Chapter 52

A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? "Is there any family history of acromegaly?" "Has your shoe size increased recently?" "Have you had a recent head injury?" "Do you experience skin breakouts?"

"Has your shoe size increased recently?"

A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder?

pituitary gland

The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? Potassium of 6.0 mEq/L A blood pressure reading of 135/90 mm Hg Glucose of 100 mg/dL Sodium of 140 mEq/L

Potassium of 6.0 mEq/L

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? hand flexing inward moon face and buffalo hump cardiac dysrhythmia bulging forehead

hand flexing inward

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? "I'll schedule a follow-up visit with my physician as soon as I get home." "I will take my pain medications according to the schedule we developed." "I'll call my physician if I notice tingling around my lips." "I will increase my fluid and calcium intake."

"I will increase my fluid and calcium intake."

A client who is postpartum is receiving intravenous oxytocin, and the client asks the nurse about the function of oxytocin in the body. How should the nurse respond? "It stimulates bone and muscle growth and promotes protein synthesis and fat mobilization." "It stimulates the production and secretion of thyroid hormones." "It stimulates the contraction of the pregnant uterus before birth and stimulates the release of breast milk after childbirth." "It increases blood calcium by stimulating calcium release from the bone and decreases the blood phosphate level."

"It stimulates the contraction of the pregnant uterus before birth and stimulates the release of breast milk after childbirth."

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? "Lose weight." "Jog at least 2 miles per day." "Rest as much as possible." "Maintain a moderate exercise program."

"Maintain a moderate exercise program."

The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? A rise in serum calcium inhibits the release of calcitonin. A rise in serum calcium stimulates the release of T lymphocytes. A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. A rise in serum calcium stimulates the release of erythropoietin.

A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.) Dexamethasone (Decadron) Synthetic levothyroxine Acetaminophen Iodine Propylthiouracil

Acetaminophen Iodine Propylthiouracil Dexamethasone Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.

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? Acromegaly Deficient growth hormone Hypothyroidism Type 1 diabetes mellitus

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.

A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply. Administer prescribed diuretics. Examine extremities for pitting edema. Provide a high sodium diet. Monitor weight. Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg.

Administer prescribed diuretics. Monitor weight. Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. Examine extremities for pitting edema.

A nurse is caring for a client suspected of having a pituitary tumor that is causing panhypopituitarism. During assessment of the client, which clinical manifestation would the nurse expect to find? Hypertension Tachycardia Carpopedal spasm Atrophy of the gonads

Atrophy of the gonads

Trousseau's sign is elicited by which of the following? A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. The patient complains of pain in the calf when his foot is dorsiflexed. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery.

Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.

A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for? Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes insipidus (DI) Hypothyroidism Pituitary tumor

Diabetes insipidus (DI)

While the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. What is the nurse's most appropriate response? Inquire about frequent urination Consult the institution's procedure manual Palpate the thyroid gland Document the allergy and inform the physician

Document the allergy and inform the physician

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? It helps determine the client's general status. Diet and drug histories are related to the family history. An allergy to iodine is inherited. Endocrine disorders can be inherited.

Endocrine disorders can be inherited.

A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? Exophthalmos Bulging eyes Retinal detachment Periorbital swelling

Exophthalmos Exophthalmos is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment. Bulging eyes and periorbital swelling are only individual aspects of exophthalmos

A nurse should perform which intervention for a client with Cushing's syndrome? Offer clothing or bedding that's cool and comfortable. Explain that the client's physical changes are a result of excessive corticosteroids. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather. Suggest a high-carbohydrate, low-protein diet.

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? Serum immunoassay for TSH Free T4 analysis Ultrasound of the thyroid gland Fine-needle biopsy of the thyroid gland

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.

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? Serum ketone test Fluid deprivation test Urine glucose test Capillary blood glucose test

Fluid deprivation test

Which outcome indicates that treatment of a client with diabetes insipidus has been effective? Heart rate is 126 beats/minute. Urine output measures more than 200 ml/hour. Fluid intake is less than 2,500 ml/day. Blood pressure is 90/50 mm Hg.

Fluid intake is less than 2,500 ml/day. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? Hypercalcemia Hypophosphaturia Hyperphosphatemia Hypocalcemia

Hypercalcemia

The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of: Increased serum levels of phosphate. Decreased levels of vitamin D. Cardiac arrhythmias. Hypocalcemia.

Hypocalcemia.

The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: Constipation Weight gain Intolerance to heat Fatigue

Intolerance to heat

The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: Fatigue Weight gain Constipation Intolerance to heat

Intolerance to heat

Which intervention is the most critical for a client with myxedema coma? Warming the client with a warming blanket Measuring and recording accurate intake and output Administering an oral dose of levothyroxine (Synthroid) Maintaining a patent airway

Maintaining a patent airway

For a client with Graves' disease hyperthyroidism, which nursing intervention promotes comfort? Limiting intake of high-carbohydrate foods Restricting intake of oral fluids Placing extra blankets on the client's bed Maintaining room temperature in the low-normal range

Maintaining room temperature in the low-normal range

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? Moon face Pale thick skin Hypotension Weight loss

Moon face

Hypocalcemia is associated with which of the following manifestations? Bowel hypomotility Fatigue Muscle twitching Polyuria

Muscle twitching Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are associated with hypocalcemia.

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? Monitor bowel patterns. Observe urine output. Monitor vital signs every 4 hours. Observe stool color.

Observe stool color.

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? Monitor bowel patterns. Observe urine output. Observe stool color. Monitor vital signs every 4 hours.

Observe stool color.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? Thymus gland, thymosin Pineal gland, melatonin Parathyroid glands, parathormone Adrenal cortex, corticosteroids

Pineal gland, melatonin

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: TSH, triiodothyronine (T3), and calcitonin. iodine and thyroid-stimulating hormone (TSH). thyrotropin-releasing hormone (TRH) and TSH. T3, thyroxine (T4), and calcitonin.

T3, thyroxine (T4), and calcitonin.

Which group of clients should not receive potassium iodide? Those who are allergic to corticosteroids Those taking medications such as cough medicines Those who are allergic to seafood Those who are pregnant

Those who are allergic to seafood Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.

Which diagnostic test is done to determine suspected pituitary tumor? radioimmunoassay measurement of blood hormone levels radiographs of the abdomen computed tomography scan

computed tomography scan

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? hormonal underproduction decrease in hormonal levels hormonal overproduction increase in hormonal levels

decrease in hormonal levels

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: systolic murmur at the left sternal border. exophthalmos and conjunctival redness. flushed, warm, moist skin. decreased body temperature and cold intolerance.

decreased body temperature and cold intolerance.

Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? liver cardiac atria kidneys brain

kidneys