Endocrine hesi practise endocrine

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na (sodium) 149 mEq/L; K (potassium) 3.2 mEq/L; Hb (hemoglobin) 17 g/dL; and glucose 90 mg/dL. What should the nurse teach the client? Select all that apply. 1 Avoid foods high in salt. 2 Restrict your fluid intake. 3 Eat foods high in potassium. 4 Limit your carbohydrate intake. 5 Continue your regular diet as before

1, 3 A sodium level of more than 145 mEq is considered hypernatremia; the client should be taught to avoid foods high in sodium (e.g., processed foods, specific condiments). A potassium level less than 3.5 mEq/L is considered hypokalemia. Therefore, the client should be encouraged to eat foods high in potassium. Restricting fluid intake will increase the serum sodium level and therefore is contraindicated. A glucose level of 90 mg/dL is within the expected range of less than 110 mg/dL and is not a concern.

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Select all that apply. 1 Use tinted glasses. 2 Use warm, moist compresses. 3 Elevate the head of the bed 45 degrees. 4 Tape eyelids shut at night if they do not close. 5 Apply a petroleum-based jelly along the lower eyelid

1, 3, 4 Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly.

What change in blood pressure (BP) should the nurse anticipate after a client has an aldosteronoma surgically removed? 1Rise quickly above preoperative levels. 2Fluctuate greatly during this entire period. 3Gradually return to expected levels for an adult. 4Drop very low before increasing rapidly to expected levels.

3 Once excessive secretion of aldosterone has stopped, BP gradually drops to a near-normal level. The blood pressure drops gradually; it does not rise.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1 Diarrhea 2 Listlessness 3 Weight loss 4 Bradycardia 5 Decreased appetite

1, 3

The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication? 1Increase sources of calcium 2Observe for signs of infection 3Take the drug through a straw 4Wear sunglasses when exposed to sunlight

2 PTU may lower the white blood cell count, making the client prone to infection.

A client is admitted with a diagnosis of Cushing syndrome. For which clinical manifestations should the nurse observe when assessing this client? Select all that apply. 1 Polyuria 2 Weakness 3 Hypertension 4 Truncal obesity 5 Intermittent tonic spasms

2, 3, 4

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease? 1Estrogens 2Androgens 3Glucocorticoids 4Mineralocorticoids

4

A client in thyroid storm tells the nurse, "I know I'm going to die. I'm very sick." What is the nurse's best response? 1"You must feel very sick and frightened." 2"Tell me why you feel you are going to die." 3"I can understand how you feel, although people do not die from this problem." 4"If you would like, I will call your family and tell them to come to the hospital."

1

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply. 1 Hirsutism 2 Menorrhagia 3 Buffalo hump 4 Dependent edema 5 Migraine headaches

1, 3

The nurse is assessing a client with hyperthyroidism. For which signs and symptoms should the nurse assess the client? Select all that apply. 1 Amenorrhea 2 Hypotension 3 Facial edema 4 Flushed appearance 5 Short attention span

1, 4, 5 Hypertension is associated with hyperthyroidism; hypotension is associated with hypothyroidism. Facial edema is not related to hyperthyroidism. Hypothyroidism is associated with decreased renal blood flow that results in fluid retention (e.g., peripheral and facial edema).

The nurse expects the diagnostic studies of a client with Cushing syndrome to indicate: 1 Moderately increased serum potassium levels 2Increased numbers of eosinophils in the blood 3High levels of 17-ketosteroids in a 24-hour urine test 4Normal to low levels of adrenocorticotropic hormone (ACTH)

3 High levels of 17-ketosteroids in a 24-hour urine test is a urinary metabolite of steroid hormones that are excreted in large amounts in hyperaldosteronism. With aldosterone hypersecretion, sodium is retained and potassium is excreted, resulting in hypernatremia and hypokalemia. With Cushing syndrome, the eosinophil count is decreased, not increased. ACTH levels usually are high in Cushing syndrome.

A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery? 1Vasopressin (Pitressin) 2Propylthiouracil (PTU) 3Potassium iodide (SSKI) 4Levothyroxine (Synthroid)

3

A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations? 1Fluid balance 2Electrolyte levels 3Protein anabolism 4Masculinizing hormones

3 Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein and fat stores and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease.

A client has had a resection of an aldosterone-secreting tumor of an adrenal gland. The client says to the nurse, "It will be good for me to return to work soon." Based on an understanding of the health problem, the nurse should: 1Caution the client about high expectations because the prognosis is variable; the outcome depends on many factors. 2Tell the client that returning to work is okay because the body has two adrenal glands; the tumor was on just one of the glands. 3Advise the client to investigate other occupational alternatives if the client wishes to stay in the workforce. 4Tell the client that returning to work is possible if the client takes prescribed hormone supplements.

3 The body has two adrenal glands; an aldosteronoma is a unilateral tumor. The prognosis usually is excellent; cautioning the client about high expectations because the outcome is variable is unnecessarily alarming. Advising the client to investigate other occupational alternatives if planning to return to work is unnecessary; the prognosis usually is excellent. Hormones are not necessary; there is another adrenal gland that will secrete an adequate amount of hormones.

A nurse is caring for a client with a tentative diagnosis of pheochromocytoma who is receiving chlorpromazine (Thorazine). A 24-hour urine specimen to assess the presence of vanillylmandelic acid (VMA) is prescribed to assist in the confirmation of the diagnosis. What information should the nurse include in the client teaching regarding this test? Select all that apply. 1 The client may take chlorpromazine during the test. 2 Encourage the client to engage in usual activities during the test. 3 Only salicylates (aspirin) can be taken for discomfort during the test. 4 All urine excreted over the 24-hour period must be saved and refrigerated. 5 Avoid coffee, chocolate, and citrus fruit for three days before and during the test.

4, 5

A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. In addition to these changes, the nurse further assesses this client for: 1Fatigue 2Dry skin 3Anorexia 4Bradycardia

1 Excessive metabolic activity associated with hyperthyroidism causes fatigue.

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, "I should call my health care provider if I develop: 1Dry hair and an intolerance to cold." 2Muscle cramping and sluggishness." 3Fatigue and an increased pulse rate." 4Tachycardia and an increase in weight."

1

A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply. 1 Hirsutism 2 Round face 3 Pitting edema 4 Buffalo hump 5 Hypoglycemia

1, 2, 4 Pitting edema does not occur except with concurrent severe heart failure. Hypercortisolism increases gluconeogenesis, causing hyperglycemia, not hypoglycemia.

The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit: 1Lability of mood 2Hair thinning 3Increased skin thickness 4Ectomorphism with a moon face

1

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug: 1Increases the uptake of iodine 2Causes the thyroid gland to atrophy 3Interferes with the synthesis of thyroid hormone 4Decreases the secretion of thyroid-stimulating hormone (TSH)

3 PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine.

A client suspected of having a hyperactive thyroid is scheduled for protein-bound iodine, T3, and T4 laboratory tests. To ensure accuracy of the test, the nurse asks if the client has: 1Allergies to seafood 2Consumed more protein than usual 3Had anything to drink before the test 4Had recent x-rays using radiopaque dye

4

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. Which plan reported by the client supports the nurse's conclusion that the teaching was effective? 1"Eliminate excessive blinking." 2"Not move my extraocular muscles." 3"Keep the head of my bed elevated." 4"Avoid using a sleeping mask at night."

4 A mask may irritate or scratch the cornea if the client turns and lies on it during the night.

A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated? 1Hypotension 2Hyperglycemia 3Sodium retention 4Potassium excretion

1 After an adrenalectomy, adrenal insufficiency causes hypotension because of fluid and electrolyte alterations. Hypoglycemia, not hyperglycemia, may be a problem stemming from the loss of glucocorticoids. Hyponatremia may occur because of the lack of mineralocorticoid production. Potassium, not sodium, ions may be retained because of the lack of mineralocorticoids.

A client with malignant hot nodules of the thyroid gland has a thyroidectomy. Immediately after the thyroidectomy, the nurse's priority action for this client is to: 1Place in low-Fowler position to limit edema of the neck 2Monitor intake and output strictly to assess for fluid overload 3Encourage coughing and deep breathing to prevent atelectasis 4Assess level of consciousness to determine recovery from anesthesia

1 The inflammatory response and trauma of surgery may cause edema; elevating the head facilitates drainage preventing compression of the trachea.

A client with a diagnosis of Graves disease refuses to have radioactive iodine (RAI) therapy, and a subtotal thyroidectomy is performed. What should the nurse do postoperatively to reduce the risk of thyroid storm? 1Provide a high-calorie diet. 2Prevent infection at the surgical site. 3Encourage postoperative breathing exercises. 4Demonstrate how to support the neck after surgery

2 Conditions such as trauma and infection can precipitate thyroid storm (thyroid crisis, thyrotoxic crisis).

The client is admitted to the hospital with a large goiter, and a thyroidectomy is performed. What should the nurse do during the first four hours after the surgery? Select all that apply 1 Ensure that the client lies flat. 2 Monitor vital signs every hour. 3 Monitor for stridor or dyspnea . 4 Monitor for the signs and symptoms of tetany. 5 Assess the sides and back of the client's neck for evidence of bleeding

3, 5 monitor for stridor, dyspnea, or other symptoms of acute airway obstruction that may result postoperatively. It is important to inspect the neck dressing, as well as the sides of the neck and behind the neck, for blood that may drain in that direction by gravity. The client needs to be placed in a semi-Fowler position to decrease tension on the suture line. Vital signs need to be monitored every 15 minutes until the client is stable, then every 30 minutes for 24 hours. Although this may be a complication of this surgery, tetany will not occur during the first 4 hours after surgery.

The nurse provides postoperative care to the client following subtotal thyroidectomy by: Select all that apply. 1 Assessing for frequent swallowing 2 Ambulating the client the evening of surgery 3 Assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes 4 Instructing the client to support the head and maintain the neck in a flexed position 5 Ensuring that oxygen, suction equipment, and a tracheosomy tray are at the bedside

1, 2, 3, 5 The bed should be placed in semi-Fowler position and the client should avoid neck flexion to prevent tension on the suture line.

The nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these, if found, are signs of Cushing disease? Select all that apply. 1 Round face 2 Dependent edema in the feet and ankles 3 Increased fatty deposition in the extremities 4 Thin, translucent skin with bruising 5 Increased fatty deposition in the neck and back

1, 2, 4, 5 There are increased levels of steroids and aldosterone, causing sodium and water retention in clients with Cushing syndrome. This increased fluid retention results in dependent peripheral edema.

A nurse is providing postoperative care for a client one hour after the client had an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse should monitor the client for which complication? 1Hypotension 2Hyperglycemia 3Sodium retention 4Potassium excretion

1 hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; Sodium retention is a sign of hyperadrenalism; Potassium excretion is a response to excessive adrenal hormones;

A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? Select all that apply. 1 Excessive thirst 2 Increased blood glucose 3 Dry mucous membranes 4 Increased blood pressure 5 Decreased serum osmolarity 6 Decreased urine specific gravity

1, 3, 6

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply. 1 Tremors 2 Bradycardia 3 Somnolence 4 Heat intolerance 5 Decreased blood pressure

1, 4 all others are sign of hypothyroidism

A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? Select all that apply. 1. Nausea and vomiting 2Hyperthermia 3 Bradycardia 4 increased weight 5 Decreased serum sodium 6 Decreased level of consciousness

1, 4, 5, 6 Water retention and decreased urinary output occur because of excess secretion of antidiuretic hormone (ADH). Early manifestations are related to water retention and may include gastrointestinal (GI) disturbances, such as loss of appetite, nausea, and vomiting. Weight gain occurs because of the water retention. Serum sodium levels are decreased because of fluid retention and sodium loss. Central nervous system changes include headaches, lethargy, and decreased level of consciousness, progressing to coma and seizures. Hypothermia also occurs because of central nervous system disturbance. The pulse is full and bounding because of the increased fluid volume.

A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? Select all that apply. 1 Cool skin 2 Photophobia 3 Constipation 4 Periorbital edema 5 Decreased appetite

1, 3, 4, 5 Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edema are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.

A client with small cell carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH). What signs should the nurse expect to observe? Select all that apply. 1 Oliguria 2 Seizures 3 Vomiting 4 Polydipsia 5 Polyphagia

1, 2, 3 Cancerous cells of small cell lung cancer can produce antidiuretic hormone, which causes fluid retention, resulting in increased blood volume and decreased urine volume. Fluid retention associated with SIADH can cause cerebral edema, resulting in confusion and seizures. Fluid retention resulting in hyponatremia causes nausea and vomiting. The client will have nausea and vomiting, resulting in a decreased oral fluid and food intake.

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? Select all that apply. 1 Emotional lability 2 Dyspnea on exertion 3 Abdominal distension 4 Decreased bowel sounds 5 Hyperactive deep tendon reflexes

1, 2, 5 Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurologic manifestation related to excessive production of thyroid hormones. Abdominal distension is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.

A client is admitted to the hospital with a diagnosis of Cushing syndrome. When performing an assessment, the nurse should take into consideration that the client will most likely exhibit signs of: 1Hyperkalemia and edema 2Hypotension and sodium loss 3Muscle wasting and hypoglycemia 4Muscle weakness and frequent urination

4 Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency; protein catabolism will cause muscle weakness.As sodium ions are retained, potassium is excreted; the result is hypokalemia. Edema occurs because of sodium retention. Hypotension and sodium loss are signs of Addison syndrome; in Cushing syndrome retention of sodium and fluids leads to hypervolemia and hypertension. Muscle wasting results from increased protein catabolism; however, hyperglycemia rather than hypoglycemia will result from increased gluconeogenesis.

A nurse is caring for a client after a thyroidectomy. For which signs of thyroid storm should the client be monitored? Select all that apply. 1 Increased heart rate 2 Increased temperature 3 Decreased respirations 4 Increased pulse deficit 5 Decreased blood pressure

1, 2 respiratory rate increases (tachypnea) to meet the body's oxygen needs. blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Select all that apply. 1 Lability of mood 2 Slow wound healing 3 A decrease in the growth of hair 4 Ectomorphism with a moon face 5 An increased resistance to bruising

1, 2 Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas.

Fludrocortisone (Florinef) is prescribed for a client with adrenal insufficiency. Which responses to the medication should the nurse teach the client to report? Select all that apply. 1 Edema 2 Rapid weight gain 3 Fatigue in the afternoon 4 Unpredictable changes in mood 5 Increased frequency of urination

1, 2 Fludrocortisone has a strong effect on sodium retention by the kidneys, which leads to fluid retention, causing edema and weight gain.

The nurse is providing care for a client with small-cell carcinoma of the lung that develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical findings correspond with the secretion of antidiuretic hormone (ADH)? Select all that apply. 1 Edema 2 Polyuria 3 Bradycardia 4 Hypotension 5 Hyponatremia

1, 5 Edema results as fluid is retained because of the increased secretion of antidiuretic hormone. ADH causes water retention, which dilutes serum electrolytes such as sodium, with a resultant hyponatremia. A decreased urine output occurs with SIADH because ADH causes reabsorption of fluid in the kidney glomeruli. The increased fluid volume associated with SIADH results in tachycardia, tachypnea, and crackles. The increased fluid volume associated with SIADH results in hypertension, not hypotension.

A nurse is caring for a client with myxedema who has undergone abdominal surgery. What should the nurse consider when administering opioids to this client? 1Tolerance to the drug develops readily. 2One-third to one-half the usual dose should be prescribed. 3Opioids may interfere with the secretion of thyroid hormones. 4Sedation will have a paradoxical effect, causing hyperactivity

2 Because of a decreased metabolism, the usual adult dose of an opioid may result in an overdose.

A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will: 1Be sterile for the rest of my life." 2Require larger doses of insulin than I did preoperatively." 3Have to take cortisone or a similar drug for the rest of my life." 4Have to take thyroxine or a similar medication for the rest of my life."

2 The hypophysis (pituitary gland) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy, any elevation of blood glucose level caused by somatotropin also will stop.

A client is taking an antithyroid medication for hyperthyroidism. The nurse provides education about serious health problems that may develop if the medication is not effective and tachycardia continues. The nurse instructs the client to seek medical attention immediately if any of the problems occur. Which should be included in the teaching? Select all that apply. 1 Diaphoresis 2 Weight gain 3 Flushed skin 4 Nervousness 5 Pedal edema

2, 3 Weight gain is a sign of heart failure, which may develop with the persistent tachycardia that is present with hyperthyroidism; this should be reported to the health care provider immediately. Pedal edema is a sign of heart failure, which may develop with the persistent tachycardia that is present with hyperthyroidism; this should be reported to the health care provider immediately. Diaphoresis, flushed skin, and nervousness are expected to occur with hyperthyroidism and need not be reported immediately.

After surgical clipping of a cerebral aneurysm, the client develops the syndrome of inappropriate secretion of antidiuretic hormone (ADH). For which manifestations of excessive levels of ADH should the nurse assess the client? Select all that apply. 1 Polyuria 2 Weight gain 3 Hypotension 4 Hyponatremia 5 Decreased specific gravity

2, 4 Excessive levels of ADH cause inappropriate free water retention; for every liter of fluid retained, the client will gain approximately 2.2 lb. Free water retention results in a hypoosmolar state with dilutional hyponatremia. Oliguria, not polyuria, occurs as ADH acts on nephrons to cause water to be reabsorbed from the glomerular filtrate. Because of water reabsorption, blood volume may increase, causing hypertension, not hypotension. This increases, not decreases, as a result of increased urine concentration.

Which physiological responses should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1 Bradycardia 2 Blurred vision 3 Cold intolerance 4 Increased appetite 5 Widened pulse pressure

2, 4, 5 Blurred vision may occur as a result of exophthalmos.

A nurse is caring for a client after radioactive iodine is administered for Grave's disease. What information about the client's condition after this therapy should the nurse consider when providing care? 1 Not radioactive and can be handled as any other individual 2Highly radioactive and should be isolated as much as possible 3Mildly radioactive but should be treated with routine safety precautions 4Not radioactive but may still transmit some dangerous radiations and must be treated with precautions

3

For which client response should the nurse monitor when assessing for complications of hyperparathyroidism? 1Tetany 2Seizures 3Bone pain 4Graves disease

3 Hyperparathyroidism causes calcium release from the bones, leaving them porous, weak, and painful

A client is admitted to the hospital for an adrenalectomy. When the nurse teaches the client about the prescribed medications, the nurse emphasizes that: 1 Steroid therapy will be given in conjunction with insulin 2Once regulated, the dosage will remain the same for life 3If taken late in the evening, the medication may cause insomnia 4Salt intake may have to be restricted while taking the medications

4 Administration of adrenocortical hormones causes sodium retention; dietary intake of salt should be limited.

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. The nurse concludes that this medication is given to: 1Decrease the total basal metabolic rate 2Maintain the function of the parathyroids 3Block the formation of thyroxine by the thyroid gland 4Decrease the size and vascularity of the thyroid gland

4 Potassium iodide aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed; it should be given no longer than 10 to 14 days before surgery because its effect is temporary

A client's laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations should the nurse assess this client? Select all that apply. 1 Muscle tremors 2 Abdominal cramps 3 Increased peristalsis 4 Cardiac dysrhythmias 5 Hypoactive bowel sounds

4, 5 When the serum calcium level is increased, initially it causes tachycardia; as it progresses, it depresses electrical conduction in the heart, causing bradycardia. Hypercalcemia causes decreased peristalsis identified by constipation and hypoactive or absent bowel sounds. Muscle tremors occur with hypocalcemia, not hypercalcemia. Abdominal cramps occur with hypocalcemia, not hypercalcemia. Increased intestinal peristalsis occurs with hypocalcemia, not hypercalcemia.