Chapter 52 PrepU - Endocrine
A client who is scheduled for a thyroid test reports having an allergy to seafood. What should the nurse do?
Document the allergy and inform the physician
A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition?
Wear clothes that covers the neck
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing syndrome
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Disturbed body image related to weigh gain and edema
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:
Graves' Disease
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?
Hypocalcemia
A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function?
Metabolic rate
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see?
Serum potassium level of 6.8 mEq/L
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:
Sodium and potassium abnormalities
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?
Sympathetic
Which of the following hormones controls secretion of adrenal androgens?
Adrenocorticotropic hormone (ACTH)
For a client with Graves' disease, which nursing intervention promotes comfort?
Maintaining room temperature in the low-normal range
What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism?
Weight loss Muscular fatigability An elevated systolic blood pressure
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate?
Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones?
Methimazole
The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:
Hypocalcemia
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
Milk
A patient has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this patient?
Concentrated urine
Because there is no one cause for Graves' disease, treatment is relegated to the management of symptoms, or in severe cases, surgery to remove the thyroid gland. Which is not a symptom of Graves' disease?
Constipation
A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla?
450 pg/mL
The nurse is aware that the best time of day for the total large corticosteroid dose is between:
7am and 8am
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?
A 24-year-old client with unstable hyperthyroidism with sinus tachycardia
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:
A blood pressure of 176/88 mm Hg
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?
A decrease in urine output
Which of the following is a clinical manifestation of hypothyroidism?
A pulse rate below 60 bpm
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 stimulates the release of calcitonin 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
A nurse understands that for the parathyroid hormone to exert its effect, what must be present?
Adequate vitamin D level
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?
Administer IV calcium gluconate as ordered
A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response?
Adrenal medulla
Which of the following is the primary hormone for the long-term regulation of sodium balance?
Aldosterone
Which type of cell secretes glucagon and promotes gluconeogenesis?
Alpha
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?
Atrophy of the gonads
What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss?
Consume adequate amounts of fluid
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination?
Buffalo hump Think extremities Moon face Truncal obesity Purple striae
The primary function of the thyroid gland includes which of the following?
Control of cellular metabolic activity
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient?
Calcium
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?
Calcium gluconate
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Calcium gluconate
Trousseau's sign is elicited by which of the following?
Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted?
Decrease in hormonal levels
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:
Decreased body temperature and cold intolerance
A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find?
Deficient production of vasopressin
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP)
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following?
Detecting evidence of hormone hypersecretion
Which of the following would the nurse expect to find in a client with severe hyperthyroidism?
Exophthalmos
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands?
Four
A patient whose laboratory studies indicates a prolactin level of 200 ng/mL is assessed for a pituitary tumor. During the physical exam, the nurse practitioner notices a number of signs and/or symptoms suggestive of this condition. Which of the following is the most common indicator of a pituitary tumor?
Galactorrhea
The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following?
Gigantism
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis?
Glucagon
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose?
Goiter
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor?
Handle body fluids carefully
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?
Have regular follow-up care
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client?
Hydrochlorothiazide
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion?
Hydrocortisone
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?
Hypercalcemia
A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis?
Hyperthermia
Which of the following clinical signs are associated with diabetes insipidus?
Hypotension
A nurse is collecting data from a client who is suspected of having an endocrine disorder and is scheduled for diagnostic testing that involves the use of a contrast medium. The nurse would inform the physician if the client stated which of the following?
I have an allergy to shrimp and shellfish
One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is:
Kidney stones
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?
Kidneys
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?
MRI
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?
Maintain a moderate exercise program
The nurse is caring for a client who has an excess amount of potassium being excreted and has a serum level of 6.2 mEq/L. What group of adrenal hormones is likely to be impacting the laboratory result?
Mineralocorticoids
A patient experiences a life-threatening hypercalcemic crisis. The provider orders a cytotoxic agent. Which of the following is most likely the drug that is prescribed?
Mithramycin
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:
Myxedema coma
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer?
Observe stool color
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism?
PTU
Cardiac effects of hyperthyroidism include
Palpitations
A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?
Papillary carcinoma
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is:
Paresthesia
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?
Serum potassium level of 5.8 mEQ/L
A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer:
Phentolamine (Regitine)
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
Phosphorus
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?
Pineal gland, melatonin
Vision and visual fields are altered in disorders of which of the following endocrine glands?
Pituitary
A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland?
Posterior pituitary
ADH is secreted by which gland?
Posterior pituitary
A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?
Potassium chloride
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of:
Profound neuromuscular irritability
The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones?
Radioimmunoassay
A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies?
Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?
Related to bone demineralization resulting in pathologic fractures
A nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume?
Renin
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus.
Serum osmolality of 310 mOsm/kg Urine specific gravity of 1.001 Serum sodium level of 149 mEq/L
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient?
Symptoms of acute coronary syndrome
A nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, thyroxine (T4), and calcitonin
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?
Tachycardia
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?
Temperature of 102* F
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Tetany
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?
The functioning of endocrine glands
The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland?
The lower neck anterior to the trachea
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding?
The patient may have hyperthyroidism
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands?
The secretions are released directly into the blood stream
Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
Thyroid crisis
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering:
Vasopressin
When caring for a client with diabetes insipidus, the nurse expects to administer:
Vasopressin
Which hormone is secreted by the posterior pituitary?
Vasopressin
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:
Vitamin D
During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
You must avoid hyperextending your neck after surgery
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:
a corticotropin-secreting pituitary adenoma
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?
assess vital signs
When caring for a client who's being treated for hyperthyroidism, the nurse should:
balance the client's periods of activity and rest
What dietary modifications should be recommended to a client with hyperthyroidism?
consume a high-protein diet
A client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms?
dehydration
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:
encouraging fluids
A client with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of:
hyponatremia and hyperkalemia
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to
monitor for symptoms of hypothyroidism
A nurse should expect a client with hypothyroidism to report:
puffiness of the face and hands
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:
sodium and potassium abnormalities
When caring for a client with diabetes insipidus, the nurse expects to administer?
vasopressin
