Lewis: MED-SURG: Chapter 50: Endocrine Problems

Identify five hormonees that are replaced when panhypopituitarism from radiation therapy or total hypophysectomy as treatment for pituitary tumors

1) cortisol 2) thyroid 3) vasopressin/ ADH analog 4) Growth hormone 5) sex hormones: testosterone, follicle stimulating hormone (FSH), and leutinizing hormone (LH) if fertility is desired; estrogen/progesterone if fertility is not an issue

Bacterial or fungal infection of thyroid gland

Acute thyroiditis

Diagnostic testing of a patient with Grave's disease will reveal

Decreased TSH level

Enlarged thyroid gland

Goiter

Exopthalmus may occur in

Grave's disease

The two most common forms of hyperthyroidism

Grave's disease and toxic nodular goiters

Autoimmune fibrous and lymphocytic replacement of thyroid gland

Hashimoto's thyroiditis

Decreases release of thyroid hormone

Potassium iodide

Used to decrease size and vascularity of thyroid gland preoperatively

Potassium iodide

Used to control sympathetic symptoms of hyperthyroidism

Propanolol (Inderal)

Blocks peripheral conversion of T4 to T3

Propylthiouracil (PTU)

Often used with iodine to produce euthyroid before surgery

Propylthiouracil (PTU)

Decreases thyroid secretion by damaging thyroid gland

Radioactive Iodine (131I)

Often causes hypothyroidism over time

Radioactive Iodine (131I)

Treatment of choice for hyperthyroidism in nonpregnant adults

Radioactive iodine (131I)

Lymphocytic infiltration of thyroid gland that may occur postpartum

Silent thyroiditis

Viral induced hypothyroidism

Subacute granulomatous thyroiditis

Malignant of benign deformity of the thyroid gland

Thyroid nodules

An African American woman with a history of breast cancer has panhypopituitarism from radiation therapy for primary pituitary tumors. Which medications should the nurse teach her about needing for the rest of her life (select all that apply)? a. Cortisol b. Vasopressin c. Sex hormones d. Levothyroxine (Synthroid) e. Growth hormone (somatropin [Omnitrope]) f. Dopamine agonists (bromocriptine [Parlodel])

a, b, d, e. a. Cortisol b. Vasopressin d. Levothyroxine (Synthroid) e. Growth hormone (somatropin [Omnitrope]) With panhypopituitarism, lifetime hormone replacement is needed for cortisol, vasopressin, thyroid, and GH. Sex hormones will not be replaced because of the patient's history of breast cancer. Dopamine agonists will not be used because they reduce secretion of GH, which has already been achieved with the radiation.

Which characteristics describe the use of RAI (select all that apply)? a. Often causes hypothyroidism over time b. Decreases release of thyroid hormones c. Blocks peripheral conversion of T4 to T3 d. Treatment of choice in nonpregnant adults e. Decreases thyroid secretion by damaging thyroid gland f. Often used with iodine to produce euthyroid before surgery

a, d, e. a. Often causes hypothyroidism over time d. Treatment of choice in nonpregnant adults e. Decreases thyroid secretion by damaging thyroid gland RAI causes hypothyroidism over time by damaging thyroid tissue and is the treatment of choice for nonpregnant adults. Potassium iodide decreases the release of thyroid hormones and decreases the size of the thyroid gland preoperatively. Propylthiouracil (PTU) blocks peripheral conversion of T4 to T3 and may be used with iodine to produce a euthyroid state before surgery.

A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively? a. Ensure that any clear nasal drainage is tested for glucose. b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage. c. Assist the patient with toothbrushing every 4 hours to keep the surgical area clean. d. Encourage deep breathing, coughing, and turning to prevent respiratory complications.

a. Ensure that any clear nasal drainage is tested for glucose. A transsphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates cerebrospinal fluid (CSF) leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica. Coughing and straining are avoided to prevent increased intracranial pressure and CSF leakage. Although mouth care is required every 4 hours, toothbrushing should not be performed because injury to the suture line may occur.

Which statement accurately describes Graves' disease? a. Exophthalmos occurs in Graves' disease. b. It is an uncommon form of hyperthyroidism. c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system. d. Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.

a. Exophthalmos occurs in Graves' disease. Exophthalmos or protrusion of the eyeballs may occur in Graves' disease from increased fat deposits and fluid in the orbital tissues and ocular muscles, forcing the eyeballs outward. Graves' disease is the most common form of hyperthyroidism. Increased metabolic rate and sensitivity of the sympathetic nervous system lead to the clinical manifestations. Thyroid-stimulating hormone (TSH) level is decreased in Graves' disease.

What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy? a. How to support the head with the hands when turning in bed b. Coughing should be avoided to prevent pressure on the incision c. Head and neck will need to remain immobile until the incision heals d. Any tingling around the lips or in the fingers after surgery is expected and temporary

a. How to support the head with the hands when turning in bed To prevent strain on the suture line postoperatively, the patient's head must be manually supported while turning and moving in bed but range-of-motion exercises for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing and these should be carried out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery. This sign should be reported immediately.

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find? a. Hypertension, peripheral edema, and petechiae b. Weight loss, buffalo hump, and moon face with acne c. Abdominal and buttock striae, truncal obesity, and hypotension d. Anorexia, signs of dehydration, and hyperpigmentation of the skin

a. Hypertension, peripheral edema, and petechiae ( Will also have Buffalo hump, and Moon Face, Striae, and truncal obesity) The effects of adrenocortical hormone excess, especially glucocorticoid excess, include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility leading to petechiae. Clinical manifestations of adrenocortical hormone deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level

a. Increased thyroxine (T4) level An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine.

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels

a. Increasing serum sodium levels Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Apical pulse rate at rest 112 beats/minute c. Elevation in the patient's T3 and T4 levels d. Bruit audible bilaterally over the thyroid gland

a. New-onset changes in the patient's voice Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action.

Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm? a. Propranolol (Inderal) b. Propylthiouracil (PTU) c. Methimazole (Tapazole) d. Iodine (Lugol's solution)

a. Propranolol (Inderal) Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use? a. Provide written reminders of self-care information. b. Offer multiple options for management of therapies. c. Ensure privacy for teaching by asking visitors to leave. d. Delay teaching until patient discharge date is confirmed.

a. Provide written reminders of self-care information. Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.

Identify the rationale for having the following items immediately available in the patient's room following thyroidectomy a. Tracheostomy tray b. Calcium salts for IV administration c. Oxygen equipment

a. To use in case airway obstruction occurs because of vocal cord paralysis from recurrent laryngeal nerve damage during surgery or laryngeal stridor occurs with tetany b. needed in case hypocalcemia occurs form parathyroid gland removal or damage during surgery, resulting in tetany c. in case of airway obstruction, laryngeal stridor or edema around trachea

As a precaution for vocal cord paralysis from damage to the recurrent laryngeal nerve during thyroidectomy surgery, what equipment should be in the room in case it is needed for this emergency situation? a. Tracheostomy tray c. IV calcium gluconate b. Oxygen equipment d. Paper and pencil for communication

a. Tracheostomy tray A tracheostomy tray is in the room to use if vocal cord paralysis occurs from recurrent laryngeal nerve damage or for laryngeal stridor from tetany. The oxygen equipment may be useful but will not improve oxygenation with vocal cord paralysis without a tracheostomy. IV calcium salts will be used if hypocalcemia occurs from parathyroid damage. The paper and pencil for communication may be helpful, especially if a tracheostomy is performed, but will not aid in emergency oxygenation of the patient.

A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. How is the need for these drugs related to the effects of corticosteroids a. Furosemide (Lasix) b. Pantoprazole (Protonix) c. Alendronate (Fosamax) d. Insulin e. Potassium

a. sodium and fluid retention because of mineralcorticoid effect b. gastrointestinal irritation with an increase in secretion of pepsin and hydrochloric acid c. corticosteroid induced osteoperosis

A patient has been diagnosed with hypoparathyroidism. What manifestations should the nurse expect to observe (select all that apply)? a. Skeletal pain b. Dry, scaly skin c. Personality changes d. Abdominal cramping e. Cardiac dysrhythmias f. Muscle spasms and stiffness

b, c, d, e, f. b. Dry, scaly skin c. Personality changes d. Abdominal cramping e. Cardiac dysrhythmias f. Muscle spasms and stiffness In hypoparathyroidism the patient has inadequate circulating parathyroid hormone (PTH) that leads to hypocalcemia from the inability to maintain serum calcium levels. With hypocalcemia there is muscle stiffness and spasms, which can lead to cardiac dysrhythmias and abdominal cramps. There can also be personality and visual changes and dry, scaly skin.

A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. "Have you had a recent head injury?" b. "Do you have to wear larger shoes now?" c. "Is there a family history of acromegaly?" d. "Are you experiencing tremors or anxiety?"

b. "Do you have to wear larger shoes now?" Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.

A 38-year-old male patient is admitted to the hospital in Addisonian crisis. Which patient statement supports a nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease? a. "I frequently eat at restaurants, and my food has a lot of added salt." b. "I had the stomach flu earlier this week, so I couldn't take the hydrocortisone." c. "I always double my dose of hydrocortisone on the days that I go for a long run." d. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon."

b. "I had the stomach flu earlier this week, so I couldn't take the hydrocortisone." The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.

During discharge teaching for the patient with Addison's disease, which statement by the patient indicates that the nurse needs to do additional teaching? a. "I should always call the doctor if I develop vomiting or diarrhea." b. "If my weight goes down, my dosage of steroid is probably too high." c. "I should double or triple my steroid dose if I undergo rigorous physical exercise." d. "I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth."

b. "If my weight goes down, my dosage of steroid is probably too high." A weight reduction in the patient with Addison's disease may indicate a fluid loss and a dose of replacement therapy that is too low rather than too high. Because vomiting and diarrhea are early signs of crisis and because fluid and electrolytes must be replaced, patients should notify their health care provider if these symptoms occur. Patients with Addison's disease are taught to take two to three times their usual dose of steroids if they become ill, have teeth extracted, or engage in rigorous physical activity and should always have injectable hydrocortisone available if oral doses cannot be taken.

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? a. "How much milk do you drink?" b. "What medications are you taking?" c. "Are your immunizations up to date?" d. "Have you had any recent neck injuries?"

b. "What medications are you taking?" Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter.

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134 c. A 53-year-old male who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef). d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134 Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.

b. Administer IV calcium gluconate. The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.

Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness

b. Apical pulse rate In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.

What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. Potassium iodide c. Propylthiouracil (PTU) b. Atenolol (Tenormin) d. Radioactive iodine (RAI)

b. Atenolol (Tenormin) The β-adrenergic blocker atenolol is used to block the sympathetic nervous system stimulation by thyroid hormones. Potassium iodide is used to prepare the patient for thyroidectomy or for treatment of thyrotoxic crisis to inhibit the synthesis of thyroid hormones. Antithyroid medications inhibit the synthesis of thyroid hormones. Radioactive iodine (RAI) therapy destroys thyroid tissue, which limits thyroid hormone secretion.

Which nursing action will be included in the plan of care for a 55-year-old patient with Graves' disease who has exophthalmos? a. Place cold packs on the eyes to relieve pain and swelling. b. Elevate the head of the patient's bed to reduce periorbital fluid. c. Apply alternating eye patches to protect the corneas from irritation. d. Teach the patient to blink every few seconds to lubricate the corneas.

b. Elevate the head of the patient's bed to reduce periorbital fluid. The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.

A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? a. Restrict the patient to bed rest. b. Encourage 4000 mL of fluids daily. c. Institute routine seizure precautions. d. Assess for positive Chvostek's sign.

b. Encourage 4000 mL of fluids daily. The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.

When the patient with parathyroid disease experiences symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels? a. Administer IV normal saline. c. Administer furosemide (Lasix) as ordered. b. Have patient rebreathe in a paper bag. d. Administer oral phosphorus supplements.

b. Have patient rebreathe in a paper bag. Rebreathing in a paper bag promotes carbon dioxide retention in the blood, which lowers pH and creates an acidosis. An acidemia enhances the solubility and ionization of calcium, increasing the proportion of total body calcium available in physiologically active form and relieving the symptoms of hypocalcemia. Saline promotes calcium excretion, as does furosemide. Phosphate levels in the blood are reciprocal to calcium and an increase in phosphate promotes calcium excretion.

A patient with Addison's disease comes to the emergency department with complaints of nausea, vomiting, diarrhea, and fever. What collaborative care should the nurse expect? a. IV administration of vasopressors b. IV administration of hydrocortisone c. IV administration of D5W with 20 mEq KCl d. Parenteral injections of adrenocorticotropic hormone (ACTH)

b. IV administration of hydrocortisone Vomiting and diarrhea are early indicators of Addisonian crisis and fever indicates an infection, which is causing additional stress for the patient. Treatment of a crisis requires immediate glucocorticoid replacement and IV hydrocortisone, fluids, sodium, and glucose are necessary for 24 hours. Addison's disease is a primary insufficiency of the adrenal gland and adrenocorticotropic hormone (ACTH) is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's disease. Potassium levels are increased in Addison's disease and KCl would be contraindicated.

What is an appropriate nursing intervention for the patient with hyperparathyroidism? a. Pad side rails as a seizure precaution. b. Increase fluid intake to 3000 to 4000 mL daily. c. Maintain bed rest to prevent pathologic fractures. d. Monitor the patient for Trousseau's and Chvostek's signs.

b. Increase fluid intake to 3000 to 4000 mL daily. A high fluid intake is indicated in hyperparathyroidism to dilute the hypercalcemia and flush the kidneys so that calcium stone formation is reduced. Seizures are not associated with hyperparathyroidism. Impending tetany of hypoparathyroidism after parathyroidectomy can be noted with Trousseau's and Chvostek's signs. The patient with hyperparathyroidism is at risk for pathologic fractures resulting from decreased bone density but mobility is encouraged to promote bone calcification.

Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)? a. The medication will be needed for 3 to 6 months. b. Inject the medication subcutaneously every day. c. Blood glucose levels may decrease when taking the medication. d. Stop taking the medication if swelling of the hands or feet occurs.

b. Inject the medication subcutaneously every day. Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a. Palpate extremities for edema. b. Measure urine volume every hour. c. Check hematocrit every 2 hours for 8 hours. d. Monitor continuous pulse oximetry for 24 hours.

b. Measure urine volume every hour. After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

The nurse has identified the nursing diagnosis of fatigue for a patient who is hypothyroid. What should the nurse do while caring for this patient? a. Monitor for changes in orientation, cognition, and behavior. b. Monitor for vital signs and cardiac rhythm response to activity. c. Monitor bowel movement frequency, consistency, shape, volume, and color. d. Assist in developing well-balanced meal plans consistent with level of energy expenditure.

b. Monitor for vital signs and cardiac rhythm response to activity. Cardiorespiratory response to activity is important to monitor in this patient to determine the effect of activities and plan activity increases. Monitoring changes in orientation, cognition, and behavior are interventions for impaired memory. Monitoring bowels is needed to plan care for the patient with constipation. Assisting with meal planning will help the patient with imbalanced nutrition: more than body requirements to lose weight if needed.

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? a. Patient with Hashimoto's thyroiditis and a heart rate of 102 b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Addison's disease who takes hydrocortisone twice daily

b. Patient with tetany who has a new order for IV calcium chloride Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.

A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information is most important to communicate to the surgeon? a. The patient reports 7/10 incisional pain. b. The patient has increasing neck swelling. c. The patient is sleepy and difficult to arouse. d. The patient's cardiac rate is 112 beats/minute.

b. The patient has increasing neck swelling. The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a. bisphosphonates to reduce bone demineralization. b. calcium supplements to normalize serum calcium levels. c. increasing fluid intake to decrease risk for nephrolithiasis. d. including whole grains in the diet to prevent constipation.

b. calcium supplements to normalize serum calcium levels. Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include a. high blood pressure. b. decreased facial hair. c. elevated blood glucose. d. tachycardia and cardiac palpitations.

b. decreased facial hair. Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.

An appropriate nursing intervention for the patient with hyperparathyroidism is to a. pad side rails as a seizure precaution b. increase fluid intake to 3000 to 4000 mL daily c. maintain bed rest to prevent pathologic fractures d. monitor the patient for Trousseau's phenomenon and Chvostek's sign

b. increase fluid intake to 3000 to 4000 mL daily A high fluid intake is indicated in hyperparathyroidism to dilute hypercalcemia and flush the kindeys so that calcium stone formation is reduced. Seizures are not associated with hyperparathyroidism, but impending tetany of hypoparathyroidism can be noted with Trousseau's phenomenon and Chvostek's sign. The patient with hyperparathyroidism is at risk for pathologic fractures resulting from decreased bone density, but mobility is encouraged to promote bone calcification.

A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. "Weigh yourself daily to monitor for weight gain caused by increased appetite." b. "A weight-bearing exercise program will help minimize the risk for osteoporosis." c. "The prednisone dose should be decreased gradually rather than stopped suddenly." d. "Call the health care provider if you experience mood alterations with the prednisone."

c. "The prednisone dose should be decreased gradually rather than stopped suddenly." Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.

A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis? a. Potassium b. Furosemide (Lasix) c. Alendronate (Fosamax) d. Pantoprazole (Protonix)

c. Alendronate (Fosamax) Alendronate (Fosamax) is used to prevent corticosteroid- induced osteoporosis. Potassium is used to prevent the mineralocorticoid effect of hypokalemia. Furosemide (Lasix) is used to decrease sodium and fluid retention from the mineralocorticoid effect. Pantoprazole (Protonix) is used to prevent gastrointestinal (GI) irritation from an increase in secretion of pepsin and hydrochloric acid.

Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.

c. Antithyroid medications may take several months for full effect. Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease although surgery may be used.

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient's respiratory effort. d. Support the patient's head with pillows.

c. Assess the patient's respiratory effort. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care post thyroidectomy but are not as high of a priority.

A patient with hypoparathyroidism resulting from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient? a. Milk and milk products should be increased in the diet. b. Parenteral replacement of parathyroid hormone will be required for life. c. Calcium supplements with vitamin D can effectively maintain calcium balance. d. Bran and whole-grain foods should be used to prevent GI effects of replacement therapy.

c. Calcium supplements with vitamin D can effectively maintain calcium balance. The hypocalcemia that results from PTH deficiency is controlled with calcium and vitamin D supplementation and possibly oral phosphate binders. Replacement with PTH is not used because of antibody formation to PTH, the need for parenteral administration, and cost. Milk products, although good sources of calcium, also have high levels of phosphate, which reduce calcium absorption. Whole grains and foods containing oxalic acid also impair calcium absorption.

A patient is admitted to the hospital with thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Elevated temperature and signs of heart failure d. Lethargy progressing suddenly to impairment of consciousness

c. Elevated temperature and signs of heart failure A hyperthyroid crisis results in marked manifestations of hyperthyroidism, with severe tachycardia, heart failure, shock, hyperthermia, restlessness, irritability, abdominal pain, vomiting, diarrhea, delirium, and coma. Although exophthalmos may be present in the patient with Graves' disease, it is not a significant factor in hyperthyroid crisis. Hoarseness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first? a. Administer the ordered muscle relaxant. b. Give the ordered oral calcium supplement. c. Have the patient rebreathe from a paper bag. d. Start the PRN oxygen at 2 L/min per cannula.

c. Have the patient rebreathe from a paper bag. The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.

A patient with Addison's disease comes to the emergency department with complaints of nausea, vomiting, diarrhea, and fever. The nurse would expect collaborative care to include a. parenteral injections of adrenocorticotropic hormone (ACTH) b. IV administrations of vasopressors c. IV administration of hydrocortisone d. IV administration of D5W with 20 mEq KCL

c. IV administration of hydrocortisone Vomiting and diarrhea are early indicators of addisonian crisis, and fever indicates infection, which is causing additional stress for the patient. Treatment of a crisis requires immediate glucocorticoid replacement, and IV hydrocortisone, fluids, sodium, and glucose are necessary for 24 hours. Addison's disease is a primary insufficiency of the adrenal gland, and adrenocorticotropic hormone (ACTH) is not effective, nor would vasopressors be effective with fluid deficiency of Addison's disease. Potassium levels are increased in Addison's disease, and KCl would be contraindicated.

A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a. Reduced to promote wound healing b. Withheld until symptoms of hypocortisolism appear c. Increased to promote an adequate response to the stress of surgery d. Reduced because excessive hormones are released during surgical manipulation of adrenal glands

c. Increased to promote an adequate response to the stress of surgery Although the patient with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of corticosteroids (cortisone) be administered postoperatively for several days before weaning the dose. The nurse should monitor the patient's vital signs postoperatively to detect whether large amounts of hormones were released during surgical manipulation, obtain morning urine specimens for cortisol measurement to evaluate the effectiveness of the surgery, and provide dressing changes with aseptic technique to avoid infection as usual inflammatory responses are suppressed.

A patient with mild iatrogenic Cushing syndrome is on an alternate-day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen? a. It maintains normal adrenal hormone balance. b. It prevents ACTH release from the pituitary gland. c. It minimizes hypothalamic-pituitary-adrenal suppression. d. It provides a more effective therapeutic effect of the drug.

c. It minimizes hypothalamic-pituitary-adrenal suppression. Taking corticosteroids on an alternate-day schedule for pharmacologic purposes is less likely to suppress ACTH production from the pituitary and prevent adrenal atrophy. Normal adrenal hormone balance is not maintained during glucocorticoid therapy because excessive exogenous hormone is used.

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider? a. Patient's blood pressure is 148/94 mm Hg. b. Patient has bilateral 2+ pitting ankle edema. c. Patient stopped taking the medication 2 days ago. d. Patient has not been taking the prescribed vitamin D.

c. Patient stopped taking the medication 2 days ago. Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency. The other information will also be reported, but does not require rapid treatment.

A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c. Purplish streaks on the abdomen d. Decreased axillary and pubic hair

c. Purplish streaks on the abdomen Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.

Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8° F (40.4° C) d. Blood pressure 166/100 mm Hg

c. Temperature 103.8° F (40.4° C) The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.

During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a. Infertility b. Dry, irritated skin m c. Undesirable changes in appearance d. An increase in height of 2 to 3 inches a year

c. Undesirable changes in appearance The increased production of GH in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Infertility is not a common finding because GH is usually the only pituitary hormone involved in acromegaly. Height is not increased in adults with GH excess because the epiphyses of the bones are closed.

A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to a. cough and deep breathe every 2 hours postoperatively. b. remain on bed rest for the first 48 hours after the surgery. c. avoid brushing teeth for at least 10 days after the surgery. d. be positioned flat with sandbags at the head postoperatively.

c. avoid brushing teeth for at least 10 days after the surgery. To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.

An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering a. docusate (Colace). b. ibuprofen (Motrin). c. diazepam (Valium). d. cefoxitin (Mefoxin).

c. diazepam (Valium) Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient.

A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy.

c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.

A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse? a. "The cause of Graves' disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."

d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion." In Graves' disease, antibodies to the TSH receptor are formed, attach to the receptors, and stimulate the thyroid gland to release triiodothyronine (T3), thyroxine (T4), or both, creating hyperthyroidism. The disease is not directly genetic but individuals appear to have a genetic susceptibility to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.

What is a cause of primary hypothyroidism in adults? a. Malignant or benign thyroid nodules b. Surgical removal or failure of the pituitary gland c. Surgical removal or radiation of the thyroid gland d. Autoimmune-induced atrophy of the thyroid gland

d. Autoimmune-induced atrophy of the thyroid gland Both Graves' disease and Hashimoto's thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.

What characteristic is related to Hashimoto's thyroiditis? a. Enlarged thyroid gland b. Viral-induced hyperthyroidism c. Bacterial or fungal infection of thyroid gland d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue In Hashimoto's thyroiditis, thyroid tissue is destroyed by autoimmune antibodies. An enlarged thyroid gland is a goiter. Viral-induced hyperthyroidism is subacute granulomatous thyroiditis. Acute thyroiditis is caused by bacterial or fungal infection.

Priority Decision: When replacement therapy is started for a patient with long-standing hypothyroidism, what is most important for the nurse to monitor the patient for? a. Insomnia c. Nervousness b. Weight loss d. Dysrhythmias

d. Dysrhythmias All these manifestations may occur with treatment of hypothyroidism. However, as a result of the effects of hypothyroidism on the cardiovascular system, when thyroid replacement therapy is started myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac dysrhythmias, and heart failure, so monitoring for dysrhythmias is most important.

A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate? a. Hyperinsulinemia b. Plasma glucose of <70 mg/dL (3.9 mmol/L) c. Decreased GH levels with an oral glucose challenge test d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1) A normal response to growth hormone (GH) secretion is stimulation of the liver to produce somatomedin C, or insulin-like growth factor-1 (IGF-1), which stimulates growth of bones and soft tissues. The increased levels of somatomedin C normally inhibit GH but in acromegaly the pituitary gland secretes GH despite elevated IGF-1 levels. When both GH and IGF-1 levels are increased, overproduction of GH is confirmed. GH also causes elevation of blood glucose and normally GH levels fall during an oral glucose challenge but not in acromegaly.

A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have? a. SIADH c. Cushing syndrome b. Hypothyroidism d. Hyperparathyroidism

d. Hyperparathyroidism The patient with hyperparathyroidism may have calcium nephrolithiasis, skeletal pain, decreased bone density, psychomotor retardation, or cardiac dysrhythmias. The other endocrine problems would not be related to calcium kidney stones or decreased bone density.

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? a. Changes in visual field b. Milk leaking from breasts c. Blood glucose 150 mg/dL d. Nausea and projectile vomiting

d. Nausea and projectile vomiting Nausea and projectile vomiting may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid action to prevent life-threatening complications.

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image related to changes in appearance? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.

What findings are commonly found in a patient with a prolactinoma? a. Gynecomastia in men b. Profuse menstruation in women c. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH) d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

d. Signs of increased intracranial pressure, including headache, nausea, and vomiting Compression of the optic chiasm can cause visual problems as well as signs of increased intracranial pressure, including headache, nausea, and vomiting. About 30% of prolactinomas will have excess prolactin secretion with manifestations of impotence in men, galactorrhea or amenorrhea in women without relationship to pregnancy, and decreased libido in both men and women. There is decreased follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? a. Never miss a daily dose of thyroid replacement therapy. b. Avoid regular exercise until thyroid function is normalized. c. Use warm saltwater gargles several times a day to relieve throat pain. d. Substantially reduce caloric intake compared to what was eaten before surgery.

d. Substantially reduce caloric intake compared to what was eaten before surgery. With the decrease in thyroid hormone postoperatively, calories need to be reduced substantially to prevent weight gain. When a patient has had a subtotal thyroidectomy, thyroid replacement therapy is not given because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. Regular exercise stimulates the thyroid gland and is encouraged. Saltwater gargles are used for dryness and irritation of the mouth and throat following radioactive iodine therapy.

When replacement therapy is started for a patient with long-standing hypothyroidism, it is most important for the nurse to monitor the patient for a. insomnia b. weight loss c. nervousness d. dysrhythmias

d. dysrhythmias All these manifestations may occur with treatment of hypothyroidism, but as a result of the effects of hypothyroidism on the cardiovascular system, when thyroid replacement therapy is started, myocardial oxygen consumption is increased, and resultant oxygen demand may cause angina, cardiac dysrhythmias, and heart failure

A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, the nurse would also expect the patient's diagnostic results to include a. hyperinsulinemia b. a plasma glucose of < 70 mg/dL c. decreased GH levels with an oral glucose challenge test d. elevated serum somatomedin C (insulin like growth factor-1 (IGF-1))

d. elevated serum somatomedin C (insulin like growth factor-1 (IGF-1)) A normal response to growth hormone (GH) secretion is stimulation of the liver to produce somatomedin C, or IGF-1, which stimulates growth of bones and soft tissues. The increased levels of somatomedin C normally inhibit GH, but in acromegaly, the pituitary gland secretes GH despite elevated IGF-1 levels. When both GH and IGF-1 levels are increased, overproduction of GH is confirmed. GH also causes elevation of blood glucose, and normally GH levels fall during an oral glucose challenge but not in acromegaly.

Clinical manifestations of hyperthyroidism occur as a result of...

increased metabolic rate and tissue sensitivity to the sympathetic nervous system