyperthyroidism.

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

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

A client with a recent history of total thyroidectomy has developed iatrogenic hypoparathyroidism. Which observed findings does the nurse determine are associated with the hypoparathyroidism? Select all that apply. 1. Laryngospasm 2. Nephrolithiasis 3. Muscle weakness 4. Positive Chvostek's sign 5. Positive Trousseau's sign

Laryngospasm Positive Chvostek's sign Positive Trousseau's sign Rationale:Hypoparathyroidism is an uncommon condition associated with inadequate circulating parathyroid hormone (PTH). It is characterized by hypocalcemia resulting from a lack of PTH to maintain serum calcium levels. The most common cause is iatrogenic; for example, accidental removal of the parathyroid gland during neck surgery. Signs and symptoms of hypocalcemia include laryngospasm and positive Chvostek's and Trousseau's signs. The remaining options are incorrect.

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

Maintain a patent airway. Rationale:Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen needs to be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

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

Monitor for neck swelling. Rationale:After thyroidectomy, the nurse needs to check the client's neck frequently to assess for the occurrence of postoperative edema; edema could lead to airway obstruction. The client would be placed in an upright position to facilitate air exchange and prevent edema at the surgical site. A pressure dressing is not placed on the operative site because it may restrict breathing. The nurse would monitor the dressing closely and would loosen the dressing if necessary. The nurse would assist the client with deep-breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision.

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

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

The nurse provides instructions to a client who is taking levothyroxine. The nurse would tell the client to take the medication in which way? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

On an empty stomach Rationale:Oral doses of levothyroxine need to be taken on an empty stomach to enhance absorption. Dosing would be done in the morning before breakfast.

Teaching of the normal effects of aging on the endocrine system would be based on which physiological problem that can occur? 1. Osteoporosis 2. Hypoglycemia 3. Hypertrophy of the thyroid gland 4. Elevated levels of triiodothyronine (T3) and thyroxine (T4)

Osteoporosis Rationale:Bone loss may occur as a result of the normal aging process. As the client ages, levels of T3 and T4 decrease, hyperglycemia may occur because of decreased insulin production, and the aging pancreas and thyroid gland may shrink in size.

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

Periorbital edema Rationale:Because cellular edema occurs in hypothyroidism, the client's appearance is changed. Nonpitting edema occurs, especially around the eyes and in the feet and hands. Flushed, warm skin; hyperactive bowel sounds; and tachycardia (heart rate >100 beats/min) are clinical manifestations of hyperthyroidism, which occurs as a result of excess thyroid hormone secretion, resulting in a hypermetabolic state.

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

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

Nursing management of the client with syndrome of inappropriate antidiuretic hormone (SIADH) includes which intervention? 1. Administration of potassium supplements 2. Insertion of a nasogastric tube for gastric suction 3. Restriction of fluid intake to 1000 mL or less per day 4. Elevation of the head of the bed to at least 45 degrees

Restriction of fluid intake to 1000 mL or less per day Rationale:In SIADH, the body produces an excess of antidiuretic hormone (ADH) causing the body to retain water. Restricting total intake will result in a gradual restoration of homeostasis with normal serum sodium levels, weight loss, and resolution of symptoms. Sodium, not potassium, would be required supplementation for SIADH. Insertion of a nasogastric tube will not improve SIADH. The head of the bed should be 10 degrees or lower to assist with venous return to the heart.

A client who has been taking iodine solution is admitted to the emergency department, and an iodine overdose is suspected. Gastric lavage is initiated to remove the iodine from the stomach. In addition to treatment with gastric lavage, the nurse anticipates that which medication will be administered? 1. Vitamin K 2. Acetylcysteine 3. Sodium thiosulfate 4. Calcium gluconate

Sodium thiosulfate Rationale:Iodine solution can cause iodine toxicity. Iodine is corrosive, and an overdose will injure the gastrointestinal tract. Symptoms include abdominal pain, vomiting, and diarrhea. Swelling of the glottis may result in asphyxiation. Treatment consists of gastric lavage to remove iodine from the stomach and administration of sodium thiosulfate to reduce iodine to iodide. Vitamin K is the antidote for warfarin. Acetylcysteine is the antidote for acetaminophen overdose. Calcium gluconate is used for acute hypocalcemia.

The nurse is preparing to care for a client recovering from a subtotal thyroidectomy. Which supplies would the nurse have readily accessible for the care of this client? Select all that apply. 1. Tourniquet 2. Suction supplies 3. Calcium gluconate 4. Prefilled syringe of 50% glucose 5. Tracheostomy tube insertion set

Suction supplies Calcium gluconate Tracheostomy tube insertion set Rationale:Although not common, airway obstruction after thyroid surgery is an emergency situation. Therefore, oxygen, suction equipment, calcium gluconate (to treat tetany if it occurs), and a tracheostomy tube insertion set need to be readily available in the client's room. These items will be needed to treat this emergency situation. Therefore, options 2, 3, and 5 are correct. There is no reason that a tourniquet needs to be readily available; 50% glucose is used to treat severe hypoglycemia.

The nurse is caring for a client who has pheochromocytoma. The nurse monitors for the major symptom of pheochromocytoma when the nurse implements which action? 1. Takes the client's weight 2. Takes the client's blood pressure 3. Tests the client's urine for occult blood 4. Palpates the client's skin for its temperature

Takes the client's blood pressure Rationale:Hypertension is the major symptom associated with pheochromocytoma. The blood pressure status is monitored by taking the client's blood pressure. Weight loss, glycosuria, and diaphoresis are clinical manifestations as well; however, hypertension is the major symptom. Hematuria is not associated with this disorder.

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse would suspect dysfunction of which endocrine gland? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex

Thyroid Rationale:The thyroid gland is responsible for a number of metabolic functions in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic function places a demand on the cardiovascular system for a higher cardiac output. A client with increased activity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-stimulating hormone. Antidiuretic hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

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

Tingling around the mouth Rationale:After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. Bradycardia, flaccid paralysis, and absence of Chvostek's sign are not signs of hypocalcemia.

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

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

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

Answer: 2 Rationale: Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding? 1. "It replaces thyroid hormone." 2. "It prevents iodine absorption." 3. "It increases thyroid hormone." 4. "It suppresses thyroid hormone."

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

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

Answer: 2 Rationale: After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if positive, this would indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated 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 has been admitted to the acute care unit with a diagnosis of thyroid storm. What is the priority nursing intervention? 1. Administer antipyretic medications, as prescribed. 2. Identify stressors that may have triggered the condition. 3. Begin a continuous infusion of normal saline 0.9% at keep vein open (KVO) rate. 4. Obtain a blood specimen to evaluate levels of thyroid-stimulating hormone (TSH), T3, and T4.

Administer antipyretic medications, as prescribed. Rationale:Manifestations of thyroid storm include severe tachycardia, heart failure, shock, hyperthermia, nausea, vomiting, and diarrhea. Although it is important to identify triggers that caused the illness and to monitor levels of T3 and T4, the priority is to stabilize the client, which includes reduction of temperature because this can be severely elevated (up to 105° F [40.6° C]) and potentially fatal. Nausea, vomiting, and diarrhea will require more aggressive fluid replacement than KVO.