Endocrine

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Which of the following is a priority outcome for the client with Addison's disease? 1.Maintenance of medication compliance. 2.Avoidance of normal activities with stress. 3.Adherence to a 2-g sodium diet. 4.Prevention of hypertensive episodes.

1. Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease.

The client with Addison's disease is taking glucocorticoids at home. Which of the following statements indicate that the client understands how to take the medication? 1."Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." 2."My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day." 3."Glucocorticoids are cumulative, so I will take a dose every third day." 4."I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids."

1. The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, addisonian crisis could result. Two-thirds of the daily dose should be taken at about 8 am and the remainder at about 4 pm. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 4 and 6 am and lowest levels in the evening.

The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. 1.Addison's disease will resolve over a few weeks, requiring no further treatment. 2.Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3.Fatigue, weakness, dizziness, and mood changes need to be reported to the physician. 4.A medical identification bracelet should be worn. 5.Family members need to be informed about the warning signals of adrenal crisis. 6.Dental work or surgery will require adjustment of daily medication.

2, 3, 4, 5, 6 - Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.

The nurse should assess a client with Addison's disease for which of the following? 1.Weight gain. 2.Hunger. 3.Lethargy. 4.Muscle spasms.

3. Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and depression as early symptoms. Other early signs and symptoms include mood changes, emotional lability, irritability, weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles become weak, not spastic, because of adrenocortical insufficiency.

Cortisone acetate and fludrocortisone acetate are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy? 1.Take both drugs three times a day. 2.Take the entire dose of both drugs first thing in the morning. 3.Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. 4.Take half of each drug in the morning and the remaining half of each drug at bedtime.

3. Fludrocortisone acetate can be administered once a day, but cortisone acetate administration should follow the body's natural diurnal pattern of secretion. Greater amounts of cortisol are secreted during the day to meet the increased demand of the body. Typically, baseline administration of cortisone acetate is 25 mg in the morning and 12.5 mg in the afternoon. Taking it three times a day would result in an excessive dose. Taking the drug only in the morning would not meet the needs of the body later in the day and evening.

The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations? 1.Returning to work after a weekend. 2.Going on vacation. 3.Having oral surgery. 4.Having a routine medical checkup.

3. Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, a vacation, or a routine checkup usually will not alter glucocorticoid dosage needs.

When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from: 1.Insufficient secretion of growth hormone (GH). 2.Dysfunction of the hypothalamic pituitary 3.Idiopathic atrophy of the adrenal gland. 4.Oversecretion of the adrenal medulla.

3. Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands. The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insufficiency are autoimmune destruction (70%) and tuberculosis (20%). Insufficient secretion of GH causes dwarfism or growth delay. Hyposecretion of glucocorticoids, aldosterone, and androgens occur with Addison's disease. Pituitary dysfunction can cause Addison's disease, but this is not a primary disease process. Oversecretion of the adrenal medulla causes pheochromocytoma.

Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? 1.Anorexia. 2.Dizziness. 3.Rapid weight gain. 4.Poor skin turgor.

3. Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.

The nurse should teach the client with Addison's disease that the bronze-colored skin is thought to be caused by which of the following? 1.Hypersensitivity to sun exposure. 2.Increased serum bilirubin level. 3.Adverse effects of the glucocorticoid therapy. 4.Increased secretion of adrenocorticotropic hormone (ACTH).

4. Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison's disease and is caused by melanocyte-stimulating hormone produced in response to increased ACTH secretion. The hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to the sun. Additionally, areas that may not be exposed to the sun, such as the nipples, genitalia, tongue, and knuckles, become bronze-colored. Treatment of Addison's disease usually reverses the hyperpigmentation. Bilirubin level is not related to the pathophysiology of Addison's disease. Hyperpigmentation is not related to the effects of the glucocorticoid therapy.

A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes? Allowing the client to express feelings related to body image changes Restricting foods high in potassium Assess the clint's metal status regularly Reduce fluid intake

Assess the client's mental status regularly. Explanation: Central nervous system changes include such symptoms as apathy, lethargy, and decreased concentration. Seizures and coma can also occur. The nurse should assess the client's level of consciousness at regular intervals and maintain client safety.

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

B. Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss.

A client is seen in the clinic with suspected parathormone (PTH) deficiency. Which electrolyte levels would the nurse expect to be abnormal in a client with PTH deficiency? Select all that apply. Calcium Potassium Phosphorous Sodium Chloride Glucose

Calcium, Phosphorous Explanation:A client with PTH deficiency has abnormal serum calcium and phosphorous levels because PTH regulates these two electrolytes. PTH deficiency does not affect sodium, potassium, chloride, or glucose.

A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply. High-fiber, low-calorie diet High-protein, high-calorie diet Review of the procedure for thyroid radiation therapy Use of stool softeners Thyroid hormone replacements Plan for a thyroidectomy

High-fiber, low-calorie diet Use of stool softeners Thyroid hormone replacements

The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? Acromegaly Cushing's Syndrome Hypopituitarism Diabetes Mellitus

Hypopituitarism Explanation - Most clients who undergo adenoma removal experience a gradual return of normal pituitary secretion and do not experience complications. However, hypopituitarism can cause growth hormone, gonadotropin, thyroid-stimulating hormone, and adrenocorticotropic hormone deficits. The client should be taught to monitor for change in mental status, energy level, muscle strength, and cognitive function. In adults, changes in sexual function, impotence, or decreased libido should be reported.

Which of the following results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? Increased energy, weight loss, and a higher temperature and pulse rate Elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels Improved appetite, weight gain, and sleeping fewer hours Decreased edema, stable temperature, and decreased respiratory rate

Increased energy, weight loss, and a higher temperature and pulse rate Explanation:The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.

The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find? 1. hyperkalemia 2. reduced BUN 3. hypernatremia 4. hyperglycemia

RATIONALES (1): In adrenal insufficiency, the client has hyperkalemia due to reduced aldosterone secretion. BUN increases as the glomerular filtration rate is reduced. Hyponatremia is caused by reduced aldosterone secretion. Reduced cortisol secretion leads to impaired glyconeogenesis and a reduction of glycogen in the liver and muscle, causing hypoglycemia.

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. When he awoke this morning, his wife noticed that he acted confused and was extremely weak. 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 would the nurse expect to administer by I.V. infusion? 1. Insulin 2. Hydrocortisone 3. Potassium 4. Hypotonic saline

RATIONALES (2) : Emergency treatment for acute adrenal insufficiency (Addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until the client's blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? 1. pitting edema of the legs 2. an irregular apical pulse 3. dry mucous membranes 4. frequent urination

RATIONALES (2): Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

During the first 24 hours after a client is diagnosed with Addisonian crisis, which intervention should the nurse perform frequently? 1. Weigh the client 2. Test urine for ketones 3. Assess vital signs 4. Administer oral hydrocortisone

RATIONALES (3): Because the client in Addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.

The nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take my hydrocortisone in the late afternoon, before dinner." 2. "I'll take all of my hydrocortisone in the morning, right after I wake up." 3. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 4. "I'll take the entire dose at bedtime."

RATIONALES (3): Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.

The nursing care for the client in addisonian crisis should include which intervention? 1. Encouraging independence with activities of daily living (ADLs) 2. Allowing ambulation as tolerated 3. Offering extra blankets and raising the heat in the room to keep the client warm 4. Placing the client in a private room

RATIONALES(4): The client in addisonian crisis has a reduced ability to cope with stress due to an inability to produce corticosteroids. Compared to a multibed room, a private room is easier to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.

Before discharge, what should a client with Addison's disease be instructed to do when exposed to periods of stress? 1. administer hydrocortisone I.M. 2. Drink 8 oz of fluids. 3. Perform capillary blood glucose monitoring four times daily 4. Continue to take his usual dose of hydrocortisone.

RATIONALES: (1) Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. It's important to keep well hydrated during stress, but the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: 1. fresh fruits 2. dairy products 3. processed meats 4. cereals and grains

RATIONALES: (1) Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in: 1. serum glucose level 2. hair loss 3. bone mineralization 4. menstrual flow

RATIONALES: (1) Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? 1. Risk for Infection 2. Decreased cardiac output 3. Impaired physical mobility 4. Imbalanced nutrition: less than body requirement

RATIONALES: (2) 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 is also an appropriate nursing diagnosis for the client with Addison's disease, but it isn't a priority in a crisis. Imbalanced nutrition: Less than body requirements is also an important nursing diagnosis for the client with Addison's disease but not a priority during a crisis.

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. BUN level of 12 mg/dl 2. Blood glucose level of 90 mg/dl 3. Serum sodium level of 134 mEq/L 4. Serum potassium level of 5.8 mEq/L

RATIONALES: (4) 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.

Which nursing diagnosis is most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia

RATIONALES:(1) Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis. Which statements by the client would indicate that client teaching has been effective? 1. "I have to take my steroids for 10 days." 2. "I need to weigh myself daily to be sure I don't eat too many calories." 3. "I need to call my doctor to discuss my steroid needs before I have dental work." 4. "I will call the doctor if I suddenly feel profoundly weak or dizzy." 5. "If I feel like I have the flu, I'll carry on as usual because this is an expected response." 6. "I need to obtain and wear a Medic Alert bracelet."

RATIONALES:(3, 4, 6) Dental work can be a cause of physical stress; therefore, the client's physician needs to be informed about the dental work and an adjusted dosage of steroids may be necessary. Fatigue, weakness, and dizziness are symptoms of inadequate dosing of steroid therapy; the physician should be notified if these symptoms occur. A Medic Alert bracelet allows health care providers to access the client's history of Addison's disease if the client is unable to communicate this information. A client with Addison's disease doesn't produce enough steroids, so routine administration of steroids is a lifetime treatment. Daily weights should be monitored to monitor changes in fluid balance, not calorie intake. Influenza is an added physical stressor and the client may require an increased dosage of steroids. The client shouldn't "carry on as usual."

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? Restricting sodium intake to 1 gm/day Elevating the head of the client's bed to 90 degrees Restricting fluids to 800 ml/day Administering vasopressin as ordered

Restricting fluids to 800 ml/day Explanation:Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion, thus worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.

Which adverse reactions to the prescribed exogenous corticosteroid medication should the nurse monitor for? Select all that apply. a. Hyperglycemia b. Fluid retention c. Increased muscle mass d. Abnormal fat distribution e. Decreased serum potassium

a. Hyperglycemia b. Fluid retention d. Abnormal fat distribution e. Decreased serum potassium Rationale: An adverse reaction to prescribed exogenous corticosteroid medication is Cushing's syndrome. Cushing's syndrome manifests with hyperglycemia, fluid retention, hypokalemia, and abnormal fat distribution. This syndrome also manifests with decreased, not increased, muscle mass. Other clinical manifestations of Cushing's syndrome for Mrs. DeToro may include virilization (male sexual characteristics developing in females), breast atrophy, vocal changes (deepening), and amenorrhea.

The nurse is providing care for a 35-year-old female client, Mrs. DeToro, who was admitted to the hospital with weakness, fatigue, nausea, and abdominal pain. When conducting the health history, Mrs. DeToro tells the nurse that she was diagnosed with Addison's disease a year ago and is concerned that her current symptoms might be related to her diagnosis. Which assessment findings support the nurse's suspicion that Mrs. DeToro is experiencing an adrenal crisis? Select all that apply. a. Hypoglycemia b. Hyperkalemia c. Hypernatremia d. Severe hypotension e. Severe hypovolemia

a. Hypoglycemia c. Hypernatremia d. Severe hypotension e. Severe hypovolemia Rationale: Adrenal crisis is a life-threatening emergency that leads to severe hypovolemia and hypotension. The client is also at risk for hyperkalemia and hypoglycemia related to lack of mineralocorticoids and glucocorticoids. Risk factors for adrenal crisis include stressful events such as trauma, surgery, and infections.

Which clinical manifestations should the nurse anticipate when providing care to a client diagnosed with Cushing's disease? Select all that apply. a. Moon face b. Hypotension c. Buffalo hump d. Hypoglycemia e. Hypotension

a. Moon face c. Buffalo hump

Which diagnostic tests should the nurse anticipate will be ordered for Mrs. DeToro by the healthcare provider to evaluate her adrenal gland? Select all that apply. a. Serum potassium b. Serum magnesium c. Serum sodium d. Computed tomography (CT) e. Abdominal x-ray

a. Serum potassium c. Serum sodium d. Computed tomography (CT) Rationale: Appropriate diagnostic tests include serum potassium (to monitor for hypokalemia), serum sodium (to monitor for hyponatremia), and a CT scan (to assess for changes in the size and morphology of the adrenal gland). You would not anticipate a serum magnesium level nor an abdominal x-ray for this patient.

After several days in the hospital, Mrs. DeToro's condition has stabilized and she is approaching discharge. Which topics should the nurse include in the discharge teaching plan? Select all that apply. a. Taking oral hormone replacement daily b. Wearing a medical-alert bracelet when traveling c. Monitoring for symptoms of corticosteroid excess d. Using prescribed sedatives for sleep e. Monitoring for anticipated weight loss

a. Taking oral hormone replacement daily c. Monitoring for symptoms of corticosteroid excess Rationale: Topics that you should include in Mrs. DeToro's discharge teaching include the importance of taking oral hormone replacement daily and monitoring for symptoms of corticosteroid excess. A medical-alert bracelet should be worn at all times, not just when traveling. The client should be warned against the use of prescribed sedatives for sleep, as Mrs. DeToro's diagnosis contradicts this classification of medication. The client should be taught to monitor for weight gain, not weight loss, due to the prescribed glucocorticoids necessary for treatment.

A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. depression b. neuropathy c. hypoglycemia d. hyperthyroidism

a. 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 client with Cushing's syndrome is admitted to the medical surgical unit. during the admission assessment, the nurse notes that the client has a flat affect but is irritable when questioned, has a poor memory, reports a loss of appetite, wants to sleep all the time, and doesn't care if she gets well. what collaborative action should the nurse take in response to the information? a. discuss with the health care provider a concern for depression b. request a neurology consult for a CT scan c. discuss with the dietician a need for nutritional consult d. request a social service consult for home evaluation

a. discuss with the health care provider a concern for depression Cushing's syndrome develops because of an excess of cortisol, in this case from prolonged exogenous steroid administration. depression and a marked change in personality are common. it is important that the client be taught how to deal with the emotional changes of the disease

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. a. Monitor daily weight. b. Monitor intake and output. c. Assess extremities for edema. d. Maintain a high-sodium diet. e. Maintain a low-potassium diet.

a. monitor daily weight b. monitor intake and output c. assess extremities for edema The client with Cushing's syndrome and a problem of excess fluid volume should be on daily weights and intake and output and have extremities assessed for edema. He or she should be maintained on a high-potassium, low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water.

The nurse is caring for a client with Cushing's disease. during change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply. a. serum sodium level b. hemoglobin and hematocrit c. serum potassium level d. blood glucose level e. white blood cell count f. creatinine clearance total

a. serum sodium level c. serum potassium level d. blood glucose level Cushing's disease results in an excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. electrolyte disturbance is common for the nurse to report. sodium retention is typically accompanied by potassium depletion. clients exhibit

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? a. "I will need to limit the amount of protein in my diet." b. "I should eat foods that have a lot of potassium in them." c. "I am fortunate that I can eat all of the salty foods I enjoy." d. "I am fortunate that I do not need to follow any special diet."

b. "I should eat foods that have a lot of potassium in them." A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue

A client diagnosed with pheochromocytoma is post-operative following an adrenalectomy. What clinical data should the nurse monitor following surgery? Select all that apply. a. Red blood cell level b. Blood pressure c. Heart rate d. Blood glucose level e. Blood potassium level

b. Blood pressure c. Heart rate d. Blood glucose level

Which hormones are produced by the adrenal glands? Select all that apply. a. Insulin b. Cortisol c. Epinephrine d. Aldosterone e. Norepinephrine

b. Cortisol c. Epinephrine d. Aldosterone e. Norepinephrine

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse should expect an excess of which substance? a. Calcium b. Cortisol c. Epinephrine d. Norepinephrine

b. cortisol Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla.

Which diet would likely be ordered for the client with hypothyroidism: a) high protein, high calorie b) restricted fluids, low protein c) high roughage, low calorie d) high carbohydrates, low roughage

c) high roughage, low calorie

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? a. "I should avoid contact sports." b. "I should check my ankles for swelling." c. "I need to avoid foods high in potassium." d. "I need to check my blood glucose regularly."

c. "I need to avoid foods high in potassium." Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

A client with suspected Cushing's syndrome is scheduled for adrenal venography. A nurse has provided instructions to the client regarding the test. Which statement by the client indicates a need for further instruction? a. "I need to sign an informed consent." b. "The insertion site will be locally anesthetized." c. "I will be placed in a high-sitting position for the test." d. "I may feel a burning sensation after the dye is injected."

c. "I will be placed in a high-sitting position for the test." The test aids in determining whether signs and symptoms are caused by abnormalities in the adrenal gland. The nurse assesses the client for allergies to iodine before the test. The client is informed that the supine position is necessary to access the femoral vein. An informed consent form is required, the insertion site will be locally anesthetized, and the client will experience a transient burning sensation after the dye is injected.

Which hormones should the nurse anticipate being affected for a client who is diagnosed with an adrenal medulla tumor? Select all that apply. a. Insulin b. Cortisol c. Epinephrine d. Aldosterone e. Norepinephrine

c. Epinephrine e. Norepinephrine

The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: a. hypotension b. thick, coarse skin c. Deposits of adipose tissue in the trunk and dorsocervical area d. weight gain in arms and legs

c. deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), 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 male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? a. it decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs b. it interacts with plasma membrane receptors to inhibit enzymatic actions c. it interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. d. it regulates the threshold for water resorption in the kidneys

c. it interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn't decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.

When formulating the plan of care for Mrs. DeToro, which psychosocial nursing diagnosis is a priority? a. Fluid volume deficit b. Risk for unstable blood glucose c. Risk for decreased cardiac output d. Body image disturbance

d. Body image disturbance Rationale: While all of these nursing diagnoses are appropriate for a patient who is experiencing an adrenal crisis, the priority psychosocial nursing diagnosis is disturbed body image due to the hyperpigmentation of the skin.

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? a. encourage the client's expression of feelings. b. Assess the client's understanding of the disease process. c. Encourage family members to share their feelings about the disease process. d. Encourage the client to recognize that the body changes need to be dealt with.

d. Encourage the client to recognize that the body changes need to be dealt with. Encouraging the client to understand that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. The remaining options are appropriate because they address the client and family feelings regarding the disorder.

Mrs. DeToro's laboratory values indicate she is experiencing an adrenal crisis. Which treatment should the nurse anticipate? Select all that apply. a. Digoxin b. Furosemide c. Sliding scale insulin d. IV fluid with glucose e. IV glucocorticoids

d. IV fluid with glucose e. IV glucocorticoids Rationale: Cortisol replacement is the definitive treatment for adrenal insufficiency. Patients presenting with acute adrenal insufficiency require emergency stabilization with IV fluids and glucose, along with IV administration of glucocorticoids (cortisol), such as 50 to 100 mg of hydrocortisone sodium succinate (Solu-Cortef) or 4 to 12 mg of dexamethasone (Decadron).

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? a. Thick hard nails b. Inability to tolerate cold c. Complaints of sleepiness d. Reports of increased appetite

d. Reports of increased appetite Explanation:Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.

The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? A Fatigue B Weight loss C Hair loss D Dyspnea

Which statement made by a client diagnosed with adrenal insufficiency requires further education by the nurse? a. "I need to take my oral hormone replacement every day." b. "I no longer need to worry about symptoms of my disorder because it cannot recur." c. "I will purchase and wear a medical alert bracelet." d. "I will notify my doctor if I begin to gain weight."

b. "I no longer need to worry about symptoms of my disorder because it cannot recur."

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? a) Tetanic contractionsb) Polyuriac) Jugular vein distentiond) Weight loss

c. Jugular vein distention

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms should the nurse monitor for? Select all that apply. a. Anorexia b. Dizziness c. Weight loss d. Moon face e. Hypertension f. Truncal obesity

d. Moon face e. Hypertension f. Truncal obesity A client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon face, truncal obesity, and a buffalo hump fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

The nurse is aware that the following is the most common cause of hyperaldosteronism? a. excessive sodium intake b. pituitary adenoma c. deficient potassium intake d. an adrenal adenoma

d. 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 as well as of pituitary stimulation.

Which of the following would be an expected finding in a client with adrenal crisis (addisonian crisis)? 1.Fluid retention. 2.Pain. 3.Peripheral edema. 4.Hunger.

2. Adrenal hormone deficiency can cause profound physiologic changes. The client may experience severe pain (headache, abdominal pain, back pain, or pain in the extremities). Inhibited gluconeogenesis commonly produces hypoglycemia, and impaired sodium retention causes decreased, not increased, fluid volume. Edema would not be expected. Gastrointestinal disturbances, including nausea and vomiting, are expected findings in Addison's disease, not hunger.

A client diagnosed with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should: 1.Collect a 24-hour urine specimen to measure serum cortisol levels. 2.Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. 3.Draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels. 4.Administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels.

2. When Cushing's syndrome is suspected a 24-hour urine collection for free cortisol is performed. Levels of 50 to 100 mcg/day (1,379 to 2,756 nmol/L) in adults indicate Cushing's syndrome. If these results are borderline a high-dose dexamethasone suppression test is done. The Dexamethasone is given at 11 pm to suppress secretion of the corticotrophin-releasing hormone. A plasma cortisol sample is drawn at 8 am. Normal cortisol level less than 5 mcg/dL (140 nmol/L) indicates normal adrenal response.

A client with Addison's disease is admitted to the medical unit. The client has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which of the following fluids would be most appropriate? 1.Milk and diet soda. 2.Water and eggnog. 3.Bouillon and juice. 4.Coffee and milkshakes.

3. Electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia, and hyperkalemia. Salted bouillon and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium.

Which of the following is the best indicator for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement?1.Skin turgor. 2.Temperature. 3.Thirst. 4.Daily weight.

4. Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss.

A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? A. Administer prescribed diuretics. B. Provide a high-sodium diet. C. Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. D. examine extremities for pitting edema.

A nurse is preparing an IV dose of hydrocortisone that is to be administered to an adult patient on an acute medical unit. The endocrine disorder for which this treatment is most clearly indicated is: A. Cushing's syndrome B Addison's disease C Diabetes insipidus D Syndrome of inappropriate antidiuretic hormone (SIADH)

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? A A decrease in blood pressure B A decrease in urine output C A decrease in appetite D A decrease in blood glucose levels

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? A. Hamburger B. Milk C Bananas D Chicken livers

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. calcium and phosphorus abnormalities 2. chloride and magnesium abnormalities 3. sodium and chloride abnormalities 4. sodium and potassium abnormalities

RATIONALES:(4) 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.

A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? The client with diabetic ketoacidosis. The client with diabetes mellitus. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The client with diabetes insipidus.

The client with diabetes insipidus.

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? Weight gain, decreased appetite, and constipation Weight loss, increased urination, and increased thirst Weight loss, increased appetite, and hyperdefecation Weight gain, increased urination, and purplish-red stria

Weight gain, decreased appetite, and constipation Explanation:Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?Cerebral edema Hypovolemic shock Severe hyperkalemia Tetany

a. Cerebral edema

Which clinical manifestation would indicate to the nurse that the client may have pheochromocytoma? a. Hypertension b. Hypoglycemia c. Hyponatremia d. Hyperpigmentation

a. Hypertension

Which of the following is a factor affecting an increase in urine osmolality?Syndrome of inappropriate antidiuretic hormone release (SIADH) Alkalosis Fluid volume excess Myocardial infarction

a. SIADH

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate: a) increase calories b) restrict sodium c) restrict potassium d) reduce fat to 10%

b) restrict sodium

What is the most common cause of hyperaldosteronism? A. A pituitary adenoma B. Deficient potassium intake C. An adrenal adenoma D. Excessive sodium intake

A nurse is caring for a client with a low calcium level. Place the following options in chronological order to indicate the regulatory feedback mechanism of parathyroid hormone (PTH) release in relation to calcium levels. All options must be used. 1 High serum calcium level inhibits PTH secretion. 2 Parathyroid gland releases PTH. 3 Low serum calcium level stimulates parathyroid gland. 4 Calcium is reabsorbed.

(3, 2, 4, 1) Low serum calcium level stimulates parathyroid gland. Parathyroid gland releases PTH. Calcium is reabsorbed. High serum calcium level inhibits PTH secretion.

Which goal is the priority for a client in addisonian crisis? 1. controlling hypertension 2. preventing irreversible shock 3. preventing infection 4. relieving anxiety

2. Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. This results in loss of extracellular fluid and dangerously low blood volume. Glucocorticoids must be administered to reverse hypotension. Preventing infection is not an appropriate goal of care in this life-threatening situation. Relieving anxiety is appropriate when the client's condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially reassuring.

Which of the following hormones promotes sodium and water retention and potassium excretion: a) insulin b) somatotropin c) aldosterone d) antidiuretic hormone

c) aldosterone

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. A. Potassium B. Magnesium C Calcium D Sodium

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? A. Inability to tolerate cold B Thick hard nails C Reports of increased appetite D Complaints of sleepiness

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? A The moon face and acne will resolve when the medication is tapered off. B Those symptoms are not related to the corticosteroid therapy. C The dose of the medication must be too high and should be lowered. D The symptoms are permanent side effects of the corticosteroid therapy.

The nurse is instructing a young adult with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which of the following situations? 1.Completing the spring semester of school. 2.Gaining 4 lb (1.8 kg). 3.Becoming engaged. 4.Undergoing a root canal.

4. Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid need than physical stress.

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? A Symptoms of acute coronary syndrome B Symptoms of pneumonia C Dietary intake of foods with saturated fats D Heat intolerance

Which of the following is a clinical manifestation of hypothyroidism? A A pulse rate below 60 beats/minute. B Systolic murmurs C Exophthalmos D An elevated systolic blood pressure.

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: A. sodium and potassium abnormalities. B sodium and chloride abnormalities. C. calcium and phosphorus abnormalities. D chloride and magnesium abnormalities.

A nurse in a large university hospital has cared for several patients with endocrine disorders over the past year. For which of the following patients would a nursing diagnosis of disturbed body image be most likely applicable? A. A woman with a longstanding diagnosis of Cushing's syndrome B A man who was treated for Hashimoto's thyroiditis C A man who was diagnosed with hypoparathyroidism after neck surgery D A woman whose diagnosis of Graves' disease required radioactive iodine therapy

A nurse is preparing an IV dose of hydrocortisone that is to be administered to an adult patient on an acute medical unit. The endocrine disorder for which this treatment is most clearly indicated is: A Addison's disease B. Cushing's syndrome C. Diabetes insipidus D. Syndrome of inappropriate antidiuretic hormone (SIADH)

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? A Myxedema coma B Thyroid storm C Tibial myxedema D Exophthalmos

A. 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.

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

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? A. Fludrocortisone B. Calcium gluconate C Methylprednisolone D Sodium bicarbonate

Patients with hyperthyroidism are characteristically: A Calm B Sensitive to heat C Apathetic and anorexic D Emotionally stable

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication? A Diabetes insipidus B Syndrome of inappropriate antidiuretic hormone secretion C Thyrotoxic crisis DMyxedema coma

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

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? A Positive Trousseau's sign B Tetany C Positive Chvostek's sign D Hyperactive deep tendon reflex

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? A. Administer a sedative as ordered. B. Administer an oral calcium supplement as ordered. C Administer IV calcium gluconate as ordered. D Start administering oxygen at 2 L/min via a cannula.

C. 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

Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. The nurse is aware that the client is at increased risk for hypothyroidism. Which signs and symptoms would the nurse anticipate in a client with hypothyroidism? Select all that apply. Cold intolerance. Heat intolerance. Fatigue. Dry skin. Hair loss. Increased energy.

Cold intolerance. Fatigue. Dry skin. Hair loss.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A Risk for infection B Imbalanced nutrition: Less than body requirements C Impaired physical mobility D Decreased cardiac output

An adult patient has undergone extensive testing that has resulted in a diagnosis of a basophilic pituitary tumor. The pathophysiological effects of the patient's tumor include excessive secretion of adrenocorticotropic hormone (ACTH). As a result, this patient is likely to exhibit signs and symptoms that are characteristic of what endocrine disorder? A. Addison's disease B. Hyperthyroidism C. Diabetes insipidus D. Cushing's disease

The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems? A. Metabolic acidosis and cardiac ischemia B Fluid volume overload and pruritus C Deep vein thrombosis and pulmonary embolism D. Renal calculi and urinary obstruction

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? A. Disturbed body image related to weight gain and edema B. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess C. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing D. imbalanced nutrition: Less than body requirements related to thyroid hormone excess

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. Tingling Muscle twitching and spasms Aphasia Numbness

Numbness Tingling Muscle twitching and spasms Explanation: When the parathyroid gland is removed, the body may not produce enough parathyroid hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral numbness, tingling, and muscle spasms. Aphasia is not a symptom of calcium depletion. Polyuria and polydipsia are symptoms of diabetes mellitus.

A client comes to the clinic verbalizing a weight loss of 20 pound (9.1 kilogram).over the last month, even with a "ravenous" appetite and no change in activity level. The client is diagnosed with Graves' disease. Which other signs and symptoms of Graves' disease would the nurse assess? Select all that apply. Rapid, bounding pulse Bradycardia Heat intolerance Constipation Mild tremors Nervousness

Rapid, bounding pulseHeat intoleranceMild tremorsNervousnessGraves' disease, or hyperthyroidism, is a hypermetabolic state that is associated with a rapid, bounding pulse; heat intolerance; tremors; and nervousness. Bradycardia and constipation are signs and symptoms of hypothyroidism.

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? tachycardia Dysuria leg cramps blurred vision

Tachycardia Explanation: 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.

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? The client must decrease the dose of steroid medication carefully to prevent crisis. The client will need to take steroids whenever her life involves physical or emotional stress. The client will require steroids only until her body can manufacture sufficient quantities. The client will need steroid replacement for the rest of her life.

The client will need steroid replacement for the rest of her life.

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? a. Hypotension and fever b. Mental status changes and hypertension c. Subnormal temperature and hypotension d. Complaints of weakness and hypertension

a. hypotension and fever The nurse should be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining options are incorrect.

Which clinical manifestations should the nurse anticipate when providing care to a client experiencing Addison's disease? Select all that apply. a. Hyperglycemia b. Hyponatremia c. Hyperkalemia d. Hypertension e. Hypocalcemia

b. Hyponatremia c. Hyperkalemia

The nurse receives several prescriptions for Mrs. DeToro. Which is the priority to administer? a. IV furosemide (Lasix) b. IV glucocorticoid (Cortisol) c. PO sodium polystyrene sulfonate (Kayexalate) d. PO hydrocortisone sodium succinate (Solu-Cortef)

b. IV glucocorticoid (Cortisol) Rationale: The priority medication for this client is an IV glucocorticoid such as Cortisol. IV furosemide (Lasix) is not appropriate for this patient as a hallmark finding for adrenal crisis is fluid volume deficit, not fluid volume excess. Kayexalate is only administered if the client is experiencing hyperkalemia. While PO Solu-Cortef may be appropriate for Mrs. DeToro, the definitive treatment is IV cortisol.

Which laboratory data should the nurse anticipate when providing care for a client who is experiencing hypercortisolism? a. Decreased cortisol level b. Increased glucose level c. Increased potassium level d. Increased serum sodium level

b. Increased glucose level Rationale: Patients with hypercortisolism present with hyperglycemia, hypokalemia, fluid retention, thinning of the skin, fat maldistribution, increased protein metabolism, and suppressed inflammatory and immune responses.

Parathyroid hormone (PTH) has which effects on the kidney? a. Increased absorption of vitamin D and excretion of vitamin E b. Increased absorption of vitamin E and excretion of vitamin D c. Stimulation of calcium reabsorption and phosphate excretion d. Stimulation of phosphate reabsorption and calcium excretion

d. Stimulation of calcium reabsorption and phosphate excretion Explanation: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

All of the following are counterregulatory hormones and will oppose the action of insulin except: a) glucagons b) cortisol c) growth hormone d) antidiuretic hormone

d) antidiuretic hormone

A patient who is taking antithyroid drugs should not stop them abruptly because it may precipitate a) respiratory distress b) hypothyroidism c) exophthamlmos d) thyroid crisis

d) thyroid crisis

Prolonged use of which type of medication can lead to Cushing's syndrome? a. Angiotensin-converting enzyme inhibitor b. Nonsteroidal anti-inflammatory c. Anticoagulant d. Corticosteroid

d. Corticosteroid

A client has been diagnosed with Cushing's syndrome. The nurse should assess the client for which expected manifestations of this disorder? a. Dizziness b. Weight loss c. Hypoglycemia d. Truncal obesity

d. truncal obesity The client with Cushing's syndrome may exhibit a number of different manifestations. These may include moon face, truncal obesity, and a "buffalo hump" fat pad. Other signs include hyperglycemia, hypernatremia, hypocalcemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? 1.The importance of watching for signs of hyperglycemia. 2.The need to adjust the steroid dose based on dietary intake and exercise. 3.To notify the health care provider when the blood pressure is suddenly high. 4.How to decrease the dose of the corticosteroids when the client experiences stress.

1. Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. A serious adverse effect of corticosteroids is hyperglycemia. Clients do not adjust their steroid dose based on dietary intake and exercise, insulin is adjusted based on diet and exercise. Addisonian crisis can occur secondary to hypoadrenocorticism resulting in a crisis situation of acute hypotension, not increased blood pressure. Addison's disease is a disease of inadequate adrenal hormone and therefore the client will have inadequate response to stress. If the client takes more medication than prescribed, there can be a potential increase in potassium depletion, fluid retention, and hyperglycemia. Taking less medication than was prescribed can trigger Addisonian crisis state which is a medical emergency manifested by signs of shock.

A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. 1. hyperkalemia 2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection 6. hypotension

2, 3, 4, 5 - The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reabsorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. CNS adverse effects are euphoria, headache, insomnia, confusion, and psychosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress the cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.

Which of the following is the priority for a client in addisonian crisis? 1.Controlling hypertension. 2.Preventing irreversible shock. 3.Preventing infection. 4.Relieving anxiety.

After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to: 1.Remove all sources of stress from daily life. 2.Use relaxation techniques such as music. 3.Take antianxiety drugs daily. 4.Avoid discussing stressful experiences.

2. Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress management. Removing all sources of stress from one's life is not possible. Antianxiety drugs are prescribed for temporary management during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion of stressful situations will not necessarily reduce stress.

The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids? 1."Take your medication with a full glass of water." 2."Take your medication on an empty stomach." 3."Take your medication at bedtime to increase absorption." 4."Take your medication with meals or with an antacid."

4. Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid. Only instructing the client to take the medication with a full glass of water will not help prevent gastric complications from steroids. Steroids should never be taken on an empty stomach. Glucocorticoids should be taken in the morning, not at bedtime.

The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems? A Renal calculi and urinary obstruction B Metabolic acidosis and cardiac ischemia C Fluid volume overload and pruritus D Deep vein thrombosis and pulmonary embolism

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? A Diabetes insipidus (DI) B Hyperthyroidism C Hypothyroidism D Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

D. Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia

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: A excessive thirst. B profound neuromuscular irritability. C. acute gastritis. D severe hypotension.

B. Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany).

During an assessment of a patient with SIADH, the nurse notes the unexpected result of: A. A blood pressure reading of 120/85 mm Hg. B Pitting edema in the lower extremities. C Moist mucous membranes. D Normal skin turgor.

B. In SIADH, the patient does not appear to retain fluids because reabsorbed water is intracellular rather than interstitial

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? A Related to exhaustion secondary to an accelerated metabolic rate B. Related to bone demineralization resulting in pathologic fractures C. Related to tetany secondary to a decreased serum calcium level D Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces

B. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This increase, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? A Parasympathetic B Gastrointestinal effects C Sympathetic D Respiratory effects

The preferred preparation for treating hypothyroidism includes which of the following? A. Methimazole (Tapazole) B. Propylthiouracil (PTU) C. Levothyroxine (Synthroid) D. Radioactive iodine

A nurse should expect a client with hypothyroidism to report: A. thyroid gland swelling. B. nervousness and tremors. C. increased appetite and weight loss. D puffiness of the face and hands.

D. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. Bradycardia. Low body temperature. ECG changes. Dry mouth. Nervousness. Tachycardia.

ECG changes. Low body temperature. Bradycardia. In hypothyroidism, the body is in a hypometabolic state. Therefore, ECG changes with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.

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 which problem? 1. depression 2. neuropathy 3. hypoglycemia 4. hyperthyroidism

RATIONALES (1): 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.

For a client in addisonian crisis, it would be very risky for a nurse to administer: 1. potassium chloride 2. normal saline solution 3. hydrocortisone 4. fludrocortisone

RATIONALES: (1) Addisonian crisis results in hyperkalemia; therefore, administering potassium chloride is contraindicated. Because the client will be hyponatremic, normal saline solution is indicated. Hydrocortisone and fludrocortisone are both useful in replacing deficient adrenal cortex hormones.

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: 1. an ectopic corticotropin-secreting tumor 2. adrenal carcinoma 3. a corticotropin-secreting pituitary adenoma 4. an inborn error of metabolism.

RATIONALES: (3) A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are often associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.

Mrs. DeToro is admitted to the medical-surgical unit for further monitoring. Which actions are appropriate? Select all that apply. a. Monitor intake and output b. Assess for hypertension c. Monitor blood glucose d. Administer IV cortisone e. Place the bed in the lowest position

a. Monitor intake and output c. Monitor blood glucose d. Administer IV cortisone e. Place the bed in the lowest position Rationale: The nursing assessment for a patient who is experiencing an adrenal crisis should include monitoring intake and output as well as blood glucose. Fluid loss occurs secondary to lack of mineralocorticoid and glucocorticoid, leading to loss of sodium followed by loss of water through the kidneys. Hypoglycemia occurs due to decreased cortisol. You would monitor for hypotension, not hypertension. IV cortisone is a priority for the treatment of the adrenal crisis and placing the bed in the lowest position is for safety.

Mrs. DeToro is at risk for pheochromocytoma as a result of the current diagnosis. Which assessment is the priority to monitor for while providing care? a. Eupnea b. Bradycardia c. Hypertension d. Hypoglycemia

c. Hypertension Rationale: Pheochromocytomas are rare catecholamine-secreting tumors of the adrenal medulla. Clinical manifestations of this disorder are related to the systematic actions of epinephrine and norepinephrine and include tachycardia (not bradycardia), hypertension, headaches, palpitations, hyperhidrosis, hypermetabolism, and hyperglycemia (not hypoglycemia). Eupnea, the term for normal respirations, would not be assessed for as a result of this complication. The severity of attacks correlates to the amount of catecholamine release. Paroxysmal (sudden-onset) hypertension is seen in some patients, with blood pressure elevations in excess of 250/140 mm Hg, posing a life-threatening emergency.

The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for during the client's focused assessment? a. peripheral edema b. Bilateral exophthalmos c. Signs and symptoms of hypovolemia d. signs and symptoms of hypocalcemia

c. Signs and symptoms of hypovolemia Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. Thus, a deficiency can cause hypovolemia. A deficiency of adrenocortical hormones (such as after adrenalectomy) does not cause the clinical manifestations noted in the remaining options.

The nurse is assessing a client diagnosed with adrenal cortical insufficiency. What clinical manifestations will the nurse expect to observe? Select all that apply. a. Weight gain b. Increased secretion of corticotropin-releasing hormone and adrenocorticotropic hormone c. Hypertension d. Increased secretion of melanocyte-stimulating hormone e. Darkened, bronzed hyperpigmentation

d. Increased secretion of melanocyte-stimulating hormone e. Darkened, bronzed hyperpigmentation

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? Myocardial infarction Thyroid storm Congestive heart failure Myxedema coma

d. Myxedema coma

Which is an expected finding in a client with adrenal crisis (addisonian crisis)? 1. fluid retention 2. pain 3. peripheral edema 4. hunger

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately report: sore throat. increased urine output. constipation. painful, excessive menstruation.

Sore Throat Explanation:The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider (HCP) signs and symptoms of infection, such as a sore throat and fever.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. muscle weakness b. tremors c. diaphoresis d. constipation

a. muscle weakness Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

In a 29-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in: a. serum glucose level b. hair loss c. bone mineralization d. menstrual flow

a. serum glucose level Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

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