Adaptive Quizzes- Chapter 52 Endocrine Disorders

Hypotension Hypoventilation Hypothermia Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. - Hypothermia - Hypertension - Hypotension - Hypoventilation - Hyperventilation

- Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? - Infusing IV fluids rapidly as ordered - Encouraging increased oral intake - Restricting fluids - Administering glucose-containing I.V. fluids as ordered

- 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 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? - Blood urea nitrogen (BUN) level of 12 mg/dl - Blood glucose level of 90 mg/dl - Serum sodium level of 134 mEq/L - Serum potassium level of 5.8 mEq/L

- 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 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? - Testosterone - Mineralocorticoids - Glucocorticoids - Estrogen

- Tracheostomy set After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? - Indwelling urinary catheter kit - Tracheostomy set - Cardiac monitor - Humidifier

- Magnetic resonance imaging (MRI) A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.

A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? - Magnetic resonance imaging (MRI) - Radioactive iodine uptake tes - Radioimmunoassay - A nuclear scan

- Pineal gland, melatonin The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamicpituitary interaction.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? - Thymus gland, thymosin - Parathyroid glands, parathormone - Pineal gland, melatonin - Adrenal cortex, corticosteroids

- 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.

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

- A pituitary tumor When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.

A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly? - A pituitary tumor - A decrease in release in the growth hormone - A decrease in the glucose level - An increase in cerebral edema

- "Maintain a moderate exercise program." Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? - "Maintain a moderate exercise program." - "Rest as much as possible." - "Lose weight." - "Jog at least 2 miles per day."

- Acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea.

A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? - Acromegaly - Type 1 diabetes mellitus - Hypothyroidism - Deficient growth hormone

- Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: - thyroiditis. - Graves' disease. - Hashimoto's thyroiditis. - multinodular goiter.

- T3, thyroxine (T4), and calcitonin. The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: - iodine and thyroid-stimulating hormone (TSH). - thyrotropin-releasing hormone (TRH) and TSH. - TSH, triiodothyronine (T3), and calcitonin. - T3, thyroxine (T4), and calcitonin.

- 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.

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

- 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.

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

- adrenal function

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

- Explain that the client's physical changes are a result of excessive corticosteroids.

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

- Calcium gluconate Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate.

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? - Calcium gluconate - Synthroid - Propylthiouracil (PTU) - Tapazole

- in 1 to 2 weeks. Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol (Inderal).

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside: - in a few days. - in 3 to 4 months. - immediately. - in 1 to 2 weeks.

phosphorus PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: - sodium. - potassium. - magnesium. - phosphorus.

- Detecting evidence of hormone hypersecretion.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? - Detecting evidence of hormone hypersecretion. - Detecting information about possible tumor growth. - Determining the presence or absence of testosterone levels. - Determining the size of the organs and location.

- "You must avoid hyperextending your neck after surgery."

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? - "The head of your bed must remain flat for 24 hours after surgery." - "You should avoid deep breathing and coughing after surgery." - "You won't be able to swallow for the first day or two." - "You must avoid hyperextending your neck after surgery."

- 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.

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

- a thyroid hormone antagonist. Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

For a client with hyperthyroidism, treatment is most likely to include: - a thyroid hormone antagonist. - thyroid extract. - a synthetic thyroid hormone. - emollient lotions.

- Stimulation of calcium reabsorption and phosphate excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

Parathyroid hormone (PTH) has which effects on the kidney? - Stimulation of calcium reabsorption and phosphate excretion - Stimulation of phosphate reabsorption and calcium excretion - Increased absorption of vitamin D and excretion of vitamin E - Increased absorption of vitamin E and excretion of vitamin D

Calcium

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. Sodium Calcium Potassium Magnesium

D

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? D C B E

- Hyperthyroidism Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism.SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.

The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? - Hypothyroidism - Hyperthyroidism - Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - Diabetes insipidus (DI)

- Temperature of 102ºF Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? - Heart rate of 62 - Blood pressure 90/58 mm Hg - Oxygen saturation of 96% - Temperature of 102ºF

- Gigantism When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? - Gigantism - Dwarfism - Acromegaly - Simmonds' disease

- Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau's sign is suggestive of latent tetany.

Trousseau's sign is elicited by which of the following? - Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. - A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. - After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. - The patient complains of pain in the calf when his foot is dorsiflexed.

- Consume adequate amounts of fluid. The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss.

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? - Come to the clinic for IV fluid therapy daily. - Limit the fluid intake at night. - Consume adequate amounts of fluid. - Weigh daily.

- 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.

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

- Hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? - Hypocalcemia - Hypercalcemia - Hyperphosphatemia - Hypophosphaturia

- computed tomography scan A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor

Which diagnostic test is done to determine suspected pituitary tumor? - computed tomography scan - measurement of blood hormone levels - radioimmunoassay - radiographs of the abdomen

- Vasopressin

Which hormone is secreted by the posterior pituitary? - Vasopressin - Calcitonin - Corticosteroids - Somatostatin

- Excessive thirst Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.

Which is a clinical manifestation of diabetes insipidus? - Low urine output - Excessive thirst - Weight gain - Excessive activities

- Hypothyroidism

Which is a complication of hyperthyroidism? - Myxedema coma - Hypothyroidism - Addisonian crisis - Acromegaly

- 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.

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

- Desmopressin (DDAVP) DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration.

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? - Desmopressin (DDAVP) - Thiazide diuretics - Ibuprofen - Diabinese

- Myxedemic coma Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? - Thyroid storm - Myxedemic coma - Addison's disease - Acromegaly

- Positive Chvostek's sign If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward.

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? - Positive Trousseau's sign - Positive Chvostek's sign - Hyperactive deep tendon reflex - Tetany