Endocrine Saunders

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. 1. Monitor daily weight. 2. Monitor intake and output. 3. Assess extremities for edema. 4. Maintain a high-sodium diet. 5. Maintain a low-potassium diet.

1. Monitor daily weight. 2. Monitor intake and output. 3. 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 determines that the client needs further instruction about prescribed thyroid replacement medication if which statement is made? 1."I should expect full therapeutic effect from the medication within 3 to 5 days." 2."I should take my medication in the morning about 1 hour before eating breakfast." 3."I need to make sure that I store the medication in the dark container I received it in." 4."I should check with my primary health care provider before taking any over-the-counter medications."

1."I should expect full therapeutic effect from the medication within 3 to 5 days."

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin. The nurse contacts the primary health care provider (PHCP), anticipating that the PHCP will prescribe which medication? 1.A decreased dosage of warfarin 2.An increased dosage of warfarin 3.A decreased dosage of levothyroxine 4.An increased dosage of levothyroxine

1.A decreased dosage of warfarin

A 33-year-old female client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 1.Amenorrhea 2.Menorrhagia 3.Metrorrhagia 4.Dysmenorrhea

1.Amenorrhea Amenorrhea or a decreased menstrual flow occurs in the client with Graves' disease. Menorrhagia, metrorrhagia, and dysmenorrhea are also disorders related to the female reproductive system; however, they are not typical manifestations of Graves' disease.

Propylthiouracil is prescribed for a client with hyperthyroidism. The nurse provides instructions to the client regarding the medication and informs the client to notify the primary health care provider (PHCP) if which sign or symptom occurs? 1.Fever 2.Dry mouth 3.Drowsiness 4.Increased urination

1.Fever

During physical examination of a client, which finding is characteristic of hypothyroidism? 1.Periorbital edema 2.Flushed, warm skin 3.Hyperactive bowel sounds 4.Heart rate of 120 beats/min

1.Periorbital edema

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1.Thyroid 2.Pituitary 3.Parathyroid 4.Adrenal cortex

1.Thyroid

The nurse should tell the client who is taking levothyroxine to notify the primary health care provider (PHCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1.Dry skin 2.Bulging eyeballs 3.Periorbital edema 4.Coarse facial features

2.Bulging eyeballs

A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse should expect which electrolyte abnormality? 1.Sodium 2.Calcium 3.Potassium 4.Magnesium

2.Calcium The C cells of the thyroid gland are helpful in maintaining normal plasma calcium levels. They do not affect the levels of sodium, potassium, or magnesium.

A client has overactivity of the thyroid gland. The nurse should expect which finding? 1.Weight gain 2.Nutritional deficiencies 3.Low blood glucose levels 4.Increased body fat stores

2.Nutritional deficiencies

The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifestations might the nurse expect to note on examination of this client? Select all that apply. 1.Irritability 2.Periorbital edema 3.Coarse, brittle hair 4.Slow or slurred speech 5.Abdominal distention 6.Soft, silky, thinning hair

2.Periorbital edema 3.Coarse, brittle hair 4.Slow or slurred speech 5.Abdominal distention

A client with diabetes insipidus asks the nurse about the purpose of a new medication, vasopressin. The nurse provides teaching about the medication. Which statement by the client indicates successful teaching? 1. "It causes muscle contractions." 2. "It opens up my blood vessels." 3. "It prevents me from 'peeing' so much." 4. "It decreases stomach and colon motility."

3. "It prevents me from 'peeing' so much."

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 1. Glycosuria 2. Diaphoresis 3. Weight loss 4. Hypertension

4. Hypertension Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms.

The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements should the nurse include in the discharge teaching instructions? Select all that apply. 1. "Include adequate fiber and fluids in your diet." 2. "Wear slip-on shoes rather than those that need to be tied." 3. "A postnasal drip may be expected for several weeks after surgery." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5. "Contact your primary health care provider immediately if you develop any headache, fever, or neck stiffness."

1. "Include adequate fiber and fluids in your diet." 2. "Wear slip-on shoes rather than those that need to be tied." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5. "Contact your primary health care provider immediately if you develop any headache, fever, or neck stiffness."

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

1. Fever 2. Nausea 4. Tremors 5. Confusion Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

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? 1. Hypotension and fever 2. Mental status changes and hypertension 3. Subnormal temperature and hypotension 4. Complaints of weakness and hypertension

1. Hypotension and fever

The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor for changes in mentation. 2. Encourage an intake of low-protein foods. 3. Encourage an intake of low-sodium foods. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output.

1. Monitor for changes in mentation. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output. The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase intake of sodium, protein, and complex carbohydrates and fluids. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required. Mentation, vital signs, skin turgor and intake and output should be monitored for signs of fluid volume deficit. Urden et al. (2018), p. 718.

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 1. Polyuria 2. Polydipsia 3. Concentrated urine 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

1. Polyuria 2. Polydipsia 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005 A triad of clinical symptoms-polyuria, polydipsia, and excessive thirst-often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L).

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply. 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care 5. A reminder to read the labels on over-the-counter medications before purchase

1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the health care provider (HCP) before purchasing any over-the-counter medications, and maintaining regular outpatient follow-up care. The nurse also should instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

Which findings should raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply. 1. Urine specific gravity is 1.001. 2. Ketones are present in the urine. 3. Jugular venous distention is observed. 4. Serum osmolality is 320 mOsm/kg (320 mmol/kg) of water. 5. Blood glucose levels are greater than 200 mg/dL (11.4 mmol/L). 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

1. Urine specific gravity is 1.001. 4. Serum osmolality is 320 mOsm/kg (320 mmol/kg) of water. 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours. Signs of diabetes insipidus include low urine specific gravity (<1.005), high serum osmolality (>300 mOsm/kg of water), and increased urine output from a deficiency of antidiuretic hormone (ADH). Options 2, 3, and 5 are not characteristic of diabetes insipidus.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1. Administer methimazole with food. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side/adverse effects such as sore throat, fever, or headaches. Skidmore-Roth (2017), pp. 761-762.

A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

1. Hypotension 3. Hyperkalemia Rationale: In Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as acute adrenal insufficiency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor. Addisonian crisis is a life-threatening emergency. One of the roles of endogenous cortisol is to enhance vascular tone and vascular response to the catecholamines epinephrine and norepinephrine. Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. The role of aldosterone in the body is to support the blood pressure by holding salt and water and excreting potassium. When there is insufficient aldosterone, salt and water are lost and potassium builds up; this leads to hypotension from decreased vascular volume, hyponatremia, and hyperkalemia. The remaining options are not associated with addisonian crisis.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1.Administer methimazole with food. 2.Place the client on a low-calorie, low-protein diet. 3.Assess the client for unexplained bruising or bleeding. 4.Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5.Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1.Administer methimazole with food. 3.Assess the client for unexplained bruising or bleeding. 4.Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the primary health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

The nurse is assessing a client who has a diagnosis of goiter. Which should the nurse expect to note during the assessment of the client? 1.An enlarged thyroid gland 2.The presence of heart damage 3.Client complaints of chronic fatigue 4.Client complaints of slow wound healing

1.An enlarged thyroid gland

A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed, and the serum calcium level is 12.0 mg/dL (3 mmol/L). Which medication should the nurse anticipate to be prescribed for the client? 1.Calcitonin 2.Calcium chloride 3.Calcium gluconate 4.Large doses of vitamin D

1.Calcitonin The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). This client is experiencing hypercalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. Calcium chloride and calcium gluconate are medications used for the treatment of tetany that occurs from acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided.

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1.Dry skin 2.Thin, silky hair 3.Bulging eyeballs 4.Fine muscle tremors

1.Dry skin

The nurse is teaching a client with hyperthyroidism about the prescribed medication, propylthiouracil. The nurse determines that teaching has been successful if the client states to report which symptom to the primary health care provider (PHCP)? 1.Fever 2.Fatigue 3.Excitability 4.Nervousness

1.Fever

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1.Fever 2.Nausea 3.Lethargy 4.Tremors 5.Confusion 6.Bradycardia

1.Fever 2.Nausea 4.Tremors 5.Confusion

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1.Fever and tachycardia 2.Pallor and tachycardia 3.Agitation and bradycardia 4.Restlessness and bradycardia

1.Fever and tachycardia Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever with temperatures greater than 100º F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.

A client with a diagnosis of Addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1.Hypotension 2.Leukocytosis 3.Hyperkalemia 4.Hypercalcemia 5.Hypernatremia

1.Hypotension 3.Hyperkalemia

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1.Insomnia 2.Weight loss 3.Bradycardia 4.Constipation 5.Mild heat intolerance

1.Insomnia 2.Weight loss 5.Mild heat intolerance

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1.Iodine 2.Calcium 3.Phosphorus 4.Magnesium

1.Iodine Adequate dietary iodine is needed to produce T3and T4. The other requirements for adequate T3and T4 production are an intact thyroid gland and a functional hypothalamus-pituitary-thyroid feedback system. The remaining options are not responsible for the abnormal amounts of circulating T3 and T4.

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1.Irritability 2.Complaints of nausea 3.Sodium level of 128 mEq/L (128 mmol/L) 4.Potassium level of 3.2 mEq/L (3.2 mmol/L) 5.Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1.Irritability 2.Complaints of nausea 3.Sodium level of 128 mEq/L (128 mmol/L) 5.Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

A client with a recent history of total thyroidectomy has developed iatrogenic hypoparathyroidism. Which observed findings does the nurse determine are associated with the hypoparathyroidism? Select all that apply. 1.Laryngospasm 2.Nephrolithiasis 3.Muscle weakness 4.Positive Chvostek's sign 5.Positive Trousseau's sign

1.Laryngospasm 4.Positive Chvostek's sign 5.Positive Trousseau's sign Hypoparathyroidism is an uncommon condition associated with inadequate circulating parathyroid hormone (PTH). It is characterized by hypocalcemia resulting from a lack of PTH to maintain serum calcium levels. The most common cause is iatrogenic; for example, accidental removal of the parathyroid gland during neck surgery. Signs and symptoms of hypocalcemia include laryngospasm and positive Chvostek's and Trousseau's signs. The remaining options are incorrect.

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1.Obtain dark glasses for the client. 2.Lubricate the eyes with tap water every 2 to 4 hours. 3.Administer methimazole every 8 hours around the clock. 4.Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.

1.Obtain dark glasses for the client.

A primary health care provider has prescribed propylthiouracil for a client with hyperthyroidism. The nurse recalls that first-line treatment calls for methimazole for medication therapy. The nurse should question the client about her past medical history, specifically regarding which condition? 1.Pregnancy 2.Renal failure 3.Prolonged QT interval 4.Adverse reaction to levothyroxine

1.Pregnancy Methimazole and propylthiouracil are both used to treat hyperthyroidism. Methimazole is considered first-line treatment; however, this medication cannot be used for clients who are in their first trimester of pregnancy, have had a previous adverse reaction to methimazole, or need rapid reduction of symptoms. Renal failure, prolonged QT interval, and adverse reaction to levothyroxine are not related to contraindications for methimazole.

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which item in the preoperative period? 1.Vital signs 2.Fluid balance 3.Anxiety level 4.Creatinine levels

1.Vital signs Hypertension is the hallmark symptom of pheochromocytoma. Severe hypertension can precipitate a stroke (brain attack) or sudden blindness. Although all of the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority? 1.Vital signs 2.Intake and output 3.Blood urea nitrogen results 4.Urine for glucose and ketones

1.Vital signs Pheochromocytoma is a catecholamine-producing tumor. Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all of the options are accurate nursing interventions for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs, particularly the blood pressure.

The nurse teaches the client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1. "This medication will turn my urine orange." 2. "I should decrease my oral fluids when I start this medication." 3. "The amount of urine I make should increase if this medicine is working." 4. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5. "I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin."

2. "I should decrease my oral fluids when I start this medication." 5. "I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin." Skidmore-Roth (2017), pp. 343-344

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1. "It relieves the headaches." 2. "It increases water reabsorption." 3. "It stimulates the production of aldosterone." 4. "It decreases the production of the antidiuretic hormone."

2. "It increases water reabsorption."

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement should the nurse make to the client? 1. "Don't be concerned; this problem can be covered with clothing." 2. "Usually these physical changes slowly improve following treatment." 3. "This is permanent, but looks are deceiving and are not that important." 4. "Try not to worry about it; there are other things to be concerned about."

2. "Usually these physical changes slowly improve following treatment."

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

2. Maintain a patent airway.

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2. Test the drainage for glucose.

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1."Cortisol will be secreted." 2."Aldosterone will be secreted." 3."Additional glucagon will be produced." 4."Adrenocorticotropic hormone production will increase."

2."Aldosterone will be secreted." Aldosterone is the primary mineralocorticoid that is produced and secreted in response to lowered blood volume. Cortisol is a glucocorticoid. Glucagon is produced by the pancreas and functions to oppose the action of insulin in regulating blood glucose levels. Adrenocorticotropic hormone is produced by the pituitary gland and stimulates the adrenal cortex to produce glucocorticoids and mineralocorticoids.

The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1.A client with hypothyroidism 2.A client with Graves' disease who is having surgery 3.A client with diabetes mellitus scheduled for a diagnostic test 4.A client with diabetes mellitus scheduled for debridement of a foot ulcer

2.A client with Graves' disease who is having surgery Thyrotoxicosis usually is seen in clients with Graves' disease in whom the symptoms are precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, delivery, or major surgery. It also must be recognized as a potential complication after thyroidectomy. The client conditions in the remaining options are not associated with thyrotoxicosis.

A client has returned to the nursing unit after a thyroidectomy. The nurse notes that the client is complaining of tingling sensations around the mouth, fingers, and toes. On the basis of these findings, the nurse should next assess the results of which serum laboratory study? 1.Sodium 2.Calcium 3.Potassium 4.Magnesium

2.Calcium After surgery on the thyroid gland, the client may experience a temporary calcium imbalance. This is due to transient malfunction of the parathyroid glands. The nurse also would assess for Chvostek's and Trousseau's signs. The correct treatment is administration of calcium gluconate or calcium lactate. The remaining options are unrelated to the client's complaints.

A client visits the primary health care provider's office for a routine physical examination and reports a new onset of intolerance to cold. Since hypothyroidism is suspected, which additional information would be noted during the client's assessment? 1.Weight loss and tachycardia 2.Complaints of weakness and lethargy 3.Diaphoresis and increased hair growth 4.Increased heart rate and respiratory rate

2.Complaints of weakness and lethargy

A client who visits the primary health care provider's office for a routine physical examination reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse should check for which manifestations? 1.Weight loss and thinning skin 2.Complaints of weakness and lethargy 3.Diaphoresis and increased hair growth 4.Increased heart rate and respiratory rate

2.Complaints of weakness and lethargy

A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. Which items would be the most appropriate choice for this client to meet nutritional needs? 1.Crackers with cheese and tea 2.Graham crackers and warm milk 3.Toast with peanut butter and cocoa 4.Vanilla wafers and coffee with cream and sugar

2.Graham crackers and warm milk The client with pheochromocytoma needs to be provided with a diet high in vitamins, minerals, and calories. Foods or beverages that contain caffeine, such as cocoa, coffee, tea, or colas, are prohibited because they can precipitate a hypertensive crisis.

The nurse is instructing a client who is taking levothyroxine and tells the client that full therapeutic benefits will be seen when? 1.Immediately 2.In 1 to 3 weeks 3.Within 24 hours 4.Within 3 to 5 days

2.In 1 to 3 weeks

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1.Warm the client. 2.Maintain a patent airway. 3.Administer thyroid hormone. 4.Administer fluid replacement.

2.Maintain a patent airway.

The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention should the nurse include in the plan of care? 1.Maintain a supine position. 2.Monitor neck circumference every 4 hours. 3.Maintain a pressure dressing on the operative site. 4.Encourage deep-breathing exercises and vigorous coughing exercises.

2.Monitor neck circumference every 4 hours. After thyroidectomy, neck circumference is monitored every 2 hours to assess for the occurrence of postoperative edema. The client should be placed in an upright position to facilitate air exchange. A pressure dressing is not placed on the operative site because it may restrict breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. The nurse should assist the client with deep-breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision

A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse that she is experiencing a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client? 1.Dilute the medication in 8 oz of water. 2.Report the symptom to the primary health care provider (PHCP). 3.Continue to take the medication because the symptom is normal. 4.Take one half dose of the prescribed medication for the next 2 days.

2.Report the symptom to the primary health care provider (PHCP).

When teaching the client with adrenal insufficiency about cortisone, the nurse should include which items? Select all that apply. 1.Increase intake of sodium. 2.Take the medication with food. 3.Increase intake of potassium-rich foods. 4.Stay away from people with active infections. 5.Discontinue the medication when symptoms subside. 6.Notify the primary health care provider if illness occurs or surgery is anticipated.

2.Take the medication with food. 3.Increase intake of potassium-rich foods. 4.Stay away from people with active infections. 6.Notify the primary health care provider if illness occurs or surgery is anticipated.

The nurse should tell the client who is taking levothyroxine to notify the primary health care provider (PHCP) if which problem occurs? 1.Fatigue 2.Tremors 3.Cold intolerance 4.Excessively dry skin

2.Tremors

The nurse is caring for a client who had intracranial surgery and is now suspected of having developed diabetes insipidus (DI). What initial prescription should the nurse expect from the primary health care provider (PHCP)? 1. Serum electrolytes 2. Urine specific gravity 3. 24-hour fluid intake and output without restricting food or fluid intake 4. Postoperative magnetic resonance imaging to detect any damage to the hypothalamus or pituitary gland

3. 24-hour fluid intake and output without restricting food or fluid intake The first step in diagnosing DI is to measure a 24-hour fluid intake and output without restricting food or fluid intake. All of the other options may be done but would not be as definitive as a 24-hour fluid intake and output test.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's primary health care provider? 1. A decreased dosage of levothyroxine 2. An increased dosage of levothyroxine 3. A decreased dosage of warfarin sodium 4. An increased dosage of warfarin sodium

3. A decreased dosage of warfarin sodium Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 99 mg/dL (5.5 mmol/L) 3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels among other abnormalities. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH)

3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH) SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 6. Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

3. On an empty stomach Hodgson, Kizior (2018), p. 675.

A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complication? 1. Diarrhea 2. Infection 3. Polydipsia 4. Weight gain

3. Polydipsia

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron? 1. The glomerulus and the calices 2. The loop of Henle and the distal tubule 3. The distal tubule and the collecting duct 4. The proximal tubule and the loop of Henle

3. The distal tubule and the collecting duct

The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions? 1."I expect to experience some tingling of my toes, fingers, and lips after surgery." 2."I will definitely have to continue taking antithyroid medications after this surgery." 3."I need to place my hands behind my neck when I have to cough or change positions." 4."I need to turn my head and neck front, back, and laterally every hour for the first 12 hours after surgery."

3."I need to place my hands behind my neck when I have to cough or change positions." The client is taught that tension needs to be avoided on the suture line; otherwise hemorrhage may develop. One way of reducing incisional tension is to teach the client how to support the neck when coughing or being repositioned. Likewise, during the postoperative period the client should avoid any unnecessary movement of the neck. That is why sandbags and pillows frequently are used to support the head and neck. Any postoperative tingling in the fingers, toes, and lips probably is due to injury to the parathyroid gland during surgery, resulting in hypocalcemia. These signs and symptoms need to be reported immediately. Removal of the thyroid does not mean that the client will be taking antithyroid medications postoperatively. Thyroid replacement medications are necessary.

Thyroid replacement therapy is prescribed for the client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which is the appropriate nursing response? 1."It depends on the results of the laboratory tests." 2."Most clients require medication for about 1 year." 3."The medication will need to be continued for life." 4."You will need to ask your primary health care provider."

3."The medication will need to be continued for life."

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's primary health care provider? 1.A decreased dosage of levothyroxine 2.An increased dosage of levothyroxine 3.A decreased dosage of warfarin sodium 4.An increased dosage of warfarin sodium

3.A decreased dosage of warfarin sodium Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

The nurse should include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1.Provide a warm environment for the client. 2.Instruct the client to consume a low-fat diet. 3.A thyroid-releasing inhibitor will be prescribed. 4.Encourage the client to consume a well-balanced diet. 5.Instruct the client that thyroid replacement therapy will be needed. 6.Instruct the client that episodes of chest pain are expected to occur.

3.A thyroid-releasing inhibitor will be prescribed. 4.Encourage the client to consume a well-balanced diet. The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the primary health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

The clinic nurse is caring for an infant who has been diagnosed with primary hypothyroidism. The nurse is reviewing the results of the laboratory tests for thyroxine (T4) and thyroid-stimulating hormone (TSH). Which laboratory finding indicates a diagnosis of primary hypothyroidism? 1.A normal T4 level 2.An elevated T4 level 3.An elevated TSH level 4.A decreased TSH level

3.An elevated TSH level Diagnostic findings in primary hypothyroidism include a low T4 level and a high TSH level. The remaining options are not diagnostic findings of this condition.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1.Hoarseness 2.Hypocalcemia 3.Audible stridor 4.Edema at the surgical site

3.Audible stridor Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible complication of thyroid surgery? 1.Increased serum sodium level 2.Increased serum glucose level 3.Decreased serum calcium level 4.Decreased serum albumin level

3.Decreased serum calcium level Hypocalcemia may occur if the parathyroid glands are removed or damaged or if their blood supply is impaired during thyroid surgery, resulting in decreased parathyroid hormone (PTH) levels and leading to decreased serum calcium levels. Serum sodium, albumin, and glucose levels are not affected by thyroid surgery.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1.Tremors 2.Weight loss 3.Feeling cold 4.Loss of body hair 5.Persistent lethargy 6.Puffiness of the face

3.Feeling cold 4.Loss of body hair 5.Persistent lethargy 6.Puffiness of the face Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. What is the appropriate nursing response to the client? 1.A higher dosage is required. 2.The medication may need to be changed. 3.Full therapeutic effect may take 1 to 3 weeks. 4.Full therapeutic effect may take up to 4 months.

3.Full therapeutic effect may take 1 to 3 weeks.

A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit a sign of thyroid storm. Which is an early indicator of this complication? 1.Bradycardia 2.Constipation 3.Hyperreflexia 4.Low-grade temperature

3.Hyperreflexia Clinical manifestations of thyroid storm include a fever as high as 106º F, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation, hypotension, atrial fibrillation, and cardiovascular collapse.

A nurse is caring for a client with thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse should assess for which sign or symptom? 1.Bradycardia 2.Constipation 3.Hypertension 4.Low-grade temperature

3.Hypertension Thyroid storm is an acute, life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Clinical manifestations of thyroid storm include systolic hypertension, tachycardia, diarrhea, and a fever as high as 106º F. Other manifestations include abdominal pain, dehydration, extreme vasodilation, stupor rapidly progressing to coma, atrial fibrillation, and cardiovascular collapse. Bradycardia, constipation, and low-grade temperature are not a part of the clinical picture in thyroid storm.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1.Provide a cool environment for the client. 2.Instruct the client to consume a high-fat diet. 3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 5.Inform the client that iodine preparations will be prescribed to treat the disorder. 6.Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 6.Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

A nurse is reviewing the primary health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify? 1.Acetaminophen 2.Docusate sodium 3.Morphine sulfate 4.Levothyroxine sodium

3.Morphine sulfate Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1.With food 2.At lunchtime 3.On an empty stomach 4.At bedtime with a snack

3.On an empty stomach

A client who has been taking iodine solution is admitted to the emergency department, and an iodine overdose is suspected. Gastric lavage is initiated to remove the iodine from the stomach. In addition to treatment with gastric lavage, the nurse anticipates that which medication will be administered? 1.Vitamin K 2.Acetylcysteine 3.Sodium thiosulfate 4.Calcium gluconate

3.Sodium thiosulfate Iodine solution can cause iodine toxicity. Iodine is corrosive, and an overdose will injure the gastrointestinal tract. Symptoms include abdominal pain, vomiting, and diarrhea. Swelling of the glottis may result in asphyxiation. Treatment consists of gastric lavage to remove iodine from the stomach and administration of sodium thiosulfate to reduce iodine to iodide. Vitamin K is the antidote for warfarin. Acetylcysteine is the antidote for acetaminophen overdose. Calcium gluconate is used for acute hypocalcemia.

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1.Bradycardia 2.Flaccid paralysis 3.Tingling around the mouth 4.Absence of Chvostek's sign

3.Tingling around the mouth After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. Bradycardia, flaccid paralysis, and absence of Chvostek's sign are not signs of hypocalcemia

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1.To treat thyroid storm 2.To prevent cardiac irritability 3.To treat hypocalcemic tetany 4.To stimulate release of parathyroid hormone

3.To treat hypocalcemic tetany Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the primary health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.

Potassium iodide is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and complains of a brassy taste in the mouth. Which instruction should the nurse provide the client? 1.Continue with the medication. 2.Take half of the prescribed dose for the next 24 hours. 3.Withhold the medication and notify the primary health care provider (PHCP). 4.Withhold the medication for the next 24 hours and then continue as prescribed.

3.Withhold the medication and notify the primary health care provider (PHCP). Chronic ingestion of iodine can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain. The client needs to be instructed to notify the PHCP if these symptoms occur.

The nurse is caring for a client with a diagnosis of Addison's disease and is monitoring the client for signs of Addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2. Diaphoresis 3. Restlessness 4. Severe abdominal pain

4 Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. The remaining options do not identify clinical manifestations associated with addisonian crisis.

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate after surgery." 4. "Brushing your teeth needs to be avoided for at least 2 weeks after surgery."

4. "Brushing your teeth needs to be avoided for at least 2 weeks after surgery." A transsphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland. Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site.

The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which should the nurse expect to note on assessment of the client? 1. Skin atrophy 2. The presence of sunken eyes 3. Drooping on 1 side of the face 4. A rounded "moonlike" appearance to the face

4. A rounded "moonlike" appearance to the face With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic corticosteroid use, the person with Cushing's syndrome develops a rounded moonlike face; prominent jowls; red cheeks; and hirsutism on the upper lip, lower cheek, and chin. The remaining options are not associated with the assessment findings in Cushing's syndrome.

Vasopressin is prescribed for a client with diabetes insipidus. The nurse should be particularly cautious in monitoring a client receiving this medication if the client has which preexisting condition? 1. Depression 2. Endometriosis 3. Pheochromocytoma 4. Coronary artery disease

4. Coronary artery disease

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? 1. Encourage the client's expression of feelings. 2. Assess the client's understanding of the disease process. 3. Encourage family members to share their feelings about the disease process. 4. Encourage the client to recognize that the body changes need to be dealt with.

4. 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.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? 1. Alleviate depression 2. Increase energy levels 3. Increase blood glucose levels 4. Achieve normal thyroid hormone levels

4. achieve normal thyroid hormone levels (Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved. An increase in the blood glucose is not associated with this condition.) NCLEX

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding? 1."It replaces thyroid hormone." 2."It prevents iodine absorption." 3."It increases thyroid hormone." 4."It suppresses thyroid hormone."

4."It suppresses thyroid hormone." Potassium iodide is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours. Peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil before potassium iodide therapy is initiated. Then potassium iodide, along with propylthiouracil, is administered for the last 10 days before surgery. Therefore, the remaining options are incorrect

The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 1.Infertility 2.Gynecomastia 3.Sexual dysfunction 4.Body image changes

4.Body image changes Because of the location of the incision in the neck area, many clients are afraid of thyroid surgery for fear of having a visible large scar postoperatively. Having all or part of the thyroid gland removed will not cause the client to experience gynecomastia. Sexual dysfunction and infertility could occur if the entire thyroid is removed and the client is not placed on thyroid replacement medications.

The nurse is admitting a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpitations and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifestations? 1.Cortisol 2.Androgens 3.Aldosterone 4.Epinephrine

4.Epinephrine Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. In addition, the other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex.

During health history taking, the client complains of weight loss and diarrhea and says that he can "feel my heart beating in my chest." The nurse anticipates that which diagnostic test will most likely be prescribed by the primary health care provider (PHCP) in order to determine the underlying condition leading to the client's signs and symptoms? 1.Endoscopy 2.Electrocardiogram 3.Stool for occult blood 4.Serum thyroid-stimulating hormone (TSH)

4.Serum thyroid-stimulating hormone (TSH)

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high-Fowler's. 5. Administer a vasopressin antagonist as prescribed.

Answer: 1, 3, 5 Rationale: Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed, and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored. To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hoarseness 2. Hypocalcemia 3. Audible stridor 4. Edema at the surgical site

Answer: 3 Rationale: Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse plans to monitor for signs and symptoms of which hormone imbalance? 1. Growth hormone (GH) 2. Luteinizing hormone (LH) 3. Antidiuretic hormone (ADH) 4. Follicle-stimulating hormone (FSH)

Antidiuretic hormone (ADH) ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. The anterior pituitary gland produces GH, LH, and FSH. Urden et al. (2018), pp. 710-711

A client has a tumor that is interfering with the function of the hypothalamus. The nurse should monitor for signs and symptoms related to which imbalance? 1. Melatonin excess or deficit 2. Glucocorticoid excess or deficit 3. Mineralocorticoid excess or deficit 4. Antidiuretic hormone (ADH) excess or deficit

Antidiuretic hormone (ADH) excess or deficit The hypothalamus exerts an influence on both the anterior and the posterior pituitary gland. Abnormalities can result in excess or deficit of substances normally mediated by the pituitary. ADH could be affected by disease of the hypothalamus because the hypothalamus produces ADH and stores it in the posterior pituitary gland. The pineal gland is responsible for melatonin production. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

1. Insomnia 2. Weight loss 5. Mild heat intolerance Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client with a history of coronary artery disease has developed diabetes insipidus as a result of cranial surgery. The client's medication therapy will include vasopressin. The nurse monitors this client most carefully for which sign or symptom that indicates a side or adverse effect of this medication? 1. Depression 2. Chest pain 3. Joint stiffness 4. Nagging cough

2. Chest pain

A nurse is caring for a client after a thyroidectomy. Which specific emergency equipment should the nurse have available as it relates to this procedure? 1.Defibrillator 2.Tracheostomy tray 3.Dextrose 50% in water 4.Normal saline for intravenous bolus

2.Tracheostomy tray

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? 1.It indicates nerve damage. 2.The hoarseness is permanent. 3.It is normal during this time and will subside. 4.It will worsen before it subsides, which may take 6 months.

3.It is normal during this time and will subside.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? 1.Alleviate depression 2.Increase energy levels 3.Increase blood glucose levels 4.Achieve normal thyroid hormone levels

4.Achieve normal thyroid hormone levels Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine is prescribed. The nurse informs the client that which is the expected outcome of the medication? 1.Alleviate depression. 2.Increase energy levels. 3.Increase blood glucose levels. 4.Achieve normal thyroid hormone levels.

4.Achieve normal thyroid hormone levels.

A client has begun medication therapy with propylthiouracil. The nurse should assess the client for which condition as an adverse effect of this medication? 1.Joint pain 2.Renal toxicity 3.Hyperglycemia 4.Hypothyroidism

4.Hypothyroidism

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hr 2. A coagulation time of 5 minutes 3. A heart rate that is 90 beats per minute and irregular 4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)

Answer: 3 Rationale: Pheochromocytoma is a catecholamine-producing tumor usually found in the adrenal medulla, but extra-adrenal locations include the chest, bladder, abdomen, and brain; it is typically a benign tumor but can be malignant. Excessive amounts of epinephrine and norepinephrine are secreted. The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A coagulation time of 5 minutes is normal. A urinary output of 50 mL/hr is an adequate output. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L) is a normal finding.

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action? 1. Increase fluid intake. 2. Document the complaints. 3. Assess for urinary glucose. 4. Assess urine specific gravity.

Assess urine specific gravity After hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess the specific gravity of the urine and notify the health care provider (HCP) if the result is lower than 1.006. Although increasing fluid intake and documenting the complaints may be components of the plan of care, they are not initial actions. Additionally, the HCP will prescribe increased fluids. Assessing for urinary glucose is unrelated to the client's condition.

The nurse caring for a client who underwent intracranial surgery is suspected of having diabetes insipidus. Which finding noted by the nurse is consistent with this complication of surgery? 1. Complaints of excessive thirst 2. Urine specific gravity of 1.030 3. Urine output of 10 to 15 mL/hour 4. Systolic blood pressures running consistently over 150 mm Hg

Complaints of excessive thirst Diabetes insipidus results from insufficient antidiuretic hormone (ADH) production, which in this case was caused by the intracranial surgery. Findings associated with diabetes insipidus include greatly increased urine output, low urine specific gravity (<1.005), hypotension, signs of dehydration, increased plasma osmolarity, increased thirst, and output that does not decrease when fluid intake decreases. A complaint of thirst is the only option consistent with diabetes insipidus.

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 1. Serum glucose 2. Blood pressure 3. Respiratory rate 4. Urine specific gravity

Urine specific gravity After hypophysectomy, temporary diabetes insipidus can result from antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess urine specific gravity and notify the health care provider if the result is less than 1.005. Although the remaining options may be components of the assessment, the nurse would next assess urine specific gravity.