ENDOCRINE QUESTIONS

A nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). Which client response is associated with an underproduction of thyroxine? A. Myxedema B. Acromegaly C. Graves disease D. Cushing disease

A. myxedema RATIONALE: Myxedema is the severest form of HYPOthyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Gravesdisease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids

When assessing a client with Graves disease (hyperthyroidism), what would the nurse expect to find in the client's history? A. Diaphoresis B. Menorrhagia C. Dry, brittle hair D. Sensitivity to cold

A. Diaphoresis RATIONALE: Increased basal metabolic rate, increased circulation, and vasodilation result in warm, moist skin.

What clinical indicators should a nurse assess when caring for a client with hyperthyroidism? A. Dry skin B. Weight loss C. Tachycardia D. Restlessness E. Constipation F. Exophthalmos

B, C, D, and F RATIONALE: Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema.

What interventions should the nurse implement in caring for a client with diabetes insipidus following a head injury? A. Providing adequate fluids within easy reach B. Reporting an increasing urine specific gravity C. Administering prescribed erythromycin D. Assessing for and reporting changes in neurological status E. Monitoring for constipation, weight loss, hypotension, and tachycardia

A, D, and E RATIONALE: Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes.

A nurse is caring for a client after a thyroidectomy. Which symptoms indicating thyroid storm should the nurse monitor the client for? A. Increased heart rate B. Increased temperature C. Decreased respirations D. Increased pulse deficit E. Decreased blood pressure

A, and B RATIONALE: Thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby causing an increased heart rate (tachycardia)

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? A. Urine output B. Glucose level C. Serum potassium D. Immune response

B. Glucose level RATIONALE: As a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels.

A client is admitted to the hospital with a diagnosis of Cushing syndrome. What signs and symptoms will the client most likely exhibit? A. Hyperkalemia and edema B. Hypotension and sodium loss C. Muscle wasting and hypoglycemia D. Muscle weakness and frequent urination

D. Muscle weakness and frequent urination

The nurse is caring for a client diagnosed with Cushing syndrome. Which symptoms does the nurse expect the client to exhibit? A. Lability of mood B. Postural hypotension C. Increased skin thickness D. Ectomorphism with a moon face

A. Lability of mood RATIONALE: Excess adrenocorticoids can cause emotional lability, euphoria, and psychosis. Ectomorphism is a term for a tall, thin, genetically-determined body type and is not related to adaptations to Cushing syndrome

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? A. Lability of mood B. Slow wound healing C. A decrease in the growth of hair D. Ectomorphism with a moon face E. An increased resistance to bruising

A, B RATIONALE: Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing

A nurse provides care to a client following a subtotal thyroidectomy. Which interventions should the nurse implement? A. Assessing for frequent swallowing B. Ambulating the client the evening of surgery C. Assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes D. Instructing the client to support the head and maintain the neck in a flexed position E. Ensuring that oxygen, suction equipment, and a tracheostomy tray are at the bedside

A, B, C, E RATIONALE: Frequent swallowing in the postoperative period following a subtotal thyroidectomy may indicate hemorrhage. In the absence of complications, the client should be ambulated within a few hours following surgery. The bed should be placed in semi-Fowler position, and the client should avoid neck flexion to prevent tension on the suture line.

During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? A. Palpitations B. Tachycardia C. Thickened skin D. Apathetic attitude E. Missed menstrual periods

A, B, and E RATIONALE: Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate ad myocardial irritability. Menstrual disturbances are associated with hyperthyroidism; when can experience lightened periods or missed periods. Thickened skin and an apathetic attitude are associated with HYPOthyroidism and myxedema

The nurse is educating the client newly diagnosed with type 2 diabetes on oral antibiotic medications. What should the nurse include in the teaching plan? A. The client should obtain a finger stick blood glucose reading before each meal. B. The client does not need to follow a specific diet until insulin is required. C. The teaching plan should include signs and symptoms of hypoglycemia. D. The teaching plan does not need to include signs and symptoms of hypoglycemia, as the client is not on insulin. E. The teaching plan should include sick day rules.

A, C, and E RATIONALE: All diabetic clients, regardless of type, should check finger stick blood sugars before each meal and snack. All diabetic clients need to be educated on sick day rules. All diabetic clients should follow the American Diabetes Association diet.

The nurse is providing care for a client with small-cell carcinoma of the lung who develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical finding correspond with the secretion of antidiuretic hormone (ADH)? A. Edema B. Polyuria C. Bradycardia D. Hypotension E. Hyponatremia

A, and E RATIONALE: Edema results as fluid is retained because of the increase secretion of antidiuretic hormone. ADH causes water retention, which dilutes serum electrolytes such as sodium, with a resultant hyponatremia.

The nurse is caring for the client posttranssphenoidal hypophysectomy. When assessing the client, the nurse observes clear drainage from the nares. What could be the cause of this drainage? A. A cerebral spinal fluid leak from an opening to the brain. B. A normal occurrence for this client's procedure. C. The client is developing an infection. D. The client may have had a cold preoperatively, and the nurse will continue to monitor.

A. A cerebral spinal fluid leak from an opening to the brain.

A nurse is caring for a newly admitted client with a diagnosis of Graves disease. In preparing a teaching plan, the nurse anticipates which diet will be prescribed for this client? A. High-calorie diet B. Low-sodium diet C. High-roughage diet D. Mechanical-soft diet

A. High-calorie diet RATIONALE: Because of the individual's increased metabolic rate, a high-calorie diet is needed to meet the energy demands of the body and prevent weight loss. Sodium is not restricted because clients with hyperthyroidism perspire heavily and lose sodium.

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

A. Hypotension RATIONALE: Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy.

A nurse is caring for an adult client with acromegaly. What clinical manifestation does the nurse expect the client to exhibit? A. Prominent jaw B. Decreased pulse C. Increased height D. Increased sodium

A. Prominent jaw

A client is admitted with a diagnosis of Cushing syndrome. Which clinical manifestations should the nurse expect the client to exhibit? A. Emaciation B. Weakness C. Hypertension D. Truncal obesity E. Intermittent tonic spasms

B, C, and D RATIONALE: Weakness occurs in response to the excessive catabolism of proteins and resulting loss of muscle mass

A nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? A. Polyuria B. Truncal obesity C. Hypotension D. Sleep disturbance E. Thin arms and legs

B, D, and E RATIONALE: Truncal obesity is a key feature of Cushing syndrome. Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting.

Postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurses observes muscle twitching. Which complication does the nurse suspect the client is experiencing? A. Hypokalemia B. Hypocalcemia C. Thyrotoxic crisis D. Hypovolemic shock

B. Hypocalcemia RATIONALE: The signs and symptoms presented in the question indicate hypocalcemia

In anticipation of a client returning to their room following a subtotal thyroidectomy, what intervention would be highest priority for the nurse to perform? A. Have sterile dressing supplies in the room. B. Place a tracheostomy set at the bedside. C. Lock the client's bed in a supine position until surgeon orders a different position. D. Have pencil and paper in the room so the client can communicate their needs in writing.

B. Place a tracheostomy set at the bedside. RATIONALE: Thyroid surgery sometimes results in accidental removal of the parathyroid glands. A resultant hypocalcemia may lead to contraction of the glottis, causing airway obstruction; edema around the operative site also may cause airway obstruction.

While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes? A. Having diabetes insipidus B. Eating low-cholesterol foods C. Being 20 pounds (9 kilograms) overweight D. Drinking a daily alcoholic beverage

C. Being 20 pounds (9 kilos) overweight RATIONALE: Excessive body weight is a known predisposing factor to type 2 diabetes; the exact relationship is unknown. Diabetes insipidus is caused by too little antidiuretic hormone (ADH) and has no relationship to type 2 diabetes.

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? A. Cortical hormones stimulate rapid weight loss. B. Tissue catabolism results in a negative nitrogen balance. C. Glucocorticoids accelerate the process of gluconeogenesis. D. Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue.

C. Glucocorticoids accelerate the process of gluconeogenesis. RATIONALE: Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH

A primary healthcare provider prescribes a low-sodium, high potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet? A. "The use of salt probably contributed to the disease." B. "Excess weight will be gained if sodium is not limited." C. "The loss of excess sodium and potassium in the urine requires less renal stimulation." D. "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."

D. "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium" Clients with Cushing syndrome must limit their intake of salt and increase their intake of potassium. The kidneys are retaining sodium and excreting potassium. An excessive secretion of adrenocortical hormones in Cushing syndrome, NOT increased or high sodium intake, is the problem

A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan to encourage this client to modify dietary intake? A. Increased amounts of potassium are needed to replace renal losses. B. Increased protein is needed to heal the adrenal tissue and thus cure the disease. C. Supplemental vitamins are needed to supply energy and assist in regaining the lost weight. D. Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium.

D. Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium. RATIONALE: Lack of mineralocorticoids (aldosterone) leads to loss of sodium ions in the urine. Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids

A nurse is caring for a client admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder? A. Diarrhea and pyrexia B. Edema and hypertension C. Moon face and hirsutism D. Hypoglycemia and hypotension

D. Hypoglycemia and hypotension RATIONALE: Adrenocortical insufficiency causes decreased glucocorticoids, resulting in fluid excretion that leads to hypotension.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." What is the nurse's best response to this statement? A. Explain that this reaction is expected and not a concern. B. Take the vital signs and place the client in a high-Fowler position. C. Request stat serum calcium and phosphorus levels and chart the results. D. Test for Chvostek and Trousseau signs and notify the primary healthcare provider of the complaints.

D. Test for Chvostek and Trousseau signs and notify the primary healthcare provider of the complaints. RATIONALE: These symptoms may indicate impending hypocalcemia tetany, a complication after removal of parathyroid tissue during a thyroidectomy