Ch50 Clients with Endo Disorders
What is the most common cause of hyperaldosteronism? (1) Excessive sodium intake (2) Deficient potassium intake (3) A pituitary adenoma (4) An adrenal adenoma
An adrenal adenoma An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.
The preferred preparation for treating hypothyroidism includes which of the following? (1) Levothyroxine (Synthroid) (2) Propylthiouracil (PTU) (3) Methimazole (Tapazole) (4) Radioactive iodine
Levothyroxine (Synthroid) Synthetic levothyroxine (Synthroid or Levothroid) is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters (enlargements of the thyroid gland). Radioactive iodine is the most common form of treatment for Graves' disease in North America. Both PTU and Tapazole are used for hyperthyroidism.
Cardiac effects of hyperthyroidism include (1) decreased BP (2) bradycardia (3) decreased systolic BP (4) palpitations
Palpitations Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy (1) Magnesium (2) Calcium (3) Sodium (4) Potassium
Calcium Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? (1) "I will take my pain medications according to the schedule we developed" (2) I'll call my physician if I notice tingling around my lips" (3) "I'll schedule a follow-up visit with my physician as soon as I get home" (4) "I will increase my fluid and calcium intake"
"I will increase my fluid and calcium intake" The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with his physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? (1)A decrease in appetite (2) A decrease in blood pressure (3) A decrease in urine output (4) A decrease in blood glucose levels
A decrease in urine output Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? (1) Synthroid (2) Propylthiouracil (PTU) (3) Tapazole (4) Calcium gluconate
Calcium gluconate Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.
A nurse is planning care for a client in acute Addisonian crisis. Which nursing diagnosis should receive the highest priority? (1) Decreased cardiac output (2) risk for infection (3) imbalanced nutrition: less than body requirements (4) impaired physical mobility
Decreased cardiac output An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: (1) Thyroiditis (2) Hashimoto's thyroiditis (3) multinodular goiter (4) Graves Disease
Graves' Disease Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau's sign. What does the nurse observe to verify this finding? (1) (2) Hand flexing inward (3) (4)
Hand flexing inward The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward.
The health care provider has ordered a fluid deprivation test for a client suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? (1) Heart rate and BP (2) breath sounds and bowel sounds (3) Temp and O2 sat (4) color, warmth, movement, and sensation of exts
Heart rate and BP The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The client's condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, blood pressure and heart rate monitoring are priorities over the other listed assessments.
Which nursing diagnosis takes highest priority for a client with hyperthyroidism? (1) Imbalanced nutrition: Less than body requirements related to thyroid hormone excess (2)Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess (3) Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing (4) Disturbed body image related to weight gain and edema
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults? (1) Papillary carcinoma (2) Follicular carcinoma (3) Anaplastic carcinoma (4) Medullary carcinoma
Papillary carcinoma Papillary carcinoma accounts for about 70% of thyroid cancer cases in adults. Follicular carcinoma accounts for roughly 15%; anaplastic carcinoma, about 5%; and medullary carcinoma, about 5%.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? (1) Thyroidectomy (2) Decreased serum calcium level (3) Steroid use (4) Renal failure
Renal Failure Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client? (1) Head of the bed elevated 30 degrees and no pillows placed under the head (2) Supine, with a small roll supporting the neck (3) Semi-Fowler with the head supported on two pillows (4) Side-lying with one pillow under the head
Semi-Fowler with the head supported on two pillows When moving and turning the client, the nurse carefully supports the client's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler position, with the head elevated and supported by pillows.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? (1) Serum potassium level of 5.8 mEq/L (2) Blood glucose level of 90 mg/dl (3) Blood urea nitrogen (BUN) level of 12 mg/dl (4) Serum sodium level of 134 mEq/L
Serum potassium level of 5.8 mEq/L Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
A client experienced postpartum emboli that resulted in the cessation of all pituitary hormonal activity. Which assessment finding would indicate that the client has developed a rare disease due to the destruction of the pituitary gland? (1) bright red rash on trunk and arms (2) pale skin (3) dry, flaky skin (4) darkening of the skin
pale skin Simmonds' disease is a rare disorder caused by destruction of the pituitary gland followed by cessation of pituitary hormonal activity. The skin becomes pale due to a decrease in melanocyte-stimulating hormone (MSH), which is under the control of adrenocorticotropic hormone (ACTH).
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: (1) more than 10 beats/minute difference between the apical and radial pulse rates. (2)a wide, staggering gait. (3) dry, waxy swelling and abnormal mucin deposits in the skin. (4) protruding eyes and a fixed stare.
protruding eyes and a fixed stare. Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.
Patients with hyperthyroidism are characteristically: (1) apathetic and anorexic (2) emotionally stable (3) calm (4) sensitive to heat
sensitive to heat Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? (1) Tachycardia (2) leg cramps (3) blurred vision (4) dysuria
tachycardia Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? (1) Type 1 Diabetes mellitus (2) Deficient growth hormone (3) Hypothyroidism (4) Acromegaly
Acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? (1) Desmopressin (DDAVP) (2) Thiazide diuretics (3) Ibuprofen (4) Diabinese
Desmopressin (DDAVP) medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.
A client with a 20-year history of hypothyroidism who has not been compliant with taking thyroid replacement therapy is brought into the ED with a diagnosis of myxedema coma. What client symptoms are consistent with this life-threatening event? Select all that apply. (1) Hypoventilation (2) Hyperactivity (3) Hypotension (4) Tachycardia (5) Hypothermia
Hypothermia Hypoventilation Hypotension The client will experience signs of hypothermia, hypotension, and hypoventilation with myxedema. Clients with myxedema will have bradycardia, not tachycardia, and will have lethargy, not hyperactivity.
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? (1) Observe urine output (2) observe stool color (3) monitor vital signs every 4 hours (4) Monitor bowel patterns
Observe stool color The nurse should observe the color of each stool and test the stool for occult blood
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? (1) Infusing IV fluids rapidly as ordered (2) Restricting fluids (3)Administering glucose-containing I.V. fluids as ordered (4)Encouraging increased oral intake
Restricting Fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load
The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? (1) O2 sat of 96% (2) Temp of 102F (3) Heart rate of 62 (4) BP of 90/58mmHg
Temperature of 102ºF Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.
A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? (1) Weight gain, constipation, and lethargy (2)Exophthalmos, diarrhea, and cold intolerance (3)Weight loss, nervousness, and tachycardia (4)Diaphoresis, fever, and decreased sweating
Weight loss, nervousness, and tachycardia Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.
Which disorder results from excessive secretion of somatotropin (growth hormone)? (1) acromegaly (2) adrenogenital syndrome (3) dwarfism (4) cretinism
acromegaly The client with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism. Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.
A nurse is caring for client with thyroiditis who is recovering from surgery to remove the thyroid gland. The client is upset about having a bright red scar on the neck, though it is barely visible. What would be an appropriate suggestion? (1) Clothing that covers the neck (2) topical medicines to remove the scar (3) cosmetic surgery (4) skin graft
clothing that covers the neck The nurse may suggest that the client wear clothing that covers the neck. In time, the scar will become almost invisible.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: (1) flushed, warm, moist skin. (2) exophthalmos and conjunctival redness. (3) decreased body temperature and cold intolerance. (4) systolic murmur at the left sternal border.
decreased body temperature and cold intolerance Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: (1) cretinism (2) Hashimoto's Thyroiditis (3) thyroid storm (4) myxedema coma
myxedema coma. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? (1) E (2) D (3) B (4) C
D The actions of PTH are increased by the presence of vitamin D.
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? (1) "I will see my ophthalmologist for a check-up" (2) "I will avoid friends and family members who are sick" (3) "I may stop taking this medication when I feel better" (4) "I will eat lots of chicken and dairy products
"I may stop taking this medication when I feel better." The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.
A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? (1) A 38-year-old client with mitral valve prolapse in sinus rhythm who is newly diagnosed with diabetes (2) A 24-year-old client with unstable hyperthyroidism with sinus tachycardia (3) A 48-year-old client in sinus rhythm transferring from intensive care unit 3 days after coronary artery bypass grafting (CABG) (4) An 80-year-old client with sinus tachycardia who is confused and agitated 2 days after a prostatectomy
A 24-year-old client with unstable hyperthyroidism with sinus tachycardia The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station. The client who had a CABG is most likely to develop an arrhythmia on his third postoperative day. The unstable client with diabetes mellitus could experience hypoglycemia or hyperglycemia and requires frequent monitoring of blood glucose levels. The elderly male is confused and agitated. The nurse should assign these three clients to beds as close to the nurses' station as possible.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? (1) Administer an oral calcium supplement as ordered. (2) Administer IV calcium gluconate as ordered. (3) Start administering oxygen at 2 L/min via a cannula. (4) Administer a sedative as ordered.
Administer IV calcium gluconate as ordered When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
What should the nurse teach a client on corticosteroid therapy in order to reduce the client's risk of adrenal insufficiency? (1)Take up to 1 extra dose per day during times of stress (2) Take the medication late in the day to mimic the body's natural rhythms. (3)Always have enough medication on hand to avoid running out. (4)Skip up to 2 doses in cases of illness involving nausea.
Always have enough medication on hand to avoid running out. The client and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The client should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? (1) Shivering (2) Heart rate of 56-64 bpm (3) complaints of nausea (4) BP varying between 120/86 and 240/130 mmHg
Blood pressure varying between 120/86 and 240/130 mm Hg Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.
A nurse should perform which intervention for a client with Cushing's syndrome? (1) Suggest a high-carbohydrate, low-protein diet (2) Explain that the clients physcial changes are a result of excessive corticosteroids (3) offer clothing or bedding that cool and comfortable (4) explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather
Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test? (1) Ultrasound of the thyroid gland (2) Fine-needle biopsy of the thyroid gland (3) serum immunoassay for TSH (4) Free T4 analysis
Fine-needle biopsy of the thyroid gland Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.
Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply. (1) Hydrocortisone (2) Acetaminophen (3) Salicylates (4) methimazole (5) Iodine
Hydrocortisone Acetaminophen Methimazole Iodine Salicylates (i.e., aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? (1) Hypercalcemia (2) Hypophosphaturia (3) Hyperphosphatemia (4) Hypocalcemia
Hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hypophosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms? (1) hypopituitarism (2) panhyperpituitarism (3) hyperpituitarism (4) panhypopituitarism
Hyperpituitarism Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? (1) hyponatremia (2) hypocalcemia (3) hypermagnesmia (4)hyperkalemia
Hypocalcemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.
The home care nurse is conducting client teaching with a client on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when should the home care nurse instruct the client to take the corticosteroids? (1) At noon every day (2) In the morning between 7 AM and 8 AM (3) Prior to going to sleep at night (4) In the evening between 4 PM and 6 PM
In the morning between 7 AM and 8 AM In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.
The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? (1) Thyroxine (2) Calcitonin (3) Thyrotropin (4) Iodine
Iodine Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is: (1) Kidney stones. (2)Pathologic fractures. (3)Pancreatitis. (4) Peptic ulcer.
Kidney Stones Kidney stones occur in 55% of patients with primary hyperparathyroidism. They are caused by renal damage from the precipitation of calcium phosphate in the renal pelvis and parenchyma.
For a client with Graves' disease, which nursing intervention promotes comfort? (1) Maintaining room temperature in the low-normal range (2) Limiting intake of high-carbohydrate foods (3) Restricting intake of oral fluids (4) Placing extra blankets on the client's bed
Maintaining room temperature in the low-normal range Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.
A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client's care plan? Select all that apply. (1) Monitor for signs and symptoms of diarrhea. (2) Monitor gait, balance, and fatigue level with ambulation. (3) Monitor for fluid overload. (4) Encourage intake of dairy products, seafood, nuts, broccoli, and spinach.
Monitor for fluid overload. Monitor gait, balance, and fatigue level with ambulation. Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet. Reference:
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? (1) Thyroid storm (2) Exophthalmos (3) Tibial myxedema (4) Myxedema coma
Myxedema coma Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? (1) Pituitary Disorder (2) Parathyroid Disorder (3) Thyroid Disorder (4) Adrenal Disorder
Pituitary Disorder Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. (1) Neurologic Function (2) Liver Function Tests (3) Strict intake and Output (4) Urine and blood chemistry (5) signs of dehydration
Strict Intake and Output Neurologic function Urine and Blood Chemistry close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? (1) The moon face and acne will resolve when the medication is tapered off. (2) Those symptoms are not related to the corticosteroid therapy. (3) The symptoms are permanent side effects of the corticosteroid therapy. (4) The dose of the medication must be too high and should be lowered.
The moon face and acne will resolve when the medication is tapered off. Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).
When caring for a client with diabetes insipidus, the nurse expects to administer: (1) vasopressin. (2) 10% dextrose. (3) regular insulin. (4) furosemide.
Vasopressin Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: (1) Folic Acid (2) Vitamin D (3) Potassium (4) Iron
Vitamin D Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: (1) thick, coarse skin (2) weight gain in arms and legs (3) deposits of adipose tissue in the trunk and dorsocervical area (4) hypotension
deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with: (1) depression. (2) neuropathy (3) hyperthyroidism (4) hypoglycemia
depression Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
A nurse is caring for a client with Simmonds' disease. Which dietary modification would be most appropriate for this client? (1) three regular meals with frequent in-between meal snacks (2) three regular meals consisting of low-fat foods (3) Dietary modifications are not needed. (4) four to six small meals per day
four to six small meals per day Most clients with Simmonds' disease tolerate four to six small meals per day better than three regular meals.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What is the most reliable method of confirming the client's condition? (1) glucose tolerance test + GH measurement (2) skull radiography + glucose level (3) MRI + GH measurement (4) skull radiography alone
glucose tolerance test + GH measurement A glucose tolerance test in combination with a growth hormone measurement is the most reliable method of confirming acromegaly.
A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau's sign. What does the nurse observe to verify this finding? (1) hand flexing inward (2) moon face and buffalo hump (3) bulging forehead (4) cardiac dysrhythmia
hand flexing inward The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: (1) sodium and chloride abnormalities. (2) calcium and phosphorus abnormalities. (3) chloride and magnesium abnormalities. (4) sodium and potassium abnormalities.
sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.
