Hesi AEQ Quiz: Endocrine System
Which drug acts as an abortifacient in female clients? 1 Mifepristone 2 Metyrapone 3 Cyproheptadine 4 Aminoglutethimide
Mifepristone Mifepristone is an antiprogesterone that blocks the progesterone receptors and acts as an abortifacient. Metyrapone, cyproheptadine, and aminoglutethimide are used to treat hyperfunctioning of the adrenal glands (Cushing's disease/syndrome).
The nurse is caring for a client who had a thyroidectomy. Which symptoms will the client exhibit if having a thyrotoxic crisis? 1 An increased pulse deficit 2 A decreased blood pressure 3 A decreased heart rate and respirations 4 An increased temperature and pulse rate
An increased temperature and pulse rate Thyrotoxic crisis is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature. During crisis there usually is no increase in the difference between the apical and the peripheral pulse rates (pulse deficit). The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during crisis. Because of the increased metabolic rate, the pulse and respiratory rates increase to meet the body's oxygen needs.
A nurse is caring for a client with Cushing syndrome. Which cardiovascular complication should the nurse assess for in this client? 1 Chest pain 2 Tachycardia 3 Hypertension 4 Atrial fibrillation
Hypertension Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.
What is the effect of parathyroid hormone on bones? Select all that apply. 1 Increased bone breakdown 2 Increased serum calcium levels 3 Increased sodium and phosphorus excretion 4 Increased absorption of calcium and phosphorus 5 Increased net release of calcium and phosphorus
Increased bone breakdown Increased serum calcium levels Increased net release of calcium and phosphorus Parathyroid hormone increases bone breakdown, which increases serum calcium levels. Parathyroid hormone increases net release of calcium and phosphorus from bone into the extracellular fluid. It increases sodium and phosphorus excretion by the kidneys, not in the bone and increases absorption of calcium and phosphorus in the gastrointestinal tract by using activated vitamin D. However, this increased absorption of calcium and phosphorus is not related to the bone.
Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematologic studies? 1 Calcium 2 Chloride 3 Phosphorus 4 Parathormone
Phosphorus Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorus levels decrease (greater than 3 mg/dL; greater than 0.17 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparathyroidism.
A nurse is providing postoperative care for a client who has begun taking levothyroxine after undergoing a thyroidectomy. Which findings in the client may indicate potential thyrotoxic crisis? 1 Elevated serum calcium 2 Sudden drop in pulse rate 3 Hypothermia and dry skin 4 Rapid heartbeat and tremors
Rapid heartbeat and tremors Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition. Hypercalcemia is not related to thyrotoxic crisis; hypocalcemia results from accidental removal of the parathyroid glands. Tachycardia is an increased, not decreased, heart rate, which occurs with thyrotoxic crisis because of the sudden release of thyroid hormones; thyroid hormones increase the basal metabolic rate. Fever, not hypothermia, and diaphoresis, not dry skin, occur with thyrotoxic crisis because of the sudden release of thyroid hormones, which increase the basal metabolic rate.
A client is injured in a motor vehicle accident and is admitted to the critical care unit. Twelve hours later the client complains of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed, and an emergency splenectomy is scheduled. What should the nurse emphasize when preparing the client for surgery? 1 The poor prognosis associated with a splenectomy 2 The expectation that postoperative bleeding will occur 3 The high risk associated with the procedure in light of the client's other injuries 4 The presence of abdominal drains for several days after the surgery
The presence of abdominal drains for several days after the surgery Drains usually are inserted into the splenic bed to facilitate removal of fluid that may lead to abscess formation. Splenectomy has a low mortality rate (5%) except when multiple injuries are present (15% to 40%). Bleeding occurs more commonly with splenic repair than with removal. Educating the client about the risks associated with surgery is the responsibility of the primary healthcare provider. There is no need to frighten the client unnecessarily.
Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1 Providing oxygen 2 Encouraging carbohydrates 3 Administering fluid replacement 4 Teaching facts about dietary principles
Administering fluid replacement As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.
A nurse is assessing a client with a suspected pituitary tumor. Which assessment finding is consistent with a pituitary tumor? 1 Tetany 2 Seizures 3 Lethargy 4 Hyperreflexia
Seizures Seizures are common in clients who have pituitary tumors. Tetany is associated with severe hypocalcemia; that condition can be caused by hypoparathyroidism. Lethargy is found in clients with hypothyroidism. Hyperreflexia is observed in clients with hyperthyroidism and hypoparathyroidism.
A client is admitted to the hospital with a potential diagnosis of excess antidiuretic hormone. Which clinical indicator should the nurse identify when assessing this client? 1 Polyuria 2 Dehydration 3 Hyponatremia 4 Hyperglycemia
Hyponatremia Antidiuretic hormone (ADH) causes increased resorption of water by renal tubules, which dilutes sodium levels, causing hyponatremia. ADH will decrease urine volume. ADH causes fluid retention. ADH does not alter glucose metabolism.
A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. What is the best response by the nurse? 1 "The client will gain excessive weight if sodium is not limited." 2 "An inadequate intake of potassium contributed to the disease." 3 "This type of diet increases emotional stability." 4 "Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium."
"Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium." Clients with Cushing syndrome or those receiving cortical hormones must limit their intake of sodium and increase their intake of potassium, because the kidneys are retaining sodium and excreting potassium. Although sodium retention causes fluid retention and weight gain, the need for increased potassium must be considered as well. An excessive secretion of adrenocortical hormones in Cushing syndrome, not inadequate potassium intake, is the problem. This type of diet has no direct effect on the client's emotional status.
A client has been on a hunger strike for 5 days. Which hormones are providing glucose as energy through catabolism? Select all that apply. 1 Cortisol 2 Prolactin 3 Glucagon 4 Calcitonin 5 Aldosterone
Cortisol Glucagon In states of fasting, cortisol and glucagon breakdown stored complex fuels to provide energy. Cortisol stimulates the liver to produce new glucose molecules, thereby providing energy to the body. Glucagon also stimulates the production of glucose, thereby supplying energy. Therefore, the hormones cortisol and glucagon may provide energy (insulin metabolizes the glucose molecules). Prolactin stimulates milk production in lactating women. Calcitonin maintains calcium and phosphorus balance in the blood. Aldosterone is a potent mineralocorticoid that promotes reabsorption of sodium and excretion of potassium from the renal tubule.
What expected effect of increased serum cortisone levels does a nurse consider when caring for clients with multiple physical and emotional problems? 1 Accelerated wound healing 2 Blocked gluconeogenesis in the liver 3 Decreased pituitary secretion of adrenocorticotropic hormone (ACTH) 4 Impaired tolerance of stressful situations
Decreased pituitary secretion of adrenocorticotropic hormone (ACTH) Cortisone and ACTH work together via a feedback loop. ACTH is released in response to decreased blood levels of cortisone. ACTH then stimulates release of additional adrenocortical hormone. Cortisone has anti-inflammatory properties that delay wound healing. As a glucocorticoid, cortisone increases gluconeogenesis in the liver. Cortisone assists the body in responding to stress.
Which clinical manifestations in a client indicate hyperfunctional thyroid gland? Select all that apply. 1 Anemia 2 Diarrhea 3 Weight loss 4 Decreased appetite 5 Distant heart sounds
Diarrhea Weight loss Diarrhea and weight loss are the characteristic manifestations of a hyperfunctional thyroid gland. Anemia is seen in a client with a hypofunctional thyroid and decreased levels of thyroid hormone. Decreased appetite and distant heart sounds are symptoms of a hypofunctional thyroid gland.
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. What should the nurse conclude is causing these clinical findings? 1 Hypokalemia 2 Hyponatremia 3 Hyperglycemia 4 Hypercalcemia
Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes
The nurse is caring for a client with nephrogenic diabetes insipidus who is prescribed a low-sodium diet and chlorothiazide therapy. The client fails to respond to the therapy. Which alternative treatment should the nurse be prepared to administer? 1 Furosemide 2 Indomethacin 3 Chlorpropamide 4 Lysine vasopressin
Indomethacin When a low-sodium diet and thiazide drugs such as chlorothiazide are ineffective in a client with nephrogenic diabetes insipidus (DI), indomethacin is prescribed. This drug helps to increase the renal responsiveness to antidiuretic hormone. Furosemide is not recommended for nephrogenic DI. Chlorpropamide helps to decrease thirst seen in clients with central DI. Lysine vasopressin is also prescribed to clients with central DI. Because the kidney is unable to respond to antidiuretic hormone in nephrogenic DI, hormone therapy has little effect. Topics
While caring for a client receiving hydrocortisone therapy, the nurse anticipates a dose adjustment in the client's prescription. Which observation in the client supports this anticipation? 1 Three episodes of vomiting 2 Passage of loose stools 3 Body temperature of 37.2°C (99°F) 4 Sudden weight gain of 8 kg
Sudden weight gain of 8 kg Excessive hydrocortisone therapy causes rapid weight gain, fluid retention, and a round face. Thus a sudden weight gain of 8 kg (17.637 lbs.) indicates excessive hydrocortisone levels and indicates the need for dose adjustment. Vomiting, diarrhea, and fever are seen in excessive prednisone therapy.
A nurse is caring for a client who had a thyroidectomy. Which client response should the nurse assess when concerned about an accidental removal of the parathyroid glands during surgery? 1 Tetany 2 Myxedema 3 Hypovolemic shock 4 Adrenocortical stimulation
Tetany Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death. Loss of the thyroid gland will upset thyroid hormone balance and may cause myxedema. The parathyroids are not involved in regulating plasma volume; the pituitary and adrenal glands are responsible. The parathyroids do not regulate the adrenal glands.
The nurse is caring for a client with hyperplasia of pituitary tissue. What would be the most appropriate goals of management? Select all that apply. 1 To alleviate headache 2 To replace lost sodium 3 To eliminate visual disturbances 4 To check the urine specific gravity 5 To return hormone levels to normal
To alleviate headache To eliminate visual disturbances To return hormone levels to normal A client with hyperplasia of pituitary tissue (tissue overgrowth) will have oversecretion of pituitary hormones resulting in hyperpituitarism. The client with hyperpituitarism will experience headaches and changes in vision, thus the goal of management should be to have normal pituitary hormone levels. Replacement of lost sodium is important if the client has syndrome of inappropriate antidiuretic hormone secretion. The specific gravity of urine may be low in certain conditions such as hyperaldosteronism.
After assessing a client, the nurse anticipates that the client has hyperpituitarism. Which questions asked by the nurse helps confirm the diagnosis? Select all that apply. 1 "Is there any change in your vision?" 2 "Do you experience severe headaches?" 3 "Are you suffering with frequent urination?" 4 "Do you eat more than five times a day?" 5 "Is there any change in your menstrual cycle?"
"Is there any change in your vision?" "Do you experience severe headaches?" "Is there any change in your menstrual cycle?" Hyperpituitarism manifests with vision disturbances and severe headaches. Due to hypersecretion of prolactin in females, a change in menstrual cycle may also be observed. Frequent urination is observed in a client with diabetes insipidus. Clients with diabetes mellitus experience intense hunger.
A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. Which component is increased in the blood and a direct cause of acidosis? 1 Ketones 2 Glucose 3 Lactic acid 4 Glutamic acid
Ketones The ketones produced excessively in diabetes are a by-product of the breakdown of body fats and proteins for energy; this occurs when insulin is not secreted or is unable to be used to transport glucose across the cell membrane into the cells. The major ketone, acetoacetic acid, is an alpha-ketoacid that lowers the blood pH, resulting in acidosis. Glucose does not change the pH. Lactic acid is produced as a result of muscle contraction; it is not unique to diabetes. Glutamic acid is a product of protein metabolism.
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? 1 Myxedema 2 Acromegaly 3 Graves disease 4 Cushing disease
Myxedema Myxedema is the severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Acromegaly results from excess growth hormone in adults once the epiphyses are closed. Graves disease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids.
A client experiencing thyrotoxic crisis tells the nurse, "I know I'm going to die. I'm very sick." Which is the best response by the nurse? 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, but 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."
"You must feel very sick and frightened." The response "You must feel very sick and frightened" reflects the client's feelings and encourages a further exploration of concerns. The response "Tell me why you feel you are going to die" does not reflect the feeling tone of the client's statement; also the client may not be able to answer a "why" question. The response "I can understand how you feel, but people do not die from this problem" is false reassurance; thyrotoxic crisis is capable of causing death. The response "If you would like, I will call your family and tell them to come to the hospital" may reinforce the client's anxiety and avoids discussing the client's concerns; it cuts off communication.
The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. What should the nurse include in the teaching plan? Select all that apply. 1 The client should obtain a finger stick blood glucose reading before each meal. 2 The client does not need to follow a specific diet until insulin is required. 3 The teaching plan should include signs and symptoms of hypoglycemia. 4 The teaching plan does not need to include signs and symptoms of hypoglycemia, as the client is not on insulin. 5 The teaching plan should include sick day rules.
-The client should obtain a finger stick blood glucose reading before each meal. -The teaching plan should include signs and symptoms of hypoglycemia. -The teaching plan should include sick day rules. All diabetic clients, regardless of type, should check finger stick blood sugars before each meal and snack. Antidiabetic medications can cause hypoglycemia; therefore, the client needs to be instructed on the symptoms of hypoglycemia. All diabetic clients need to be educated on sick day rules. All diabetic clients should follow the American Diabetes Association diet.
A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? 1 Fats 2 Protein 3 Potassium 4 Carbohydrates
Fats Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism produces nitrogenous waste, causing elevated blood urea nitrogen (BUN), not ketones. Potassium is not oxidized; potassium is not directly associated with ketones. Carbohydrates do not contain fatty acids that are broken down into ketones.
A nurse is caring for a client with hypoglycemia. Which nursing intervention would be appropriate in managing the client's condition? Select all that apply. 1 Administering insulin 2 Administering glucagon 3 Administering IV glucose 4 Administering oral hydrocortisone 5 Administering somatostatin
administering glucagon Administering IV glucose Administering oral hydrocortisone A client with hypoglycemia suffers with weakness and vision disturbances due to low glucose levels. Glucagon is the hormone secreted by the pancreas that helps with increasing the blood glucose levels. Administering IV glucose would immediately improve the blood glucose levels. Hydrocortisone is a glucocorticoid that prevents hypoglycemia by increasing liver gluconeogenesis and inhibiting peripheral glucose use. Insulin is administered when glucose levels are high as it increases the glucose reuptake, thereby reducing blood glucose levels. Somatostatin is a hormone released by delta cells of the pancreas that inhibits insulin and glucagon.
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? 1 Nervousness and tachycardia 2 Erythema toxicum rash and pruritus 3 Diaphoresis and altered mental state 4 Deep respirations and fruity odor to the breath
Deep respirations and fruity odor to the breath Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.
A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. What is the nurse's most appropriate action? 1 Administer insulin to the client 2 Give the client lunch immediately 3 Encourage the client to drink fluids 4 Assess the client's blood glucose level
Assess the client's blood glucose level The client needs glucose, not just fluids. The presence of hypoglycemia should be determined before initiating therapy; Humulin R insulin given in the morning peaks within four hours or just before lunchtime. After hypoglycemia is verified, the client should be given an immediate source of glucose. Administering insulin is contraindicated; the client is experiencing adaptations of hypoglycemia, and administering insulin will decrease further an already low blood glucose level. Giving the client lunch may be done after hypoglycemia is determined.
The nurse is providing immediate postoperative care to a client who had a thyroidectomy. The nurse should monitor the client for which clinical manifestation? 1 Urinary retention 2 Signs of restlessness 3 Decreased blood pressure 4 Signs of respiratory obstruction
Signs of respiratory obstruction The first and most important observation should be for signs of respiratory obstruction. Tracheal compression can occur because of edema in the surgical area. Tracheal compression is exhibited by decreased inspiratory/expiratory pressure, decreased ventilation, dyspnea, shortness of breath, tachypnea, tachycardia, nasal flaring, use of accessory muscles to breathe, cyanosis, reduced oxygen saturation, and altered arterial blood gases. Although urinary retention is a concern after anesthesia, it is not life threatening. Signs of restlessness may be a result of the anesthesia; however, if it is because of a lack of oxygenation, assessing for respiratory obstruction is a more direct and objective assessment associated with this surgery. The blood pressure is not significantly affected by this type of surgery unless thyroid storm occurs; when assessing for thyroid storm, all the vital signs will increase.