Patho 38 Disorders of Thyroid and Parathyroid and Adrenal Regulation

The nurse is preparing a presentation on Cushing syndrome. Which information regarding the effects of decreased ACTH production by the pituitary gland should the nurse​ give? (Select all that​ apply.) A. Gluconeogenesis is stimulated. B. Blood glucose levels are elevated. C. Hypertension develops. D. Hyperpigmentation occurs. E. Immunosuppression occurs.

A. Gluconeogenesis is stimulated. B. Blood glucose levels are elevated. E. Immunosuppression occurs. Rationale: The pathophysiology of Cushing syndrome involves elevated levels of cortisol that provide negative feedback on the pituitary gland. This results in a decreased amount of ACTH production by the pituitary​ gland, thereby elevating blood glucose​ levels, stimulating​ gluconeogenesis, and causing immunosuppression. Hypertension develops in clients with pheochromocytoma as a result of excessive catecholamine​ release, and does not develop as a result of decreased ACTH production by the pituitary gland in clients with Cushing syndrome. Hyperpigmentation of the skin and mucous membranes develops in clients with Addison disease as a result of increased pituitary ACTH production and increased blood beta​-lipotropin, and does not develop as a result of decreased ACTH production by the pituitary gland in clients with Cushing syndrome.

Which factor is associated with primary hypothyroidism? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Dietary iodine deficiency Unselected Exogenous thyroid Unselected Fibrosis of adrenal gland Unselected Cerebellar dysfunction

Dietary iodine deficiency is the only listed factor for primary hypothyroidism. Cerebellar dysfunction has no bearing on the thyroid. Fibrosis of the adrenal gland would cause other endocrine disorders. An exogenous thyroid would cause hyperthyroidism.

The nurse gives a presentation on the etiology of primary adrenal hypofunction. Which participant statement indicates a need for further teaching? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER "The disorder can be due to injury to the hypothalamus." Unselected "The disorder can be due to idiopathic causes." Unselected "The disorder can be related to disease of the adrenal cortex." Unselected "The disorder can be related to congenital adrenal hyperplasia."

Etiology for primary adrenal hypofunction includes congenital adrenal hyperplasia; disease of the adrenal cortex (related to autoimmune disease, adenoma, or infection); and idiopathic causes. Iatrogenic effects, such as corticosteroid therapy, lead to secondary adrenal hypofunction. Injury to the hypothalamus leads to tertiary adrenal hypofunction.

The nurse is preparing a presentation about Hashimoto disease. Which demographic should be included as having a higher incidence rate? ANSWER CORRECT Unselected African Americans Unselected Children Correct YOU WERE UNSURE AND CORRECT Women Unselected Men

Hashimoto disease occurs twice as often in women as in men. The disorder is not commonly seen in children, and it is not more commonly seen in African Americans than in other ethnic groups.

A patient has hoarseness, cervical lymphadenopathy, and a fixed nodule on the thyroid. Which disease should the nurse suspect in the patient? ANSWER CORRECT Unselected Multinodular goiter Correct YOU WERE UNSURE AND CORRECT Thyroid cancer Unselected Hashimoto thyroiditis Unselected Toxic multinodular goiter

Hoarseness and cervical lymphadenopathy, along with a fixed nodule, are present with thyroid cancer. Goiters can also present as nodules; however, they lack the cervical lymphadenopathy.

The nurse is preparing a presentation about hyperparathyroidism. Which population should be included as being most at risk? ANSWER I DON'T KNOW YET Unselected An older adult man Correct THE CORRECT ANSWER An older adult woman Unselected A younger adult man Unselected A younger adult woman

Hyperparathyroidism occurs most often in older adults and is three times more common in women than men. In a study, the prevalence tripled (76 to 233 per 100,000) in women as the age increased compared with men (30 to 85).

The nurse is caring for a patient with newly diagnosed Graves disease. Which lab result is consistent with this diagnosis? ANSWER I DON'T KNOW YET Unselected Increased thyroid-stimulating hormone (TSH) Unselected Increased cortisol Correct THE CORRECT ANSWER Increased triiodothyronine (T3) and thryoxine (T4) Unselected Increased aldosterone

In Graves disease, the thyroid secretes excess T3 and T4, which in turn suppresses TSH. Cortisol and aldosterone are related to the adrenal system.

Which disease process should alert the nurse to monitor calcium levels in a patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Chronic kidney disease Unselected Hyperthyroidism Unselected Coronary artery disease Unselected Cushing syndrome

In chronic kidney disease, vitamin D metabolite production is decreased resulting in increased secretion of parathyroid hormone (PTH) and parathyroid hyperplasia. Coronary artery disease, Cushing syndrome, and Graves disease are unrelated to calcium levels.

The nurse plans to examine a patient diagnosed with hypoparathyroidism for latent tetany. Which should the nurse use? ANSWER I DON'T KNOW YET Unselected Kernig sign Correct THE CORRECT ANSWER Trousseau sign Unselected Moro reflex Unselected Babinski reflex

Latent tetany can be demonstrated through the use of Trousseau sign or Chvostek sign. To check for Chvostek sign, tap on the facial nerve anterior to the ear. Twitching of the muscle on the same side of the face is a positive sign. Trousseau sign can be elicited by applying a blood pressure cuff and inflating for 3 minutes. A positive sign will be contractions of the carpal muscles.

The nurse is assessing a pregnant patient. Which system should the nurse suspect to be affected by maternal and fetal hypothyroidism? ANSWER I DON'T KNOW YET Unselected Circulatory system Unselected Respiratory system Correct THE CORRECT ANSWER Nervous system Unselected Musculoskeletal system

Maternal iodine deficiency can result in nervous system abnormalities. Iodine deficiency does not affect the musculoskeletal, circulatory, or respiratory systems during pregnancy.

The nurse finds severely decreased thyroid hormone levels in a patient experiencing emergent signs and symptoms of hypothyroidism. Which condition should the nurse suspect? ANSWER INCORRECT Correct THE CORRECT ANSWER Myxedema Unselected Thyroid storm Incorrect YOU WERE UNSURE AND INCORRECT Hashimoto disease Unselected Cretinism

Myxedema is the most severe form of hypothyroidism and is classified as a medical emergency. Cretinism refers to effects of congenital hypothyroidism. Hashimoto disease is a type of hypothyroidism caused by autoimmune response. Thyroid storm is an emergent condition associated with hyperthyroidism.

The lab results for a patient indicate very high levels of epinephrine and norepinephrine. Which adrenal gland health problem does the nurse suspect these findings to be indicative of? ANSWER INCORRECT Correct THE CORRECT ANSWER Pheochromocytoma Incorrect YOU WERE UNSURE AND INCORRECT Addison disease Unselected Cushing disease Unselected Adrenal hyperfunction

Pheochromocytomas are neuroendocrine tumors that arise from catecholamine-producing chromaffin cells that cause an oversecretion of the hormones epinephrine and norepinephrine. Adrenal hyperfunction occurs only in the adrenal cortex with the overproduction of aldosterone and/or the overproduction of cortisol. Cushing disease describes pituitary-dependent conditions, while Addison disease is caused by adrenal cortex insufficiency.

While teaching a patient about hyperparathyroidism, which risk factor should the nurse include? ANSWER CORRECT Unselected Neck surgery Unselected Autoimmune disorder Correct YOU WERE UNSURE AND CORRECT Prolonged vitamin D deficiency Unselected Smoking

Prolonged vitamin D or calcium deficiency increases the risk of hyperparathyroidism. Other risks include use of lithium, radiation treatment of the neck area, female gender, and being over the age of 50. Surgery in the neck area increases the risk of hypoparathyroidism.

The nurse is caring for a patient with hyperparathyroidism. Which lab values should the nurse expect to be elevated? ANSWER INCORRECT Incorrect YOU WERE UNSURE AND INCORRECT Propylthiouracil and vitamin D Unselected Propylthiouracil and adrenocorticotropic hormone (ACTH) Unselected Propylthiouracil and sodium Correct THE CORRECT ANSWER Propylthiouracil and calcium

Propylthiouracil (PTU) and calcium levels are elevated in hyperparathyroidism. ACTH is related to adrenocortical function. Sodium is not related to hyperparathyroidism. Vitamin D is decreased in hyperparathyroid disease.

A patient asks the nurse why it is important to maintain the lowest possible dosage of propylthiouracil during pregnancy. Which response should the nurse give? ANSWER I DON'T KNOW YET Unselected "Propylthiouracil causes teratogenic effects." Unselected "Propylthiouracil causes hyperemesis gravidarum." Correct THE CORRECT ANSWER "Propylthiouracil crosses the placental barrier." Unselected "Propylthiouracil crosses the blood-brain barrier."

Propylthiouracil (PTU) crosses the placental barrier. General recommendations are to use PTU during the first trimester at the lowest effective dose, then switch to methimazole for the remainder of the pregnancy. While PTU may cross the blood-brain barrier, this is not specific to pregnancy. PTU does not cause hyperemesis gravidarum. Methimazole is related to rare teratogenic effects.

A nurse is teaching a patient newly diagnosed with Graves disease. Which information should the nurse include? ANSWER I DON'T KNOW YET Unselected Prednisone decreases the production of the thyroid hormone. Unselected Levothyroxine decreases the production of the thyroid hormone. Unselected Spironolactone decreases the production of the thyroid hormone. Correct THE CORRECT ANSWER Propylthiouracil decreases the production of the thyroid hormone.

Propylthiouracil (PTU) is the only drug that decreases thyroid hormone. Levothyroxine is a thyroid hormone replacement. Spironolactone is an aldosterone antagonist. Prednisone is a glucocorticoid.

The nurse is caring for a patient diagnosed with hyperparathyroidism who has not responded to medication and lifestyle interventions. Which surgery should the nurse anticipate may be necessary? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Removal of the parathyroid glands Unselected Removal of the pituitary gland Unselected Removal of the adrenal medulla Unselected Removal of the pineal gland

Surgical intervention may be necessary for some patients with hyperparathyroidism. Surgical intervention may include removal of the parathyroid glands or procedures similar to those used for subtotal thyroidectomy. Removing the adrenal medulla, pituitary gland, or pineal gland would not have an impact on parathyroid hormone.

The nurse is caring for a patient with Graves disease who is experiencing exophthalmos. Which potential problem is a priority for the nurse to address? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Visual perception Unselected Pain Unselected Constipation Unselected Skin integrity

Visual perception is the priority potential problem for the nurse to address when caring for a patient with exophthalmos. Skin integrity, constipation, and pain are not priority potential problems for the nurse when caring for a patient with Graves disease and exophthalmos.

Which clinical manifestation suggests hyperthyroidism? ANSWER INCORRECT Incorrect YOU WERE UNSURE AND INCORRECT Bradycardia Unselected Constipation Correct THE CORRECT ANSWER Weight loss with increased appetite Unselected Cold intolerance

Weight loss with increased appetite is a sign of hyperthyroidism. Cold intolerance, constipation, and bradycardia are signs of hypothyroidism.

A patient reports muscle weakness, abdominal discomfort, and constipation for the past few weeks. The nurse suspects that the patient may have an increased calcium level. Which condition in the patient's health history should the nurse question that is specifically related to hypercalcemia and hyperparathyroidism? ANSWER I DON'T KNOW YET Unselected History of pancreatitis and liver or kidney disease Unselected Current manifestations of numbness and tingling around the mouth Unselected Current manifestations of shortness of breath Correct THE CORRECT ANSWER Current manifestations of increased urination, thirst, and changes in memory or thinking

The health history for a patient with hyperparathyroidism or hypercalcemia would include increased urination, thirst, and changes in memory or thinking. The health history for a patient with hypoparathyroidism or hypocalcemia would include numbness and tingling around the mouth, and shortness of breath. The health history for a patient with hypoparathyroidism or hypocalcemia would include acute and chronic conditions, such as pancreatitis and liver or kidney disease.

The nurse is caring for a patient who is newly diagnosed with papillary cancer. Which initial treatment of cancer does the nurse anticipate for this patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Total thyroidectomy Unselected Hemithyroidectomy Unselected Radioactive iodine ablation Unselected Administration of propylthiouracil

The initial treatment of papillary thyroid cancer is a total thyroidectomy. Radioactive iodine ablation may be performed to destroy any remaining cancer. A hemithyroidectomy is not indicated for papillary thyroid cancer. Propylthiouracil (PTU) is administered for hyperthyroidism to suppress hormone production.

A patient wants to know the risk factors for developing thyroid cancer. Which should the nurse include? ANSWER CORRECT Unselected Living in a rural community Unselected Family history Unselected Growing up around pesticides Correct YOU WERE UNSURE AND CORRECT Exposure to ionizing radiation

The most consistent risk factor for developing thyroid cancer is exposure to ionizing radiation in the form of x-rays to the head and neck during childhood. Growing up around pesticides, living in a rural community, and family history are not consistent risk factors.

The nurse is assessing a patient who has abdominal pain, generalized weakness, peripheral neuropathy, osteopenia, and hypercalcemia. Which disease process should the nurse suspect in the patient? Cushing syndrome Correct THE CORRECT ANSWER Primary hyperparathyroidism Unselected Graves disease Unselected Primary adrenalcortical insufficiency

The parathyroid secretes parathyroid hormone (PTH). PTH is important in the regulation of calcium and phosphate. The primary effect of PTH is maintaining normal serum calcium.

The nurse is assessing a patient who has abdominal pain, generalized weakness, peripheral neuropathy, osteopenia, and hypercalcemia. Which disease process should the nurse suspect in the patient? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Primary hyperparathyroidism Unselected Primary adrenalcortical insufficiency Unselected Graves disease Unselected Cushing syndrome

The parathyroid secretes parathyroid hormone (PTH). PTH is important in the regulation of calcium and phosphate. The primary effect of PTH is maintaining normal serum calcium.

In Cushing syndrome, the amount of ACTH released from the pituitary gland is decreased. Which event is not a part of the process that decreases the amount of ACTH released from the pituitary gland? ANSWER I DON'T KNOW YET Unselected Release of an anti-inflammatory agent Unselected Elevation of blood glucose Correct THE CORRECT ANSWER Development of inflammation Unselected Stimulation of gluconeogenesis

The pathophysiology of Cushing syndrome includes elevated levels of cortisol that provide negative feedback on the pituitary, decreasing the amount of ACTH released from the pituitary gland. This process stimulates gluconeogenesis, elevates the blood glucose level, and causes a powerful anti-inflammatory agent to be released. Inflammation is not produced in the process.

Which statement is accurate about patients diagnosed with thyroid cancer? ANSWER I DON'T KNOW YET Unselected "Mortality is greater for men than women." Correct THE CORRECT ANSWER "Mortality is greater for women than men." Unselected "Mortality is not a factor in thyroid cancer." Unselected "Mortality is equally prevalent in both genders."

The preponderance of deaths from thyroid cancer are in women. The American Cancer Society estimates about 1,090 female deaths, as compared to 920 male deaths in 2017; thus, mortality is greater in women than men.

The nurse is planning to teach a patient about the radioactive iodine uptake test. Which statement should the nurse include? ANSWER I DON'T KNOW YET Unselected "This test will help isolate the thyroid cancer." Correct THE CORRECT ANSWER "This test can help distinguish Graves disease from other hyperthyroid causes." Unselected "This test will help differentiate primary and secondary hypothyroidism." Unselected "This test will ablate the thyroid so it no longer produces the hormone.

The radioactive iodine uptake (RAIU) test helps differentiate different etiologies of hyperthyroidism. An oral radioactive iodine is administered. A high concentration of the tracer throughout the thyroid is indicative of Graves disease. This test does not ablate the thyroid. Thyroid cancer is typically diagnosed as a nodule by palpation. Primary and secondary hypothyroidism are determined by the cause. Primary hypothyroidism is located in the thyroid, while secondary hypothyroidism is caused by deficiencies with the hypothalamus or pituitary.

A patient scheduled for a rapid ACTH stimulating test asks the nurse which function the test is assessing. Which function should the nurse include in the response? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Adrenocortical Unselected Renal Unselected Thyroid Unselected Parathyroid

The rapid ACTH stimulating test is performed to differentiate primary and secondary adrenocortical insufficiency. Thyroid function is assessed with TSH, T3, and T4 levels. Renal function is assessed with BUN and creatinine levels. Parathyroid function is assessed by monitoring serum calcium levels.

The nurse teaches a patient about the rapid adrenocorticotropic hormone (ACTH) test. Which patient statement indicates understanding of the test? ANSWER I DON'T KNOW YET Unselected "A normal rise in cortisol means I have secondary adrenocortical insufficiency." Unselected "A subnormal rise in cortisol means I have secondary adrenocortical insufficiency." Unselected "A normal rise in cortisol means I have primary adrenocortical insufficiency." Correct THE CORRECT ANSWER "A subnormal rise in cortisol means I have primary adrenocortical insufficiency."

The rapid ACTH stimulation test assess adrenocortical function and helps differentiate primary from secondary adrenal insufficiency. In the rapid ACTH test, a dose of synthetic ACTH is injected, and plasma cortisol levels are drawn at specific predetermined times. A subnormal rise in cortisol in response to ACTH stimulation indicates primary adrenocortical insufficiency.

The nurse is assessing a patient who is diagnosed with hyperthyroidism. Which assessment is not related to hyperthyroidism? Correct YOU WERE UNSURE AND CORRECT Use of insulin for drug therapy Unselected Heart sounds and pulses Unselected Palpation of thyroid Unselected Weight

The use of insulin is not a recommended treatment for hyperthyroidism; the nurse would not assess this factor. Other factors to include in the nursing assessment of the patient with hyperthyroidism include, but are not limited to, vital signs, palpation of gland, respiratory and cardiac assessment, weight (to assess for weight loss), energy level, and sleep patterns.

Which condition should the nurse include when teaching about hyperthyroidism? ANSWER CORRECT Unselected Postpartum status Unselected Insufficient thyroid-stimulating hormone (TSH) secretion Correct YOU WERE UNSURE AND CORRECT Graves disease Unselected Diabetes mellitus

There are several factors that can lead to the development of hyperthyroidism. These factors include excess TSH secretion, Graves disease, thyroiditis, tumor, and excessive doses of thyroid hormone supplement. During the postpartum period, a woman may experience hypothyroidism. An insufficient production of TSH would lead to hypothyroidism, not hyperthyroidism. Diabetes mellitus does not lead to hyperthyroidism.

The nurse is assessing a patient with a thyroid disorder. Which body areas are the priority for the nurse to inspect? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Eyes, neck Unselected Skin, hair Unselected Groin, breasts Unselected Feet, legs

When performing a physical assessment for the patient with a thyroid disorder, the nurse inspects the eyes for exophthalmos and the neck for goiter. The nurse may inspect other areas of the body; however, the correct answer is specific to the patient with thyroid dysfunction.

The nurse is prepaing a presentation on thyroid cancer. Which statement should the nurse include? ANSWER CORRECT Unselected "Medullary thyroid cancer is the most common form of thyroid cancer in the United States." Unselected "Men are the most likely to die from thyroid cancer." Unselected "Anaplastic thyroid cancers are rarely fatal." Correct YOU WERE UNSURE AND CORRECT "Women are the most likely to die from thyroid cancer."

Women are the preponderance of thyroid cancer deaths. Medullary thyroid cancer is the least common thyroid cancer in the United States. Anaplastic thyroid cancer has a mortality of close to 100%.

The nurse is caring for a​ 12-year old client diagnosed with primary adrenocortical insufficiency. Which condition is the nurse most likely to see in the​ client's medical​ history? A. Inflammatory necrosis B. Congenital adrenal hyperplasia C. Amyloidosis D. Idiopathic bilateral hyperaldosteronis

​B. Congenital adrenal hyperplasia Rationale: Congenital adrenal hyperplasia is the most common cause of primary adrenal insufficiency in children. Idiopathic bilateral hyperaldosteronism is the most common cause of primary aldosteronism. Inflammatory necrosis and amyloidosis are also causes of primary adrenal​ insufficiency, but not the most common causes in children.

A client suspected of having secondary hypothyroidism asks the nurse what testing should be anticipated. Which test should the nurse include in the​ response? A. Thyroid scan B. MRI of the pituitary C. A radioactive iodine uptake​ (RAIU) test D. A complete physical to include assessment for goiter

​B. MRI of the pituitary Rationale: Secondary hypothyroidism can be caused by injury to the anterior​ pituitary, resulting in TSH deficiency. An MRI would evaluate the pituitary. Thyroid​ scans, RAIU, and physical exam for goiter are all tests for hyperthyroidism.

The nurse is caring for a client with hypothyroidism. Which risk factor should the nurse associate with this​ client? (Select all that​ apply.) A. Male gender B. Previous treatment with radioactive iodine C. Radiation of the neck D. Thyroid surgery E. Autoimmune disease

​B. Previous treatment with radioactive iodine C. Radiation of the neck D. Thyroid surgery E. Autoimmune disease Rationale: Risk factors for hypothyroidism include having an autoimmune​ disease, having a family member with an autoimmune​ disease, previous treatment with radioactive​ iodine, radiation of the​ neck, thyroid​ surgery, and being of the female​ gender, not the male gender.

The nurse is caring for a client diagnosed with secondary hyperaldosteronism. Which information should the nurse expect to find in the​ client's health​ history? A. Pituitary adenoma B. Renal artery stenosis C. Hyperplastic adrenal glands D. Conn syndrome

​B. Renal artery stenosis Rationale: Secondary hyperaldosteronism occurs when the​ renin-angiotensin-aldosterone system​ (RAAS) is overstimulated due​ to: renal artery​ stenosis, a juxtaglomerular cell​ tumor, fibromuscular​ hyperplasia, and ineffective reabsorption of sodium in the renal tubules. Adrenal​ adenoma, or Conn​ syndrome, causes primary hyperaldosteronism. Hyperplastic adrenal glands cause hypercortisolism. A pituitary adenoma also causes hypercortisolism​ (pituitary-related Cushing​ disease).

The nurse is discussing common risk factors for hypothyroidism and hyperthyroidism. Which factor should the nurse​ include? (Select all that​ apply.) A. Pregnancy B. Age C. Gender D. Radiation of the neck E. Autoimmune disease

​C. Gender E. Autoimmune disease Rationale: Both being female and having an autoimmune disease increase the risk for hypothyroidism and hyperthyroidism. Being both under 40 years of age and pregnant increases the risk for​ hyperthyroidism, but not hypothyroidism. Radiation of the neck increases the risk for​ hypothyroidism, but not hyperthyroidism.

Which is the most common cause of​ hyperthyroidism? A. Pregnancy B. Tumor C. Graves disease D. Surgery

​C. Graves disease Rationale: Graves disease is the most common cause of hyperthyroidism. This causes the thyroid cells to become hyperactive and the thyroid gland enlarges. Tumors may lead to an overactive​ thyroid; however, this is not the most common cause. Pregnancy can affect the​ thyroid; but this is not the most common cause of hyperthyroidism. Surgery does not lead to overactivity of the thyroid.