Ch 51 Endocrine system

Which hormones are responsible for blood calcium?

Calcitonin and parathyroid

A nurse is collecting data from a client who is recovering from a thyroidectomy and has harsh, high-pitched respiratory sounds. Which of the following actions should the nurse take?

Prepare for a tracheostomy The nurse should notify the provider immediately and prepare for a tracheostomy. Laryngeal stridor is a high-pitched, harsh breathing sound that indicates respiratory distress due to swelling, tetany, or laryngeal spasms. Incorrect Answers:

Mineralocorticoids (adrenal cortex)

Water and electrolyte balance; indirectly manages blood pressure.

A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? Select all that apply.

difficult to awaken dry skin hoarse cry Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie, levothyroxine). TH plays an important role in growth, development, and regulation of many bodily functions (eg, heat production, muscle tone, skin function, cardiac function, metabolism). Clinical manifestations in affected infants reflect the pathophysiology of decreased TH and may include: Difficulty awakening, lethargy, or hyporeflexia due to alterations in central nervous system function (Option 1) Dry skin due to alterations in skin function (Option 2) Hoarse cry caused by swelling of the vocal cords due to fluid retention (Option 4) Constipation due to slowed metabolism Bradycardia due to the effect of TH on cardiac function

thyroxine (thyroid)

growth, development, metabolism

parathormone (parathyroid hormone)

increases the concentration of calcium in the blood and regulates phosphorus in the blood

The nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further teaching? Select all that apply.

"I need to limit playing football to only the weekends." "I should exercise in the evening to encourage a good sleep pattern." The client should be instructed to avoid high-impact activity or contact sports such as football. Exercising late in the evening may interfere with restful sleep. The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to use energy level as a guide to activity.

The nurse is reinforcing home care instructions to a client with a diagnosis of Cushing's syndrome. Which client statement reflects a need for further teaching?

"I need to read the labels on any over-the-counter medications I purchase." The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the primary health care provider before purchasing any over-the-counter medications, and maintaining regular follow-up care. The nurse should also instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

The nurse is instructing a client with Addison's disease about a newly prescribed medication, fludrocortisone acetate. Which statement by the client indicates a need for further teaching?

"I will be glad to gain weight." The client should notify the primary health care provider of weight gain. The client should take oral drugs with food or milk. The client should wear a Medic-Alert bracelet. Fludrocortisone acetate should not be stopped abruptly but should be tapered down.

Epinephrine (adrenal medulla)

Causes the heart rate and blood pressure to increase

Antidiuretic (posterior pituitary)

Causes the kidneys to conserve water by decreasing the amount of urine produced

Norepinephrine (adrenal medulla)

Combines with epinephrine to produce fight or flight response

Which hormones are responsible for fight or flight?

Epinephrine and norepinephrine

Which electrolyte disorder is most likely to trigger early symptoms of syndrome of inappropriate antidiuretic hormone (SIADH)?

Hyponatremia Hyponatremia triggers the earliest symptoms. Most signs and symptoms (nausea, vomiting, irritability, confusion, tremors, seizures, stupor, coma, and pathologic reflexes) appear when serum sodium levels fall below 125 mEq/L.

Which signs/symptoms would the nurse expect to note when collecting data on a client with Addison's disease?

Hypotension and vomiting Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in the remaining options are not associated with Addison's disease.

A client has been diagnosed with hypoparathyroidism. Which food groups should be included in the diet?

Low in phosphorus and high in calcium Hypoparathyroidism results in hypocalcemia. A therapeutic diet for this disorder is one that is high in calcium but low in phosphorus because these two electrolytes have inverse proportions in the body. All of the other options are unrelated to this disorder and are incorrect.

Which nursing measure would be effective in preventing complications in a client with Addison's disease?

Monitoring the blood glucose The decrease in cortisol secretion that characterizes Addison's disease can result in hypoglycemia. Therefore, monitoring the blood glucose would detect the presence of hypoglycemia so that it can be treated early to prevent complications. Fluid intake should be encouraged to compensate for dehydration. Potassium intake should be restricted because of hyperkalemia. Option 4 would not prevent complications for this client.

The nurse is reviewing a primary health care provider's prescriptions for a client with newly diagnosed, untreated hypothyroidism. Which medication prescribed for the client would the nurse question and verify?

Morphine sulfate The client with hypothyroidism experiences fatigue, lethargy, and increased somnolence. The decreased metabolism and oxygen consumption is manifested by a slow heart rate, decreased cardiac output, and decreased blood pressure. Levothyroxine, a thyroid hormone, is a component of therapy. Stool softeners such as docusate sodium are prescribed to promote defecation. Morphine sulfate would further depress bodily functions. Atenolol is used with caution in clients with hyperthyroidism.

Cortisol is responsible for what bodily function?

Provides energy during stress Cortisol is a glucocorticoid that provides extra reserve energy in times of stress. Aldosterone, the principal mineralocorticoid, regulates sodium and potassium levels by affecting the renal tubules. Glucagon is a pancreatic hormone, which responds to decreased levels of glucose in the blood.

For the patient with SIADH, the health care provider orders fluid restrictions. Which finding best indicates that the therapy is working?

Serum sodium is gradually increased All of the findings are positive; however, a gradual increase of serum sodium is the purpose of the therapy.

The nurse is caring for a postoperative adrenalectomy client. Which finding does the nurse specifically monitor for in this client?

Signs and symptoms of hypovolemia Following adrenalectomy, the client is at risk for hypovolemia. Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. A deficiency of adrenocortical hormones does not cause the signs/symptoms noted in options 1, 2, and 4.

The nurse is caring for a client with hypothyroidism who is overweight. Which food items would the nurse suggest to include in the plan?

Skim milk, apples, whole-grain bread, and cereal Clients with hypothyroidism may have a problem with being overweight because of their decreased metabolic need. They should consume foods from all food groups, which will provide them with the necessary nutrients; however, the foods should be low in calories. Skim milk, apples, whole-grain bread, and cereal is the only option containing food items that are low in calories.

A client is scheduled for subtotal thyroidectomy. Potassium iodide is prescribed. The nurse understands that which outcome is the therapeutic effect of this medication?

Suppress thyroid hormone production. Potassium iodide solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days. Options 1, 2, and 3 are incorrect.

The nurse is preparing to discharge a client who has had a parathyroidectomy. When reinforcing instructions to the client about the prescribed oral calcium supplement, which information would the nurse include?

Take the calcium 30 to 60 minutes following a meal. Oral calcium supplements can be taken 30 to 60 minutes after meals to enhance their absorption and decrease gastrointestinal irritation. All the other options are unrelated to oral calcium therapy.

What is the pathophysiology of simple goiter?

The gland usually enlarges because of lack of iodine in the diet Simple goiter is usually caused by a dietary insufficiency of iodine.

The nurse prepares to administer a dose of radioactive iodine (RAI) to a 39-year-old female client with Graves' disease. Which action is most important for the nurse to take?

confirm pregnancy test result is negative RAI is the primary treatment for nonpregnant adults with hyperthyroid disorders such as Graves' disease (a type of autoimmune hyperthyroid disease). The use of RAI is contraindicated in pregnancy and could cause harm to a fetus. Pregnancy results should therefore be confirmed using a valid pregnancy test in all clients who still have menstrual cycles rather than using a subjective form of assessment such as asking when the last menstrual period occurred (Option 1).

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect?

Decreased blood sodium Blood osmolarity 230 mOsm/L An increase in the secretion of ADH leads to dilutional hyponatremia. A decreased in blood osmolarity is caused by an increase in the secretion of ADH leading to water retention and dilution of blood components.

The nurse is caring for a child with a diagnosis of diabetes insipidus. The nurse anticipates that the primary health care provider will prescribe which medications?

Desmopressin acetate Desmopressin acetate is used to treat diabetes insipidus. Propylthiouracil is used to treat hyperthyroidism. One of the uses for furosemide is to treat syndrome of inappropriate antidiuretic hormone (SIADH). Methimazole is also used to treat hyperthyroidism.

Urine excreted by a patient with diabetes insipidus will exhibit which characteristics?

Dilute, with a specific gravity of 1.001-1.005 Diabetes insipidus causes production of urine with a very low (dilute) specific gravity. The normal range of specific gravity is 1.003 to 1.030.

A nurse is collecting an admission history from a client who has hypothyroidism. Which of the following findings should the nurse expect? (select all that apply)

Menorrhagia Dry Skin Hoarseness Abnormal Menstrual periods, including menorrhagia and amenorrhea, are manifestations of hypothyroidism. Dry skin is a manifestation of hypothyroidism. Hoarseness is a manifestation of hypothyroidism

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include?

Heat intolerance Palpitations Weight loss Hyperthyroidism increases the client's metabolism, causing heat intolerance. Hyperthyroidism increases the client's metabolism, causing palpitations. Hyperthyroidism increases he client's metabolism, causing weight loss.

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which primary health care provider's prescription noted on the record indicates the need for clarification?

Apply a loose dressing if any clear drainage is noted. The nurse should observe for clear nasal drainage; constant swallowing; and a severe, persistent, generalized, or frontal headache. These signs and symptoms indicate cerebrospinal fluid leak into the sinuses. If clear drainage is noted following this procedure, the primary health care provider needs to be notified immediately. Options 1, 2, and 4 indicate appropriate postoperative interventions

A nurse is caring for a client who has Cushing's disease. The nurse should identify that this client is at increased risk for which of the following?

Infection Electrolyte imbalances Bone fractures Suppression of the immune system places the client at risk for infection. CLients who has Cushing's disease are at risk fro electrolyte imbalances including hypernatremia, hypokalemia, and hyperglycemia. CLients who have CUshing's disease are at risk for bone fractures because decreased calcium absorption leads to osteoporosis.

Glucocorticoids (adrenal cortex)

Involved in glucose metabolism; provides extra reserve energy in times of stress; exhibits anti-inflammatory properties

What is included in the treatment of Addison's disease? Select all that apply.

Prednisone Fludrocortisone Addison's disease is treated with replacement therapy to provide the missing hormones, but the patient must continue taking the hormones as lifelong therapy. Prednisone is given to replace glucocorticoids; fludrocortisone is a synthetic adrenocortical steroid to replace the mineralocorticoid aldosterone. Cushing's syndrome treatment includes drug therapy, radiation, and surgery. Bilateral benign tumors more often are treated with an aldosterone antagonist agent (i.e., a drug that reduces aldosterone secretion or blocks its effects such as potassium-sparing diuretic spironolactone.

A nurse is reviewing the medication administration record of a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? (select all that apply)

Regular insulin Hydrocortisone sodium succinate Sodium polystryrene sulfonate Furosemide CLients who have acute adrenal insufficiency are hyperkalemic. Insulin is administered to shift potassium into the cells. HYdrocortisone sodium succinate is administered as replacement therapy of both glucocorticoid and mineralocorticoid. CLients who have acute adrenal insufficiency are hyperkalemic. Sodium polystyrene sulfonate is administered because it absorbs potassium. Loop and Thiazide diuretics promote potassium excretion and are administered to treat hyperkalemia.

Calcitonin (thyroid)

decreases blood calcium levels by causing calcium deposition on bone

Oxytocin (posterior pituitary)

promotes the release of milk and stimulates uterine contractions during labor

The nurse is caring for a postoperative parathyroidectomy client. Which would require the nurse's immediate attention?

Laryngeal stridor During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which causes swelling and the compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard during inspiration and expiration that is caused by the compression of the trachea and leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway.

The nurse is caring for a patient who had a thyroidectomy 6 hours ago. The patient exhibits thyroid crisis and receives treatment. Which outcome statement indicates that the goals of therapy were met?

Patient displays euthyroid, blood pressure and temperature are at baseline The three goals of thyroid crisis management are (1) to induce a normal thyroid state, (2) prevent cardiovascular collapse, and (3) prevent excessive hyperthermia. In SIADH, the goals of therapy are to correct low sodium levels and achieve fluid balance. In severe hypoglycemia, patients will have confusion and change of mental status; restoring the glucose level to 60 to 99 mg/dL will restore mental status. In Addisonian crisis, high-dose hydrocortisone replacement therapy, restores cortisol and IV fluid is given for hypotension

A client who returned to the nursing unit 8 hours ago after hypophysectomy has clear drainage saturating the nasal dressing. The nurse would take which action

Test the drainage for glucose. Following hypophysectomy the client should be monitored for rhinorrhea (clear nasal drainage), which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the drainage should be collected and tested for the presence of CSF by testing it for glucose. CSF tests positive for glucose, whereas true nasal secretions would not. It is not necessary to test drainage that is clear for occult blood. The head of the bed should not be lowered to prevent a rise in intracranial pressure. Continuing to observe the drainage without taking action could put the client at risk for developing a serious complication.

During data collection on a postoperative client who has undergone hypophysectomy, the client complains of thirst and frequent urination. Knowing the expected complication of this surgery, the nurse would check which parameter next?

Urine specific gravity Following hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone (ADH) deficiency. This deficiency is related to surgical manipulation. The nurse should assess specific gravity and notify the registered nurse if the results are less than 1.005. Although serum glucose, blood pressure, and respiratory rate may be components of the assessment, the nurse would next check urine specific gravity.

A nurse is collecting data from a client who has Graves' disease. Which of the following findings should the nurse expect the client to display?

Difficulty sleeping A client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone.

A nursing student notes in the medical record that a client with Cushing's syndrome is experiencing body image disturbances. A need for further teaching regarding this problem is identified when the nursing student suggests which nursing intervention?

Evaluating the client's understanding that the body changes need to be dealt with Evaluating the client's understanding that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. Options 1, 2, and 3 are appropriate because they address the client and family feelings regarding the disorder.

The nurse is preparing to reinforce instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which diet would be prescribed for this client?

High-sodium, high-carbohydrate diet A high-sodium, high-complex carbohydrate, and high-protein diet will be prescribed for the client with Addison's disease. To prevent excess fluid and sodium loss, the client is instructed to maintain an adequate salt intake of up to 8 g of sodium daily and to increase salt intake during hot weather; before strenuous exercise; and in response to fever, vomiting, or diarrhea.

A nurse is collecting data from a client who has manifestations of acromegaly. Which of the following findings should the nurse expect?

Increased head size A client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. This condition results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull.

The nurse is caring for a client with hypothyroidism who has become lethargic and difficult to rouse. Which action is the priority? Click on the exhibit button for additional information.

Manually ventilate the client with a bag valve mask Myxedema coma refers to a state of severe hypothyroidism causing decreased level of consciousness (eg, lethargy, stupor) that may progress to a comatose state. Myxedema coma is characterized by hypothermia, bradycardia, hypotension, and hypoventilation. Hypoventilation may occur as a result of respiratory depression, respiratory muscle fatigue, and mechanical obstruction by an edematous tongue. Clients with signs of respiratory failure (eg, slow or shallow breathing, low oxygen saturation) will require emergent endotracheal intubation and mechanical ventilation. The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation.

The nurse is caring for a client with primary adrenal insufficiency (Addison disease). The nurse recognizes which finding associated with the disease?

bronze pigmentation of the skin Addison disease (primary adrenal insufficiency) is due to decreased function of the adrenal gland, which is responsible for the secretion of glucocorticoids, androgens, and mineralocorticoids. Bronze hyperpigmentation of the skin in sun-exposed areas is due to increased secretion of ACTH by the pituitary in response to low cortisol (ie, glucocorticoid) levels. Clients with Addison disease may develop hypovolemia, hyponatremia, and hyperkalemia from low aldosterone (ie, mineralocorticoid) levels. Other manifestations include: Slow, progressive onset of weakness and fatigue Anorexia and weight loss Orthostatic hypotension Salt cravings Nausea and vomiting Depression and irritability Vitiligo (Options 2, 3, an

Potassium iodide is prescribed for a client. The nurse reinforces instructions to the client that the primary health care provider would be notified if the client experiences which symptom? Select all that apply.

A burning in the mouth A brassy taste in the mouth Soreness of the gums and teeth The client should be informed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of gums and teeth. The client should be instructed to withhold the medication and notify the primary health care provider if these signs occur. Gastric upset and a bitter taste may occur, but do not indicate iodism. The solution can be taken with milk or juice to minimize these effects.

The practical nurse is collaborating with the registered nurse to create a care plan for a client experiencing exophthalmos as a complication of Graves disease. Which interventions should be included in the client's plan of care? Select all that apply.

Administer artificial tears to moisten the conjunctiva Lightly tape eyelids hut if they do not close during sleep Recommend the use of dark glasses to prevent irritation Teach about the importance of smoking cessation Exophthalmos is a complication of hyperthyroidism (hypermetabolic state due to thyroid hormone overproduction) from Graves disease. It is defined as protrusion of the eyeballs caused by increased orbital tissue (connective, adipose, muscular) expansion and can be irreversible. The exposed cornea is at risk for dryness, injury, and infection. Nursing care for a client with exophthalmos includes the following: Maintaining the head of the bed in a raised position to facilitate fluid drainage from the periorbital area Using artificial tears or similar products to moisten the eyes to prevent corneal drying (causes abrasions/ulcers) (Option 1) Taping the client's eyelids shut during sleep if they do not close on their own (Option 2) Teaching the client the following:Regular visits to the ophthalmologist are necessary to measure eyeball protrusion and evaluate the condition.If recommended, anti-thyroid drugs should be used to prevent further exacerbation of exophthalmos.Smoking cessation is necessary as smoking increases the risk of Graves disease and associated eye problems (Option 4).Restrict salt intake to decrease periorbital edema.Use dark glasses to decrease glare and prevent external irritants and infection (Option 3).

The clinic nurse evaluates a client's response to levothyroxine after 8 weeks of treatment. What therapeutic responses to the medication should the nurse expect? Select all that apply.

Apical heart rate of 88/min Elevation of mood Improved energy levels The client's therapeutic response to levothyroxine (Synthroid) is evaluated by resolution of hypothyroidism symptoms. The expected response includes improved well-being with elevated mood (Option 2), higher energy levels (Option 3), and a heart rate that is within normal limits (Option 1). The nurse should consult the health care provider if the heart rate is >100/min, or if the client reports chest pain, nervousness, or tremors; this may indicate that the dose is higher than necessary. Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8 weeks after initiation to see the full therapeutic effect.

A nurse is reinforcing teaching with a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse reinforce? (select all that apply)

Avoid brushing teeth for two weeks post operatively. Expect to experience a diminished sense of smell. The client should avoid brushing their teeth for 2 weeks to allow time for the incision to heal. A diminished sense of smell is an expected finding after surgery.

The nurse caring for a client who has had a subtotal thyroidectomy reviews the plan of care and determines which problem is the priority for this client in the immediate postoperative period?

Bleeding Hemorrhage is one of the most severe complications that can occur following thyroidectomy. The nurse must frequently check the neck dressing for bleeding and monitor vital signs to detect early signs of hemorrhage, which could lead to shock. T3 and T4 do not regulate fluid volumes in the body. Infection is a concern for any postoperative client, but it is not the priority in the immediate postoperative period. Urinary retention can occur in postoperative clients as a result of medication and anesthesia, but it is not the priority from the options provided.

The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring?

Blood pressure of 80/60 mm Hg Signs/symptoms associated with thyroid storm include a fever as high as 106° F (41.1° C), severe tachycardia, profuse diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hyperreflexia, abdominal pain, diarrhea, and dehydration. With this disorder, the client's condition can rapidly progress to coma and cardiovascular collapse.

A client with a pituitary tumor will undergo transsphenoidal hypophysectomy. The nurse reinforces which information in the preoperative teaching plan for the client?

Blowing the nose following surgery is prohibited. The approach used for this surgery is the oronasal route, specifically where the upper lip meets the gum. The surgeon then uses a route through the sphenoid sinus to get to the pituitary gland. The client is not allowed to blow the nose, sneeze, or cough vigorously because these activities could raise intracranial pressure. The client also is not allowed to brush the teeth to avoid disrupting the surgical site. Alternate methods for performing mouth care are used.

A nurse is reviewing the laboratory reports for a client and notes an elevated thyroid-stimulating hormone (TSH) level. When collecting data from the client, which of the following findings should the nurse expect?

Bradycardia An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations

A nurse is assisting with the plan of care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care?

Check for hypertension The nurse should check the client for hypertension, which can indicate fluid volume overload.

The nurse working on an endocrine nursing unit understands that which correct concepts are used in planning care? Select all that apply.

Clients with Cushing's syndrome are likely to experience hypertension. Clients who have hyperparathyroidism should be protected against falls. Clients who have pheochromocytoma should be monitored for signs of orthostatic hypotension. Hyperparathyroidism is a disease that involves excess secretion of parathyroid hormone (PTH). Elevation of PTH causes excess calcium to be removed from the bones. There is a decline in bone mass, which may cause a fracture if a fall occurs. Cushing's syndrome is likely to cause hypertension. Clients with hypothyroidism must be monitored for weight gain and clients with hyperthyroidism must be monitored for weight loss. Clients who have diabetes insipidus should be assessed for fluid deficit. Before surgery, the client with pheochromocytoma may be in hypertensive crisis and require close monitoring of vital signs and administration of IV antihypertensive medications. The client should be monitored for signs of orthostatic hypotension related to medication therapy

The school nurse is taking height and weight measurements for all children at the beginning of the school year. Measurement for one of the students shows a deviation over two percentile levels from the median. What should the nurse do?

Contact the parents and suggest they take the child to the health care provider. A school nurse would notify the parents, so the child could be evaluated by a health care provider (for diagnostic testing to rule out giantism). A nurse who works with/for the health care provider would perform the other options. The health care provider might also contact the school nurse and ask for regular height and weight reports.

The nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide. The nurse reinforces dietary instructions to the client. Which are appropriate instructions? Select all that apply.

Drink at least 2 to 3 L of fluid daily. Increase dietary intake of potassium. The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption. This is aided by the sufficient intake of fluids. Dietary restriction of calcium may be used as a component of therapy. The parathyroid is responsible for calcium production, and the term hyperparathyroidism can be indicative of an increase in calcium. The client should eat foods high in potassium, especially if the client is taking furosemide. Limiting nutrients is not advisable. Remember the inverse relationship between calcium and phosphorus.

The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? Select all that apply.

Dry skin Constipation Cold intolerance Signs of hypothyroidism include dry skin, hair, and loss of body hair; constipation; cold intolerance; lethargy and fatigue; weakness; muscle aches; paresthesia; weight gain; bradycardia; generalized puffiness and edema around the eyes and face; forgetfulness; menstrual disturbances; cardiac enlargement; and goiter. Irritability, palpitations, and weight loss are signs of hyperthyroidism.

The nurse is caring for a client for a patient who had thyroidectomy. The routine postoperative intervention would the nurse clarify with the health care provider?

Encourage coughing and deep breathing In the postsurgical period, patients who have had thyroidectomy surgery are encouraged to deep-breathe, but the nurse would check with the health care provider about coughing, because of potential strain on the suture line.

A client scheduled for a thyroidectomy says to the nurse, "I am so scared to get cut in my neck." Based on the client's statement, the nurse determines that the client is experiencing which problem?

Fear about impending surgery The client is having a difficult time coping with the scheduled surgery. The client is able to express fears but is scared. No data in the question support options 2, 3, and 4.

A nurse is checking a client with Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider?

Fever A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the sudden development of an extreme elevation in body temperature, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone.

The nurse is caring for a client following an adrenalectomy and is monitoring for signs of adrenal insufficiency. Which signs and symptoms are related to adrenal insufficiency? Select all that apply.

Fever Weakness Hypotension Mental status changes The nurse should be alert to signs and symptoms of adrenal insufficiency in a client following adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. Double vision is generally not associated with this condition.

Which patient has the greatest risk for developing SIADH?

Has malignant cancer. For any of these patients, the nurse would be aware of the possibility of developing SIADH; however, malignancies are the most common cause of SIADH; cancerous cells are capable of producing, storing, and releasing ADH.

The nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus. Which statement by the client is most important for the nurse to report to the health care provider?

I have recently started to experience frequent headaches Desmopressin is a medication often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone (ADH) levels that may result in dehydration and hypernatremia. Desmopressin mimics the effects of naturally occurring ADH, which increases renal water resorption and concentrates urine. However, this effect also increases the risk for water intoxication from decreased urine output. Clients receiving desmopressin must have their fluid and electrolyte status closely monitored for symptoms of water intoxication/hyponatremia (eg, headache, mental status changes, weakness). The nurse should immediately notify the health care provider (HCP) of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death (Option 4).

A client is diagnosed with hyperparathyroidism. The nurse teaching the client about dietary alterations to manage the disorder tells the client to limit which food in the diet?

Ice cream The client with hyperparathyroidism is likely to have elevated calcium levels. This client should reduce intake of dairy products such as milk, cheese, ice cream, or yogurt. Apples, bananas, chicken, oatmeal, and pasta are low-calcium foods.

The clinic nurse is reinforcing teaching to a client about levothyroxine, which the health care provider has prescribed for newly diagnosed hypothyroidism. Which statement made by the client indicates that further teaching is needed?

If this makes my stomach upset, i will take it with an antacid Several medications impair the absorption of levothyroxine (Synthroid). Common offenders are antacids, calcium, and iron preparations. Some of these could be present in several over-the-counter multivitamin and mineral tablets. Therefore, clients with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications. The most common reason for inadequately treated hypothyroidism is deficient knowledge related to the medication regimen (eg, not taking daily, taking with other medications).

A nurse is reinforcing teaching with a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include?

Increase her caloric intake with meals Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in a loss of protein stores and a negative nitrogen balance. Even with an increased appetite, it is often difficult to meet energy demands, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake.

The nurse is caring for a client who underwent a transsphenoidal hypophysectomy to remove a pituitary adenoma. Which intervention(s) should the nurse implement? Select all that apply.

Inspect the mouth and perform mouth care every 4 hours Perform frequent neurological checks Remind the client to not use a toothbrush for 10 days A hypophysectomy is a surgical procedure that involves removal of part of the pituitary gland. A transsphenoidal approach involves insertion of an endoscope between the inner aspect of the upper lip and gingiva, through the sella turcica, bottom of the nose, and sphenoid sinuses to the pituitary gland. There is no external incision. The dural opening is closed with a patch of fat graft taken from the abdomen or outer thigh. As a result, the client should be prepared for an additional incision. Postoperative care focuses primarily on preventing disruption of the patch closure of the dura and cerebrospinal fluid (CSF) leak. This care includes the following:

The nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique would provide data necessary to support the admitting diagnosis?

Inspection of facial features Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and a blank expression that are characteristic of myxedema. The techniques in the remaining options will not reveal any data that would support the diagnosis of myxedema

The nurse would expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply.

Instruct the client about thyroid replacement therapy. Encourage the client to consume fluids and high-fiber foods Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur. The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormones and providing measures to support the signs and symptoms related to a decreased metabolism. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. The client often has cold intolerance and requires a warm environment. The client would notify the PHCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone. Iodine preparations are used to treat hyperthyroidism. These medications decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone.

A nurse is monitoring a client following a thyroidectomy. Which of the following findings should the nurse identify as an indication of hypoparathyroidism?

Involuntary muscle spasms The nurse should identify involuntary muscle spasms as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and paresthesias can result due to decreased parathyroid hormone levels and calcium deficiency.

After receiving furosemide 40 mg slow intravenous push for chest pain related to shortness of breath and generalized edema, the client responds poorly. The client has no relief of the chest pain, shortness of breath, or edema and only minimal urine output (less than 40 mL of urine). The primary health care provider is notified, and after reviewing the chart, suspects the client has syndrome of inappropriate antidiuretic hormone (SIADH). Which findings would lead to this specific diagnosis?

Minimal responsiveness to furosemide and small-cell lung cancer The minimal responsiveness to furosemide combined with the generalized edema, shortness of breath, and history of small-cell lung cancer suggest SIADH. Although hypertension and weight gain are common in SIADH, they are also common in other diseases, such as heart failure. A seizure disorder does not place a client at higher risk for SIADH, but a lower sodium level through dilution is common in SIADH. The increased pulse could be a compensatory mechanism for the blood pressure, the retained fluid, and weight gain.

A nurse is contributing to the plan of care for a client who has myxedema coma. Which of the following actions should the nurse include?

Monitor daily weights. Observe for evidence of urinary tract infection. Record input and output. Initiate aspiration precautions. The nurse should monitor the client's daily weight because decreasing weight is an indication of effective therapy. An infection, such as in the urinary tract, can precipitate myxedema coma. The nurse should observe the client for manifestations of infection and treat any underlying illness. The nurse should record daily I&O because increased urine output is an indication of effective therapy. The nurse should initiate aspiration precautions because myxedema coma is a severe complication of hypothyroidism that can lead to the compromised airway.

The nurse reviews a plan of care for a postoperative client following a thyroidectomy and notes that the client is at risk for breathing difficulty. Which nursing intervention would the nurse include in the plan of care?

Monitor neck circumference frequently. Following a thyroidectomy, the client should be placed in an upright position to facilitate air exchange. The nurse should assist the client with deep-breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision. A pressure dressing is not placed on the operative site because it could affect breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. Neck circumference is monitored at least every 4 hours to assess for postoperative edema.

The nurse is preparing a plan of care to monitor for complications in a client who will be returning from the operating room following transsphenoidal resection of a pituitary adenoma. Which nursing intervention does the nurse document in the plan as a priority for this client?

Monitor urine output. The most common complication of surgery on the pituitary gland is temporary diabetes insipidus. This results from deficiency in antidiuretic hormone (ADH) secretion as a result of surgical trauma. The nurse measures the client's urine output to determine whether this complication is occurring. Options 1, 3, and 4 are also components of the plan, but option 2 clearly identifies the priority intervention for this type of surgery.

The nurse notes in the medical record that a client with Cushing's syndrome is experiencing fluid overload. Which interventions would be included in the plan of care? Select all that apply.

Monitoring daily weight Monitoring intake and output Maintaining a low-sodium diet Monitoring extremities for edema The client with Cushing's syndrome experiencing fluid overload should be maintained on a high-potassium and low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water. Monitoring weight, intake, output, and extremities for edema are all appropriate interventions for such a nursing diagnosis.

The nurse is monitoring a client following a thyroidectomy for signs/symptoms of hypocalcemia. Which signs/symptoms noted in the client indicates the presence of hypocalcemia? Select all that apply.

Muscle spasms Positive Trousseau's sign Tingling around the mouth Following a thyroidectomy, the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and fingertips, muscle twitching or spasms, palpitations or dysrhythmias, and positive Chvostek's and Trousseau's signs. Options 1 and 4 are not signs of hypocalcemia.

A nurse in an urgent care center is collecting data from an infant who has laryngotracheobronchitis. Which of the following findings should the nurse report to the provider as an indication of impending airway obstruction?

Nasal flaring Acute laryngotracheobronchitis (croup) causes dyspnea and swelling of the upper airway. Indications of impending airway instruction include tachycardia, tachypnea, increasing restlessness, flaring nares, and intercostal retractions.

The nurse reinforces teaching to a client who was newly prescribed levothyroxine sodium after thyroid removal. Which instructions will the nurse include? Select all that apply.

Notify the health care provider if you feel a fluttering or rapid heartbeat Levothyroxine sodium (eg, Levoxyl, Levothroid, Synthroid) is used to replace thyroid hormone in clients with hypothyroidism (inadequate thyroid hormone) and for those who have had their thyroid removed. These clients must understand that this medication must be taken for the rest of their lives (Option 5). A client's dose is adjusted based on serum thyroid-stimulating hormone (TSH) levels to prevent too much or too little hormone. Clients must be taught to report signs of excess thyroid hormone such as heart palpitations/tachycardia, weight loss, and insomnia (Option 3).

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which intervention would best assist the client with this problem?

Obtaining dark glasses for the client Because photophobia (light intolerance) accompanies this disorder, dark glasses are helpful in alleviating the symptom. Medical therapy for Graves' disease does not help alleviate the clinical symptom of exophthalmos. Other interventions may be used to relieve the drying that occurs from not being able to completely close the eyes; however, the question is asking what the nurse can do for photophobia. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client is at risk for developing an eye infection because the solution is not sterile. There is no need to prevent straining with exophthalmos.

The nurse is caring for a client with a diagnosis of myasthenia gravis. The primary health care provider plans to perform an edrophonium test on the client to determine the presence of cholinergic crisis. In addition to planning care for the client during this testing, which equipment will the nurse ensure is at the bedside?

Oxygen equipment An edrophonium test is performed to distinguish between myasthenic and cholinergic crisis. Following administration of edrophonium, if symptoms intensify, the crisis is cholinergic. Because the symptoms of cholinergic crisis will worsen with the administration of edrophonium, atropine sulfate and oxygen should be immediately available whenever edrophonium is used.

The nurse is collecting data from a client who is being admitted to the hospital for a diagnostic workup for primary hyperparathyroidism. The nurse understands that which client complaint would be characteristic of this disorder?

Polyuria Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis (polyuria). This diuresis leads to dehydration and the client would lose weight. Options 1, 3, and 4 are gastrointestinal (GI) symptoms but are not associated with the common GI symptoms typical of hyperparathyroidism (nausea, vomiting, anorexia, constipation).

The nurse is collecting data regarding a client after a thyroidectomy and notes the development of a hoarse and weak voice. Which nursing action is appropriate?

Reassure the client that this is usually a temporary condition. Weakness and hoarseness of the voice can occur as a result of trauma to the laryngeal nerve. If this develops, the client should be reassured that the problem will subside in a few days. Unnecessary talking should be discouraged. It is not necessary to notify the registered nurse immediately. These signs do not indicate bleeding or the need to administer calcium gluconate.

The nurse is reinforcing medication teaching to a client who has been prescribed oral hydrocortisone for newly diagnosed Addison disease. Which of the following statements by the nurse are appropriate to include in the teaching? Select all that apply.

Report even a low grade fever to the health care provider immediately Report signs of hyperglycemia, including increased urine, hunger, and thirst The dose of hydrocortisone may need to be increased during times of stress Adrenal glands are responsible for producing hormones that regulate the body's stress response, metabolism, fluid and electrolyte balance, and immune system. Damage or destruction to the adrenal glands leads to chronic adrenal insufficiency (ie, Addison disease) and the hypofunction of hormones, including mineralocorticoids (eg, aldosterone) and glucocorticoids (eg, cortisol). Clinical manifestations include low blood pressure, hypoglycemia, weight loss, and muscle weakness. Management of Addison disease includes long-term oral glucocorticoid replacement (eg, prednisone, hydrocortisone). Medication teaching reinforcement by the nurse should include the following: Report signs and symptoms of infection (eg, fever) immediately (Option 2). Oral corticosteroids can cause immunosuppression, placing the client at risk for infection. Contact the health care provider if increased urination, hunger, and thirst occur that would indicate rising blood glucose as corticosteroids may cause glucose intolerance (Option 3). Increase the dose of hydrocortisone as prescribed during times of stress and infection and before major surgeries (Option 4).

When caring for a client diagnosed with pheochromocytoma, which signs and symptoms would the nurse note? Select all that apply.

Severe headache Profuse diaphoresis Severe hypertension Pheochromocytoma is a catecholamine-producing tumor of the adrenal gland and causes secretion of excessive amounts of epinephrine and norepinephrine. Signs and symptoms of pheochromocytoma are related to excess catecholamine release. These include tachycardia and severe hypertension (as high as 250/150 mm Hg) that can be intermittent or persistent. Profuse diaphoresis, severe headache, palpitations, nausea, weakness, and pallor may also be present.

The nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which item in the diet?

Vegetables The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals. Vegetables are allowed in the diet.

A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take?

Warm the dialysate solution to room temperature prior to administration The nurse should warm the dialysate solution to room temperature prior to administration. This prevents the client from experiencing pain and abdominal cramping due to a cold solution during dialysis.

The nurse is caring for a client with Addison's disease. The diagnosis is supported by which noted data? Select all that apply.

Weight loss Skin hyperpigmentation Orthostatic hypotension Addison's disease is a decreased secretion of the adrenal cortex. Signs and symptoms include orthostatic hypotension, decreased body hair, weight loss, skin hyperpigmentation, and progressive weakness.

The health care provider tells the nurse that the patient needs diagnostic testing for a possible hyperthyroidism. What symptoms is the patient most likely to exhibit?

Weight loss, increased appetite, and nervousness The symptoms of hyperthyroidism, reflect an increased metabolism.

The nurse assesses a client who had a thyroidectomy 8 hours ago. The nurse finds the client anxious, with tingling around the mouth and muscle twitching in the right arm. Which action is most important for the nurse to implement first?

obtain a serum calcium level Normal serum calcium is 8.6-10.2 mg /dL (2.15-2.55 mmol/L). Hypocalcemia (serum calcium <8.6 mg/dL [2.15 mmol/L]) is a potential complication of thyroidectomy because the parathyroids that regulate calcium levels in the blood are accidentally removed during this surgical procedure. The nurse should monitor the client closely for signs of hypocalcemia, which include tetany (overactive neurological responses such as tingling in the hands, feet, and around the mouth; spasms or cramps that can occur even in the larynx; positive Trousseau or Chvostek sign). A serum calcium level should be drawn, and the nurse should ensure that calcium gluconate is readily available in case this complication occurs.