Ch 45 Endocrine (The Point)
Antithyroid medications are not generally recommended for elderly patients because of which side effect? Mental confusion Weight loss Granulocytopenia Fatigue
Granulocytopenia
During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? "Do you have to get up at night to empty your bladder?" "Can you describe the amount of stress in your life?" "Do you experience fatigue even if you have slept a long time?" "Have you experienced any headaches or sinus problems?"
"Do you experience fatigue even if you have slept a long time?" With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.
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? "I can refer you to a support group. Talking to someone may help you feel better." "I do not think you look bad and I am sure your family loves you very much." "I can show you how to change your style of dress so that the changes are not so noticeable." "If treated successfully, the major physical changes will disappear with time."
"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.
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? 12:00:00 08:00:00 17:00:00 20:00:00
17:00:00 A 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 at bedtime, and a plasma cortisol concentration is measured when the client awakens the next day. Often, therefore, the medication is administered late in the evening and the measurement taken around 8:00 AM. However, for this client who sleeps during the day, the medication would be given before the 8:00 AM bedtime, and the plasma concentration would be measured soon after awakening in the late afternoon.
Which disorder results from excessive secretion of somatotropin (growth hormone)? Acromegaly Adrenogenital syndrome Cretinism Dwarfism
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.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? Administer IV calcium gluconate as ordered. Administer an oral calcium supplement as ordered. Start administering oxygen at 2 L/min via a cannula. Administer a sedative as ordered.
Administer IV calcium gluconate as ordered. When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
Long-term use of antithyroid medication is not generally recommended for elderly clients because of which events? Renal disease and mental confusion Gastrointestinal complications and weight loss Agranulocytosis and hepatic injury Cardiac arrhythmias and fatigue
Agranulocytosis and hepatic injury Long-term use of certain antithyroid medications, such as propylthiouracil (PTU), is not recommended for treatment of toxic nodular goiter in older clients because of the risk of side effects. Although rare, evidence indicates that PTU can result in agranulocytosis and hepatic injury. However, use of antithyroid medications versus radioactive iodine or surgery may be the client's preferred choice or the option for some older clients and other ill clients with "limited longevity" who can be monitored at least every 3 months. (extreme low number of granulocytes, a type of WBC)
Which symptom of thyroid disease is seen in older adults? Weight gain Restlessness Atrial fibrillation Hyperactivity
Atrial fibrillation Symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.
A nurse is caring for a client suspected of having a pituitary tumor that is causing panhypopituitarism. During assessment of the client, which clinical manifestation would the nurse expect to find? Hypertension Carpopedal spasm Atrophy of the gonads Tachycardia
Atrophy of the gonads Undersecretion (hyposecretion) commonly involves all of the anterior pituitary hormones and is termed panhypopituitarism. In this condition, the thyroid gland, the adrenal cortex, and the gonads atrophy (shrink) because of loss of tropic-stimulating hormones.
Which diagnostic test is done to determine a suspected pituitary tumor? Computed tomography Radioimmunoassay Radiography of the abdomen Measuring blood hormone levels
Computed tomography
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? Graves disease Hashimoto disease Addison disease Cushing syndrome
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.
Hypophysectomy is the treatment of choice for which endocrine disorder? Acromegaly Hyperthyroidism Cushing syndrome Pheochromocytoma
Cushing syndrome Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.
A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? Increased antidiuretic hormone Increased oxytocin Deficient production of vasopressin A deficient amount of somatostatin
Deficient production of vasopressin The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.
While the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. What is the nurse's most appropriate response? Inquire about frequent urination Consult the institution's procedure manual Document the allergy and inform the physician Palpate the thyroid gland
Document the allergy and inform the physician Recording the health history is an important step in the diagnosis of endocrine disorders. The nurse documents an allergy to iodine, a component of contrast dyes and seafood, and informs the physician. Repeated or forceful palpation of the thyroid in the case of thyroid hyperactivity can result in a sudden release of thyroid hormones, which may have serious implications. Consulting the institution's procedure manual and inquiring about frequent urination are not immediate follow-up actions.
Which is a clinical manifestation of diabetes insipidus? Excessive activities Low urine output Weight gain Excessive thirst
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 feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? Hand flexing inward Bulging forehead Moon face and buffalo hump Cardiac dysrhythmia
Hand flexing inward Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.
Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines? Hyporeflexia Hypoglycemia Hypertension Hyperglycemia
Hypoglycemia Hypotension and hypoglycemia may occur in the postoperative period because of the sudden withdrawal of excessive amounts of catecholamines. Hypertension and hyporeflexia are not related to the sudden withdraw of excessive amounts of catecholamines.
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? SSKI PTU Potassium iodide Methimazole
PTU Propylthiouracil (PTU), rather than methimazole (MMI), is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism due to the teratogenic effects of MMI.
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? Parathyroid glands, parathormone Thymus gland, thymosin Adrenal cortex, corticosteroids Pineal gland, melatonin
Pineal gland, melatonin The pineal gland secretes melatonin, which aids in regulating sleep cqycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.
A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland? Posterior pituitary Anterior pituitary Thyroid Adrenal
Posterior pituitary
ADH is secreted by which gland? Adrenal Thyroid Anterior pituitary Posterior pituitary
Posterior pituitary
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? Insomnia related to increased nighttime voiding Activity intolerance related to muscle cramps, cardiac dysrhythmias, and weakness Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns Impaired nutrition: more than body requirements related to polyphagia
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.
Dilutional hyponatremia occurs in which disorder? Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Pheochromocytoma Diabetes insipidus (DI) Addison disease
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate? Normal dosages of sedative agents are prescribed. TH may increase the effect of digitalis preparation. Increased resorption occurs with TH. TH may decrease blood glucose concentrations.
TH may increase the effect of digitalis preparation. Thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? Diaphoresis Headache Hypotension Palpitations
THINK FIGHT OR FLIGHT Hypotension The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.
Which hormone is secreted by the posterior pituitary? Somatostatin Calcitonin Corticosteroids Vasopressin
Vasopressin Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.
A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition? Undergo a skin graft Consider cosmetic surgery Wear clothing that covers the neck Apply medicines to remove the scar
Wear clothing that covers the neck The nurse may suggest that the client wear clothing that covers the neck and assure the client that the scar is almost invisible. Application of medicines, skin graft, and cosmetic surgery are not appropriate suggestions.
Trousseau sign is elicited when the foot is dorsiflexed and there is pain in the calf. 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. by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. after making a clenched fist and opening the hand; the palm remains blanched when pressure is placed over the radial artery.
by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. 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.
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to watch for symptoms of hyperthyroidism to disappear within 1 week. continue radioactive precautions with all body secretions. monitor for symptoms of hypothyroidism. discontinue all antithyroid medications.
monitor for symptoms of hypothyroidism.
Cardiac effects of hyperthyroidism include decreased pulse pressure. palpitations. decreased systolic BP. bradycardia.
palpitations. Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.
