PrepU Chapter 52 - Endocrine Disorders

A group of students are reviewing information about the relationship of the hypothalamus and the pituitary gland. The students demonstrate the need for additional study when they state which of the following? A. "The pituitary gland, as the master gland, controls the secretion of hormones by the hypothalamus." B. "The hypothalamus secretes releasing hormones that stimulate or inhibit pituitary gland secretions." C. "The hypothalamus, a portion of the brain between the cerebrum and brain stem, creates a pathway for neurohormones." D. "Corticotropin-releasing hormone from the hypothalamus triggers ACTH secretion by the pituitary gland."

A. "The pituitary gland, as the master gland, controls the secretion of hormones by the hypothalamus." Although the pituitary gland is considered the master gland because it regulates the function of other glands, the hypothalamus influences the pituitary gland. The hypothalamus creates a pathway for neurohormones also known as releasing hormones or factors that stimulate and inhibit secretions from the anterior and posterior lobes of the pituitary gland. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. For example, corticotropin-releasing hormone from the hypothalamus causes the anterior pituitary gland to secreted ACTH.

A client who is frightened of needles has been told that he will have to have an intravenous (IV) line inserted. The client's blood pressure and pulse rate increase, and the nurse observes the pupils dilating. What does the nurse recognize has occurred with this client? A. The client is showing the fight-or-flight response. B. The client is having a response to dehydration. C. The client is developing an infection. D. The client is in a hypertensive crisis.

A. The client is showing the fight-or-flight response. The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what is referred to as the physiologic stress response, also known as the fight-or-flight response. Many organs respond to the release of epinephrine and norepinephrine. Responses include increased blood pressure and pulse rate, dilation of the pupils, constriction of blood vessels, bronchodilation, and decreased peristalsis. The client does not demonstrate the signs of infection, dehydration, or hypertensive crisis.

A client has suffered from several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. The client's healthcare provider suspects Addison's disease. Which symptom would the nurse NOT expect to see? A. depression B. weight gain C. hypoglycemia D. hypotension

B. weight gain Weight loss, anemia, anorexia, and gastrointestinal symptoms are signs and symptoms of adrenal insufficiency. The consequences of decreased adrenal cortical function include decreased available glucose and hypoglycemia. Nervousness and periods of depression are often seen in clients with adrenal insufficiency. Weakness, fatigue, dizziness, hypotension, postural hypotension, and hypothermia are often seen in clients with adrenal insufficiency.

A client with symptoms of Cushing syndrome is admitted to the hospital for evaluation and treatment. The nurse is creating a plan of care for the client. Which is an appropriate nursing diagnosis? A. Impaired nutrition: more than body requirements related to polyphagia B. Activity intolerance related to muscle cramps, cardiac dysrhythmias, and weakness C. Insomnia related to increased nighttime voiding D. Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns

D. Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns The major goals for the client include decreased risk of injury, decreased risk of infection, increased ability to perform self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications. The other nursing diagnoses do not apply in Cushing syndrome.

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? adrenal function thyroid function thymus function parathyroid function

adrenal function The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.

Hypocalcemia is associated with which of the following manifestations? A. Muscle twitching B. Bowel hypomotility C. Fatigue D. Polyuria

A. Muscle twitching Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching).

ADH is secreted by which gland? A. Posterior pituitary B. Thyroid C. Adrenal D. Anterior pituitary

A. Posterior pituitary Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? A. Pressure on the optic nerve B. Corneal abrasions C. Glaucoma D. Retinal detachment

A. Pressure on the optic nerve Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.

After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland? A.Testes B. Kidneys C. Adrenal gland D. Pancreas

B. Kidneys Although the kidneys secrete renin and erythropoietin, they are typically not considered endocrine glands. The pancreas, adrenal glands, and testes are considered endocrine glands.

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: A. weight gain in arms and legs. B. deposits of adipose tissue in the trunk and dorsocervical area. C. hypotension. D. thick, coarse skin.

B. deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find? A. Excessive urine output B, Constant thirst C. Weight loss D. Bulging forehead

D. Bulging forehead Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet. Excessive urine output, weight loss, and constant thirst are associated with diabetes insipidus.

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? A. The functioning of endocrine glands B. The concentration of a substance in plasma C. The client's blood sugar level D. Details about the size of the organ and its location

A. The functioning of endocrine glands Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.

A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? A. Glucocorticoids B. Epinephrine C. Mineralocorticoids D. Glucagon

B. Epinephrine The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.

A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? A. "The gland does not have any other function other than to cause secretion of the growth hormones." B. "It is the gland that is responsible for regulating the hypothalamus." C. "It regulates metabolism." D. "It regulates the function of other endocrine glands."

D. "It regulates the function of other endocrine glands." The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.

The nurse is aware that the best time of day for the total large corticosteroid dose is between: A. 4:00 AM and 5:00 AM B. 8:00 PM and 9:00 PM C. 4:00 PM and 6:00 PM D. 7:00 AM and 8:00 AM

D. 7:00 AM and 8:00 AM The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: calcium and phosphorus abnormalities. chloride and magnesium abnormalities. sodium and chloride abnormalities. sodium and potassium abnormalities.

sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? A. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." B. "I'll take my hydrocortisone in the late afternoon, before dinner." C. "I'll take the entire dose at bedtime." D. "I'll take all of my hydrocortisone in the morning, right after I wake up."

A. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.

Which of the following is the primary hormone for the long-term regulation of sodium balance? A. Aldosterone B. Calcitonin C. Antidiuretic hormone (ADH) D. Thyroxin

A. Aldosterone aldosterone is the primary hormone for the long-term regulation of sodium balance. Vasopressin (ADH) release will result in reabsorption of water into the bloodstream, rather than excretion by the kidneys. Calcitonin is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone. Thyroxin is important in brain development and is necessary for normal growth.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? A. Serum potassium level of 5.8 mEq/L B. Blood glucose level of 90 mg/dl C. Blood urea nitrogen (BUN) level of 12 mg/dl D. Serum sodium level of 134 mEq/L

A. Serum potassium level of 5.8 mEq/L Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? A. pituitary disorder B. parathyroid disorder C. thyroid disorder D. adrenal disorder

A. pituitary disorder Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? Pitting edema of the legs An irregular apical pulse Dry mucous membranes Frequent urination

An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response? A. "I can show you how to change your style of dress so that the changes are not so noticeable." B. "If treated successfully, the major physical changes will disappear with time." C. "I do not think you look bad and I am sure your family loves you very much." D. "I can refer you to a support group. Talking to someone may help you feel better."

B. "If treated successfully, the major physical changes will disappear with time." If treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationships with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? A. Hashimoto disease B. Cushing syndrome C. Graves disease D. Addison disease

B. Cushing syndrome The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.

A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. A. Hypotension B. Hypertension C. Poor wound healing D. Weight loss E. Alterations in glucose metabolism

B. Hypertension C. Poor wound healing E. Alterations in glucose metabolism Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? A. Diet and drug histories are related to the family history. B. An allergy to iodine is inherited. C. Endocrine disorders can be inherited. D. It helps determine the client's general status.

C. Endocrine disorders can be inherited. Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history. A complete blood count and chemistry profile are performed to determine the client's general status and to rule out disorders. Obtaining information about an allergy to iodine is important because diagnostic testing may involve the use of contrast dyes. However, an allergy to iodine is not related to endocrine disorders. Diet and drug histories, although important information, are not associated with the family history.

A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage. Encourage deep breathing and coughing. Offer the client a straw when drinking liquids.

Closely monitor nasal packing and postnasal drainage. Assess for neurologic changes. The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.

Which disorder results from excessive secretion of somatotropin (growth hormone)? A. Dwarfism B. Cretinism C. Adrenogenital syndrome D. Acromegaly

D. Acromegaly The client with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism. Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.

A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating: A. Aldosterone. B. Cortisol. C. Glucocorticoids. D. Catecholamines.

D. Catecholamines. A pheochromocytoma releases high levels of the catecholamines epinephrine and norepinephrine. These levels directly affect the incidence and severity of side effects such as headache, diaphoresis, palpitations, and hypertension. Blood pressure readings exceeding 250/150 have been recorded.

A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress? A. Testosterone B. Mineralocorticoids C. Estrogen D. Glucocorticoids

D. Glucocorticoids Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse QUESTION? A. Normal saline solution B. Hydrocortisone (Cortef) C. Fludrocortisone (Florinef) D. Potassium chloride

D. Potassium chloride The nurse should question an order for potassium chloride because addisonian crisis results in hyperkalemia. Administering potassium chloride is contraindicated. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.

A client has experienced several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. What assessments would the nurse expect to find with a client with suspected Addison disease? Select all that apply. Weight gain Increased appetite Hypoglycemia Depression Hypotension

Hypotension Depression Hypoglycemia Addison disease is characterized by muscle weakness, anorexia, GI symptoms, fatigue, emaciation, hypotension, low blood glucose levels, low serum sodium levels, high serum potassium levels, and dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows. Depression, emotional lability, apathy, and confusion may also be present.

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? Observe the color of stool. Monitor bowel patterns. Monitor vital signs every 4 hours. Observe urine output.

Observe the color of stool. The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? Stimulate more hormones using the negative feedback system Stimulate more hormones using the positive feedback system Produce a new hormone to try and regulate the thyroid function The feedback loop will be unable to perform in response to low levels of thyroid hormone.

Stimulate more hormones using the negative feedback system Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

A nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume? A. renin B. gastrin C. cholecystokinin D. erythropoietin

A. renin Renin is released from the kidneys and initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys secrete erythropoietin, a substance that promotes the maturation of red blood cells. Cholecystokinin released from cells in the small intestine stimulates contraction of the gallbladder to release bile when dietary fat is ingested. Gastrin is released within the stomach to increase the production of hydrochloric acid.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: A. a blood pressure of 130/70 mm Hg. B. bradycardia. C. a blood pressure of 176/88 mm Hg. D. a blood glucose level of 130 mg/dl.

C. a blood pressure of 176/88 mm Hg. Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response? A. thyroid gland B. pineal gland C. adrenal cortex D. adrenal medulla

D. adrenal medulla The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? decrease in hormonal levels increase in hormonal levels hormonal overproduction hormonal underproduction

decrease in hormonal levels Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.

Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? kidneys cardiac atria brain liver

kidneys The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.

During a client education session, the nurse describes the role of endocrine glands. Which homeostatic process is regulated by hormones? A. All options are correct. B. growth C. fluid balance D. sleep

A. All options are correct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes such as metabolism, growth, fluid and electrolyte balance, reproductive processes, sleep and wake cycles, etc.

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11:00 PM to 7:00 AM, and normally sleeps from 8:00 AM to 4:00 PM. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time? A. 12:00 PM B. 8:00 PM C. 5:00 PM D. 8:00 AM

C. 5:00 PM An overnight dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally late in the evening or at bedtime, and a plasma cortisol concentration is measured at 8 AM the next day. However, in a client who sleeps during the day, the medication would be given before bed and the plasma concentration would be measured soon after awakening in the late afternoon.

A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? A. Examine extremities for pitting edema. B. Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. C. Provide a high-sodium diet. D.Administer prescribed diuretics.

C. Provide a high-sodium diet. Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water.

Which of the following hormones controls secretion of adrenal androgens? A. Thyroid-stimulating hormone (TSH) B. Calcitonin C. Adrenocorticotropic hormone (ACTH) D. Parathormone

C. Adrenocorticotropic hormone (ACTH) ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.

A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer: A. phentolamine (Regitine). B. felodipine (Plendil). C. methyldopa (Aldomet). D. mannitol (Osmitrol).

A. phentolamine (Regitine). Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn't effective in treating hypertensive emergencies. Mannitol, a diuretic, isn't used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.

A nurse should perform which intervention for a client with Cushing's syndrome? A. Offer clothing or bedding that's cool and comfortable. B. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather. C. Explain that the client's physical changes are a result of excessive corticosteroids. D. Suggest a high-carbohydrate, low-protein diet.

C. Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.

The adrenal cortex is responsible for producing which substances? A. Norepinephrine and epinephrine B. Mineralocorticoids and catecholamines C. Glucocorticoids and androgens D. Catecholamines and epinephrine

C. Glucocorticoids and androgens The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.

A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? A. Hysteroscopy B. Ablation C. Hypophysectomy D. Thyroidectomy

C. Hypophysectomy The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? A. Hypotension B. Pale thick skin C. Moon face D. Weight loss

C. Moon face Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.

A client with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of: A. hyponatremia and hypokalemia. B. hypernatremia and hypokalemia. C. hyponatremia and hyperkalemia. D. hypernatremia and hyperkalemia.

C. hyponatremia and hyperkalemia. Adrenal crisis may be sudden or gradual. Clients experiencing an adrenal crisis should be monitored for hyponatremia and hyperkalemia. *Adrenal insufficiency is Addison's disease

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? A. Pancreas B. Adrenal medulla C. Parathyroid D. Adrenal cortex

D. Adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A. Imbalanced nutrition: Less than body requirements B. Impaired physical mobility C. Risk for infection D. Decreased cardiac output

D. Decreased cardiac output An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.

A client with pheochromocytoma is scheduled for an adrenalectomy. Which of the following would the nurse perform preoperatively? A. Initiate intravenous access for fluid therapy. B. Check for the signs of adrenal insufficiency. C. Begin administering prescribed corticosteroid. D. Monitor blood pressure (BP) frequently.

D. Monitor blood pressure (BP) frequently. The nurse should monitor BP frequently before surgery when a client has a pheochromocytoma. When bilateral adrenalectomy is scheduled, the nurse may start IV administration of a solution containing a corticosteroid preparation the morning of surgery. Some surgeons prefer to initiate corticosteroid administration during removal of the adrenals. The nurse monitors for signs of adrenal insufficiency after the surgery.

When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? A. The glands contain ducts that produce the hormones. B. The secreted hormones act like target cells. C. The glands play a minor role in maintaining homeostasis. D. The secretions are released directly into the blood stream.

D. The secretions are released directly into the blood stream. The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: A. an ectopic corticotropin-secreting tumor. B. an inborn error of metabolism. C. adrenal carcinoma. D. a corticotropin-secreting pituitary adenoma.

D. a corticotropin-secreting pituitary adenoma. A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: A. dairy products. B. cereals and grains. C. processed meats. D. fresh fruits.

D. fresh fruits. Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? Glaucoma Corneal abrasions Retinal detachment Pressure on the optic nerve

Pressure on the optic nerve Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.