Ch 45: Assessment and Management of Patients with Endocrine Disorders

d) Exophthalmos Pg. 1447 The nurse would document the finding of abnormal bulging of the eyes as exophthalmos. Palpation of the thyroid would reveal thyroid enlargement. Hypopigmentation would suggest a loss of color to an area. Tremor would be used to denote shaking or quivering.

1. During the physical examination of a client with a suspected endocrine disorder, the nurse observes an abnormal bulging of the eyes. The nurse documents this finding as which of the following? a) Tremor b) Thyroid enlargement c) Hypopigmentation d) Exophthalmos

c) Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff Pg. 1473 A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when 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. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

10. Trousseau's sign is elicited by which of the following? a) After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery b) The patient complains of pain in the calf when his foot is dorsiflexed c) Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff d) 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

d) Those who are allergic to seafood Pg. 1464 Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.

11. Which group of clients should not receive potassium iodide? a) Those who are pregnant b) Those taking medications such as cough medicines c) Those who are allergic to corticosteroids d) Those who are allergic to seafood

a) Computed tomography (CT) scan Pg. 1451 A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.

12. Which diagnostic test is done to determine suspected pituitary tumor? a) Computed tomography (CT) scan b) Radioimmunoassay c) Radiographs of the abdomen d) Measurement of blood hormone levels

d) Hyperthyroidism Pg. 1462 Clients with hyperthyroidism characteristically are restless despite feeling 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.

13. 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? a) Diabetes insipidus (DI) b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c) Hypothyroidism d) Hyperthyroidism

b) Hypocalcemia Pg. 1473 A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

14. For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate: a) Hyperkalemia b) Hypocalcemia c) Hypokalemia d) Hypercalcemia

d) Levothyroxine sodium Pg. 1466 Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.

15. Which of the following would the nurse expect the physician to order for a client with hypothyroidism? a) Propranolol b) Propylthiouracil c) Methimazole d) Levothyroxine sodium

c) Adequate vitamin D level Pg. 1470 Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

16. A nurse understands that for the parathyroid hormone to exert its effect, what must be present? a) Decreased phosphate level b) Increased calcium level c) Adequate vitamin D level d) Functioning thyroid gland

a) Palpitations Pg. 1461 Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.

17. Cardiac effects of hyperthyroidism include a) Palpitations b) Decreased systolic blood pressure c) Decreased pulse pressure d) Bradycardia

a) Pituitary Pg. 1449 Commonly referred to as the master gland, the pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands. The thyroid, parathyroid, and adrenal glands are not considered the master gland.

18. Which of the following glands is considered the master gland? a) Pituitary b) Adrenal c) Thyroid d) Parathyroid

c) Gigantism Pg. 1450 When oversecretion 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.

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

c) Myxedema coma Pg. 1456-1457 Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.

2. A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? a) Diabetes insipidus b) Thyroid storm c) Myxedema coma d) Syndrome of inappropriate antidiuretic hormone (SIADH)

d) Serum potassium level of 5.8 mEq/L Pg. 1477 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.

20. 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) Blood glucose level of 90 mg/dl b) Blood urea nitrogen (BUN) level of 12 mg/dl c) Serum sodium level of 134 mEq/L d) Serum potassium level of 5.8 mEq/L

b) By occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff Pg. 1473 A positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.

21. Trousseau sign is elicited a) By tapping sharply over the facial nerve just in front of the parotid gland and anterior to the ear, causing spasm or twitching of the mouth, nose, and eye b) By occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff c) After making a clenched fist and opening the hand; the palm remains blanched when pressure is placed over the radial artery d) When the foot is dorsiflexed and there is pain in the calf

c) Weight gain, decreased appetite, and constipation Pg. 1455-1456 Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

22. Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? a) Weight loss, increased urination, and increased thirst b) Weight gain, increased urination, and purplish-red striae c) Weight gain, decreased appetite, and constipation d) Weight loss, increased appetite, and hyperdefecation

c) Potassium of 6.0 mEq/L Pg. 1477 Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L.

23. The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? a) Glucose of 100 mg/dL b) Sodium of 140 mEq/L c) Potassium of 6.0 mEq/L d) A blood pressure reading of 135/90 mm Hg

a) "Maintain a moderate exercise program" Pg. 1472 The nurse should instruct the client to 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. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.

24. 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? a) "Maintain a moderate exercise program" b) "Jog at least 2 miles per day" c) "Lose weight" d) "Rest as much as possible"

a) Hypothermia b) Hypotension e) Hypoventilation Pg. 1456 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.

25. 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. a) Hypothermia b) Hypotension c) Hypertension d) Hyperventilation e) Hypoventilation

d) Tracheostomy set Pg. 1469 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.

26. 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? a) Humidifier b) Indwelling urinary catheter kit c) Cardiac monitor d) Tracheostomy set

b) Blood pressure varying between 120/86 and 240/130 mm Hg Pg. 1475 Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.

27. A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? a) Heart rate of 56-64 bpm b) Blood pressure varying between 120/86 and 240/130 mm Hg c) Complaints of nausea d) Shivering

a) Vasopressin Pg. 1452 Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

28. When caring for a client with diabetes insipidus, the nurse expects to administer: a) Vasopressin b) Regular insulin c) 10% dextrose d) Furosemide

b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Pg. 1452 Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

29. Dilutional hyponatremia occurs in which disorder? a) Addison disease b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c) Pheochromocytoma d) Diabetes insipidus (DI)

a) Muscle twitching Pg. 1473 Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are not associated with hypocalcemia.

3. Hypocalcemia is associated with which of the following manifestations? a) Muscle twitching b) Bowel hypomotility c) Fatigue d) Polyuria

a) A blood pressure of 176/88 mm Hg Pg. 1475 Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

30. 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 176/88 mm Hg b) A blood glucose level of 130 mg/dl c) A blood pressure of 130/70 mm Hg d) Bradycardia

a) Cushing syndrome Pg. 1479 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.

31. Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a) Cushing syndrome b) Hashimoto disease c) Graves disease d) Addison disease

a) Stimulate more hormones using the negative feedback system Pg. 1453 Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

32. 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? a) Stimulate more hormones using the negative feedback system b) Produce a new hormone to try and regulate the thyroid function c) Stimulate more hormones using the positive feedback system d) Be unable to perform in response to low levels of thyroid hormone.

b) Tetany Pg. 1473 Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

4. A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a) Hemorrhage b) Tetany c) Thyroid storm d) Laryngeal nerve damage

b) Observe the color of stool Pg. 1480 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.

5. 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? a) Observe urine output b) Observe the color of stool c) Monitor vital signs every 4 hours d) Monitor bowel patterns

a) Assess for neurologic changes d) Closely monitor nasal packing and postnasal drainage Pg. 1451 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.

6. 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. a) Assess for neurologic changes b) Offer the client a straw when drinking liquids c) Encourage deep breathing and coughing d) Closely monitor nasal packing and postnasal drainage

b) Temperature of 102ºF Pg. 1463 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.

7. 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? a) Oxygen saturation of 96% b) Temperature of 102ºF c) Blood pressure 90/58 mm Hg d) Heart rate of 62

d) Palpate the thyroid gland gently Pg. 1462 The nurse should inspect the neck for thyroid enlargement and gently palpate the thyroid gland. Repeated palpation of the thyroid in case of thyroid hyperactivity can result in a sudden release of a large amount of thyroid hormones, which may have serious implications. Pigment changes in the neck and excessive oiliness of the skin are not related to assessment for thyroid enlargement.

8. The nurse is evaluating a client's neck for thyroid enlargement. Which action by the nurse is appropriate during the evaluation? a) Perform repeated palpation of the thyroid gland b) Inspect changes in pigmentation in the neck c) Examine the skin of the neck for excessive oiliness d) Palpate the thyroid gland gently

c) Pituitary disorder Pg. 1450 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.

9. 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) Parathyroid disorder b) Adrenal disorder c) Pituitary disorder d) Thyroid disorder