Chapter 44 Pituitary, Thyroid, and Adrenal

Which should the nurse anticipate will be included in a client's treatment plan to limit the incidence of serious adverse effects when prescribing corticosteroids? 1. Administer steroids every other day 2. Administer small doses over a period of several weeks 3. Administer oral doses of the prescription whenever possible 4. Administer large doses for acute conditions then discontinue the prescription

Answer: 1 Explanation: 1. Administer corticosteroids every other day (alternate-day dosing) to limit adrenal atrophy. 2. Doses should be kept to the lowest amount possible that will achieve a therapeutic effect and prescribed for the amount of time necessary. 3. Oral doses of corticosteroids have the highest risk for systemic effects. For acute conditions administer large doses for a few days and then gradually decrease the drug until it is discontinued.

Which symptom should the nurse monitor the client for that is diagnosed with diabetes insipidus? 1. Increased dilute urine output 2. Hyperglycemia 3. Hyponatremia 4. Fluid retention

Answer: 1 Explanation: 1. Diabetes insipidus results from decreased ADH (antidiuretic hormone) production, so the client will have increased urine output. 2. Hyperglycemia is not an effect of diabetes insipidus. 3. Hypernatremia results from the volume of fluid that is lost. 4. The client will have increased urine output and fluid volume depletion.

Which food selection should the client with hyperthyroidism be instructed to avoid? 1. Soy sauce 2. Dairy products 3. High-calorie foods 4. Caffeine-free soda

Answer: 1 Explanation: 1. Foods high in iodine, such as soy sauce, can affect the effectiveness of medication therapy for clients who are diagnosed with hyperthyroidism. 2. Milk products should be included in the diet for the client with hyperthyroidism because they are high in protein and calcium. 3. High-calorie foods are important for clients with hyperthyroidism in order to meet metabolic demands. 4. There is no reason to restrict caffeine-free soda.

Which electrolyte disturbance should the nurse assess a client for that is receiving hydrocortisone therapy? 1. Hypernatremia and hyperglycemia 2. Hypernatremia and hyperkalemia 3. Hypercalcemia and hyperkalemia 4. Hypoglycemia and hyponatremia

Answer: 1 Explanation: 1. Hydrocortisone may increase serum values for sodium and glucose. Hypernatremia and hyperglycemia occur due to the aldosterone effects (mineralocorticoid activity) which cause sodium and fluid retention and elevations of blood glucose due to promotion of gluconeogenesis. 2. Hypernatremia and hypokalemia can occur. 3. Hypercalcemia and hypokalemia can occur. 4. Hypoglycemia and hyponatremia does not occur.

Which result from the diagnostic testing with cosyntropin (Cortrosyn) for adrenocortical insufficiency indicates secondary adrenocortical insufficiency has occurred? 1. The client's plasma level of cortisol rises following the injection. 2. The client has carpal spasms following injection. 3. The client's urine cortisol fails to rise following the injection. 4. The client experiences flushing following the injection

Answer: 1 Explanation: 1. If the adrenal gland responds by secreting corticosteroids after the cosyntropin injection, the pathology lies at the level of the pituitary or hypothalamus (secondary adrenocortical insufficiency). 2. Carpal spasms are not related to this test. 3. The test involves plasma levels of cortisol. 4. Flushing is not associated with the test.

The nurse is reviewing the records of a child being treated for a short stature. Which prescription should the nurse anticipate the child is receiving? 1. Somatotropin (Accretropin) 2. Pegmisovant (Somavert) 3. Octreotide (Sandostatin) Bromocriptine (Cycloset

Answer: 1 Explanation: 1. Somatotropin is used to treat short stature by stimulating growth. 2. Pegmisovant is used to treat acromegaly. 3. Octreotide is a synthetic GH antagonist used to treat acromegaly. Bromocriptine is used to treat acromegaly

The nurse has provided education for a client prescribed glucocorticoid therapy. Which statement made by the client indicates further teaching is required? 1. "I can take the medication at any time as long as I don't forget it." 2. "I will monitor my blood sugar on a regular basis." 3. "I will eat a diet that is high in protein." 4. "I should take my medication after I have eaten."

Answer: 1 Explanation: 1. The medication must be taken at the same time of day to maintain serum levels. 2. It is important for the client to monitor blood glucose levels with glucocorticoid medications. 3. A high-protein diet is necessary with glucocorticoid medications. Glucocorticoid medications should be taken after eating.

For which condition does vasopressin (Vasostrict) treat? 1. Diabetes insipidus 2. Dehydration 3. Electrolyte imbalances 4. Diabetes mellitus

Answer: 1 Explanation: 1. Vasopressin (Vasostrict) is a synthetic drug with a structure identical to that of human ADH used for the treatment of diabetes insipidus. 2. Vasopressin is not used to treat dehydration. 3. Vasopressin is not used to treat electrolyte imbalances. Vasopressin is not used to treat diabetes mellitus

Which information should the nurse include in the teaching for the client prescribed long-term corticosteroid therapy? (Select All That Apply) 1. Avoid carbonated beverages. 2. Participate in regular weight-bearing exercises. 3. Avoid taking calcium supplements. 4. Take your prescription with food or milk. 5. Avoid caffeine in the diet.

Answer: 1, 2 Explanation: 1. The client on long-term corticosteroid therapy is at risk for osteoporosis and should avoid carbonated beverages. 2. Regular weight-bearing exercises help to strengthen the bones. 3. The client should have a sufficient calcium intake, either from foods or from supplements. 4. The client should take their prescription with food or milk to avoid GI upset. 5. There is no reason to avoid caffeine in the diet.

Which assessment findings are associated with Cushing's disease? (Select All That Apply) 1. Acne 2. Osteoporosis 3. Confusion 4. Delayed wound healing 5.Lethargy

Answer: 1, 2, 4 Explanation: 1. Acne, osteoporosis, and delayed wound healing are symptoms associated with Cushing's disease. 2. Acne, osteoporosis, and delayed wound healing are symptoms associated with Cushing's disease. 3. Confusion and lethargy are associated with Addison's disease. 4. Acne, osteoporosis, and delayed wound healing are symptoms associated with Cushing's disease. Confusion and lethargy are associated with Addison's disease

1) The nursing instructor teaches the student nurses about the endocrine system. The nursing instructor evaluates that learning has occurred when the student nurses make which statements?(Select All That Apply) 1. "The hypothalamus secretes releasing hormones." 2. "Hormones released by the endocrine system influence every organ in the body." 3. "The hypothalamus is considered the master gland." 4. "The pituitary gland secretes TSH (thyroid-stimulating hormone)." 5. "The endocrine system is a major controller of homeostasis."

Answer: 1, 2, 4, 5 Explanation: 1. The hypothalamus secretes releasing hormones. 2. Hormones released by the endocrine system influence every organ in the body. 3. The pituitary, not the hypothalamus, is often called the master gland; however, the pituitary and hypothalamus are best visualized as an integrated unit. 4. The pituitary gland secretes TSH (thyroid-stimulating hormone). The endocrine system is a major controller of homeostasis.

Which information should the nurse include in the education for a client who has been prescribed levothyroxine (Levothroid)? (Select All That Apply) 1. "It may take a few weeks for you to see the full benefits from this drug." 2. "Be sure to keep all of your follow-up appointments." 3. "Take this medication at whatever time you eat your evening meal." 4. "Do not start a fiber laxative without first discussing it with your healthcare team." 5."Take your calcium supplement at least 4 hours after taking this drug.

Answer: 1, 2, 4, 5 Explanation: 1. When given orally, it may take up to 3 weeks for the full effect of the drug to be realized. 2. Serum TSH levels will be drawn frequently as the client begins this therapy and to monitor its effectiveness as therapy continues. 3. The medication should be taken at the same time every day, not at variable meal times. It should be taken in the morning to decrease insomnia. 4. Dietary fiber may bind to and decrease the absorption of levothyroxine. Calcium and iron supplements should be taken at least 4 hours after taking levothyroxine to prevent interference with drug absorption.

Which should the nurse instruct a client to report that has been prescribed methimazole (Tapazole)? (Select All That Apply) 1. Unexplained bruising 2. Anxiety 3. Decrease sense of taste 4. Weight loss 5. Intolerance to cold

Answer: 1, 3, 5 Explanation: 1. Adverse effects of methimazole include thrombocytopenia. 2. Methimazole is prescribed to treat hyperthyroidism. Anxiety is a symptom of hyperthyroidism and is expected. 3. An overdose of methimazole will cause signs of hypothyroidism. A decreased sense of taste is associated with hypothyroidism. 4. Methimazole is prescribed to treat hyperthyroidism. Weight loss is a symptom of hyperthyroidism and is expected. An overdose of methimazole will cause signs of hypothyroidism. Intolerance to cold is a severe symptom of hypothyroidism

Which assessment finding should the nurse recognize is an adverse CNS effect of mitotane (Lysodren)? (Select All That Apply) 1. Confusion 2. Tinnitus 3. Lethargy 4. Increasing depression 5. Dizziness

Answer: 1, 4, 5 Explanation: 1. Confusion is not an adverse effect associated with the use of mitotane. 2. Tinnitus is not an adverse effect associated with the use of mitotane. 3. CNS adverse effects include dizziness, depression, and lethargy. 4. CNS adverse effects include dizziness, depression, and lethargy. CNS adverse effects include dizziness, depression, and lethargy

A client with Addison's disease is experiencing nausea, vomiting, and confusion. Which priority intervention should the nurse anticipate to be included in the plan of care? 1. Placement of a nasogastric tube 2. Administration of intravenous hydrocortisone 3. Administration of intravenous diuretic 4. Immediate endotracheal intubation

Answer: 2 Explanation: 1. A nasogastric tube may be necessary but is not the priority. 2. Acute adrenal insufficiency requires immediate treatment with intravenous hydrocortisone. 3. A diuretic may or may not be necessary but is not the priority. 4. Intubation may or may not be necessary but is not the priority.

Which finding is a sign or symptom of hypothyroidism? 1. Anxiety 2. Bradycardia 3. Tachycardia 4. Weight loss

Answer: 2 Explanation: 1. Anxiety is a symptom of hyperthyroidism. 2. Bradycardia can be a more severe symptom of hypothyroidism. 3. Tachycardia is symptom of hyperthyroidism. 4. Weight loss is a sign of hyperthyroidism.

Which should the nurse monitor a client for who has been on long-term steroid therapy? 1. Acute closed angle glaucoma 2. Muscle wasting 3. Ulcerative colitis 4. Weight loss

Answer: 2 Explanation: 1. Open-angle glaucoma is associated with long-term steroid therapy. 2. Myopathy is associated with long-term steroid therapy which is characterized by muscle wasting. 3. Peptic ulcers are associated with long-term steroid therapy. 4. Weight gain is most likely to occur with long-term steroid therapy.

Which is the initial step of the negative feedback regulation that results in the suppression of secretion of TSH and TRH thyroid hormone? 1. Blood levels of thyroid hormone rise. 2. Hypothalamus secretes thyroid-releasing hormone (TRH). 3. T3 and T4 are secreted. 4. The anterior pituitary secretes thyroid-stimulating hormone (TSH).

Answer: 2 Explanation: 1. When the blood level of thyroid hormone is low, the hypothalamus secretes thyroid-releasing hormone, which stimulates the anterior pituitary to secrete thyroid-stimulating hormone. This stimulates production and secretion of T3 and T4. As the levels of thyroid hormones rise, the secretion of TSH and TRH is suppressed. 2. When the blood level of thyroid hormone is low, the hypothalamus secretes thyroid-releasing hormone, which stimulates the anterior pituitary to secrete thyroid-stimulating hormone. This stimulates production and secretion of T3 and T4. As the levels of thyroid hormones rise, the secretion of TSH and TRH is suppressed. 3. When the blood level of thyroid hormone is low, the hypothalamus secretes thyroid-releasing hormone, which stimulates the anterior pituitary to secrete thyroid-stimulating hormone. This stimulates production and secretion of T3 and T4. As the levels of thyroid hormones rise, the secretion of TSH and TRH is suppressed. When the blood level of thyroid hormone is low, the hypothalamus secretes thyroid-releasing hormone, which stimulates the anterior pituitary to secrete thyroid-stimulating hormone. This stimulates production and secretion of T3and T4. As the levels of thyroid hormones rise, the secretion of TSH and TRH is suppressed.

Which statements made by a client indicate an understanding of the education for corticosteroid therapy? (Select All That Apply) 1. "If I cannot take my medicine for more than 2 days, I will contact my healthcare provider." 2. "I will take my medication at the same time every day." 3. "I will take my medication with food or a meal." 4. "I will avoid dairy products while taking this medication." "If I notice my vision is changing, I will contact my healthcare provider."

Answer: 2, 3, 5 Explanation: 1. The client should not stop the corticosteroid abruptly and should contact the healthcare provider if unable to take the medication for over 1 day. 2. The client should take this medication regularly and at the same time every day. 3. Taking the medication with food or a meal will help to reduce gastric upset. 4. There is no reason to avoid dairy products when taking this medication. 5. Corticosteroids may cause increased intraocular pressure and an increased risk of glaucoma and may cause cataracts.

The nurse has provided education for a client prescribed desmopressin (DDAVP). Which statement made by the client indicates an understanding of the information? 1. "This medication is a potent vasodilator." 2. "This medication promotes diuresis in my body." 3. "This medication increases water reabsorption in my kidneys." 4. "This medication suppresses hormone secretion from my posterior pituitary gland."

Answer: 3 Explanation: 1. Desmopressin is a potent vasoconstrictor. 2. Desmopressin promotes water retention. 3. Desmopressin is a synthetic form of human ADH (antidiuretic hormone) and acts on the collecting ducts in the kidney to increase water reabsorption. 4. Desmopressin does not suppress hormone secretion from the posterior pituitary gland.

1) Which assessment findings should the nurse anticipate for the client with Cushing's syndrome? 1. Hypotension 2. Tachycardia 3. Upper body obesity 4. Thin, gaunt appearance of the face

Answer: 3 Explanation: 1. Hypertension is a symptom associated with Cushing's disease. 2. Tachycardia is not associated with Cushing's disease. 3. Primary symptoms of Cushing's syndrome include upper body obesity. 4. Cushing's disease is characterized by a redistribution of fat around the face resulting in a "moon face" appearance.

Which should the nurse monitor the client for that is receiving glucocorticoid therapy? 1. Hypothermia 2. Hypotension 3. Hypertension 4. Weight loss

Answer: 3 Explanation: 1. Hypothermia would not be seen; temperature regulation is not related to glucocorticoid therapy. 2. Hypotension would not be expected related to the increased production of angiotensin II. 3. Hypertension would be expected related to the increased production of angiotensin II. 4. Weight loss would not be seen; weight gain is more likely with glucocorticoid therapy.

Which information should the nurse include in education for a client prescribed methimazole (Tapazole)? 1. "Occasionally you may feel your heart beating fast." 2. "Call the clinic if you are having trouble sleeping." 3. "It is important for you to schedule periodic liver function tests." 4. "You may experience a weight loss while taking this prescription."

Answer: 3 Explanation: 1. Methimazole may result in a slower pulse rate. 2. Methimazole results in a less insomnia. 3. Periodic liver function tests should be obtained because methimazole may be hepatotoxic. 4. The client prescribed methimazole may experience weight gain. Page Ref: 701

Which should the nurse be most concerned about during the treatment of a client experiencing a thyroid storm? 1. The client requires a second dose of propylthiouracil. 2. The client develops crackles in both lung bases. 3. The client begins to shiver. The client becomes hyperglycemic.

Answer: 3 Explanation: 1. The amount of prescription required to alter the high fever associated with a thyroid storm is not the most concerning. 2. The development of crackles is not the most concerning. 3. Shivering increases metabolic stress and is the most concerning assessment finding since a goal in the treatment of a thyroid storm is to reduce body temperature. 4. Hypoglycemia can occur during a thyroid storm as a result of the increased metabolic rate.

Which describes the primary goal of pharmacotherapy for the treatment of hyperthyroidism (Graves' disease)? 1. Decrease the metabolic processes 2. Increase synthesis of thyroid hormones 3. Lower the activity of the thyroid gland 4. Prevent a thyroid storm from occurring

Answer: 3 Explanation: 1. The primary goal of treatment is to lower the activity of the thyroid gland which will decrease the metabolic processes. 2. The primary goal of treatment is to lower the activity of the thyroid gland which is intended to decrease the synthesis of thyroid hormones. 3. The goal is to lower the activity of the thyroid gland. 4. The primary goal is to lower the activity of the thyroid gland, thus decreasing the risk for a thyroids storm.

Which outcome should the nurse anticipate for the client receiving treatment with radioactive iodine (Iodine-131) therapy? 1. The client will only temporarily accomplish the euthyroid state. 2. The client should limit fluid intake during the treatment. 3. The client will most likely require thyroid replacement therapy. 4. The client should avoid contact with others until the treatment is over.

Answer: 3 Explanation: 1. Treatment with radioactive iodine (Iodine-131) usually results in a permanent euthyroid state. 2. The client should increase fluid intake and to void frequently to avoid irradiation to gonads from radioactivity in the urine. 3. Clients treated with radioactive iodine (Iodine-131) therapy often end up with hypothyroidism and require replacement therapy. 4. The client should limit contact with family to 1 hour per day per person until the treatment period is over but should be instructed to avoid contact with young children and pregnant women.

1) Which finding should the nurse be most concerned about for a client with hypothyroidism? 1. Dry skin 2. Generalized weakness 3. Muscle cramps 4. Weight gain

Answer: 4 Explanation: 1. Dry skin is an early sign of hypothyroidism. 2. Generalized weakness is an early sign of hypothyroidism and is likely the reason the client sought treatment. 3. Muscle cramps are an early sign of hypothyroidism. 4. Weight gain is a more severe symptom associated with hypothyroidism and should be reported to the healthcare provider.

Which describes the function of the thyroid gland? 1. Stimulate growth 2. Control pituitary gland secretion 3. Conserve water in the body 4. Control basal metabolism

Answer: 4 Explanation: 1. Growth hormone stimulates growth. 2. The thyroid gland does not control the pituitary. 3. Antidiuretic hormone conserves water in the body. 4. The function of the thyroid gland is to control basal metabolism and affect every cell in the body.

Which should the nurse include in the plan of care when administering intranasal desmopressin (DDAVP) to a client? 1. Instruct the client to blow his nose following administration. 2. Be sure to have fresh water at the bedside. 3. Withhold other prescriptions when administering desmopressin (DDAVP) to ensure absorption. 4. Direct the spray high into the nasal cavity.

Answer: 4 Explanation: 1. Intranasal sprays of desmopressin should be alternately rotated between nares. There is no need for the client to blow his nose following administration of intranasal desmopressin (DDAVP). 2. Fresh water at the bedside is not required when administering intranasal desmopressin. 3. There is no need to withhold other medications when a client receives intranasal desmopressin. The spray should be directed high into the nasal cavity, not into the nasopharynx

The nurse is preparing to educate a client prescribed levothyroxine (Synthroid). Which information should the nurse include in the teaching? 1. Monitor daily temperature. 2. Assess for decreased appetite. 3. Assess weekly serum blood levels. 4. Assess for altered sleep patterns.

Answer: 4 Explanation: 1. Monitoring daily temperatures is not necessary when taking levothyroxine. 2. The appetite tends to increase for clients receiving levothyroxine. 3. Serum blood levels are not required on a weekly basis with clients receiving levothyroxine. 4. Insomnia is an adverse effect of levothyroxine so altered sleep patterns must be assessed.